Hysterectomy Patients May Face Incontinence Later
It's not clear why women who have their uteruses removed develop incontinence more often, but it may be that the procedure simply results in chronic, progressive damage to the pelvic area that takes years to show up, Brown and colleagues theorize. "It's like if you have a knee injury when you're 20; you don't start wearing a knee brace until you're 40, and all the other [aging] factors kick in," says Brown.
On the whole, hysterectomies are probably done too often in the U.S., she says. "In Scandinavia, the rate of hysterectomy among women is 11%; in the United Kingdom, it's about 20%, and in the U.S., it's 40%. That's a huge [percentage]."
Women considering hysterectomies should talk the matter over with their physicians and weigh all the risks and benefits, Brown tells WebMD. "You need to decide as an individual, 'How bad are my symptoms?' If you are miserable, I'd take the roll of the dice and go for the hysterectomy."
But, Shari Thomas, MD, MPH, assistant professor of obstetrics and gynecology at UCLA, does not agree. "You have to follow the basic indications for hysterectomy and not scare the patient and say, 'Wait until you?re miserable, because you might get incontinent later.'"
Also, Thomas is not convinced incontinence is a long-term outcome of hysterectomy.
She tells WebMD anywhere from 25 to 50% of these patients are having hysterectomies for conditions that "already have an underlying increased risk of urinary incontinence. So you have to take out the people who have had surgery for pelvic organ prolapse, and [Brown]hasn?t done that. She has built her own bias into the meta-analysis," says Thomas.
"Menopause is also a risk factor for incontinence; we know that," says Thomas. "We have a decreased amount of collagen in our tissue with menopause, and that means decreased blood flow and a decrease in elasticity, which helps support our pelvic organs."
Lawrence Gratkins, MD, a gynecologist at Christie Clinic in Champaign, Ill., tells WebMD that there are also more options now than in the past for women. He suggests that women and their physicians use all conservative or medical approaches to treament before proceeding with a hysterectomy.
For instance, there is surgery a woman can undergo just for the bleeding that can save her uterus. Even if she needs a hysterectomy, Gratkins says, there are newer procedures that are getting less invasive all the time.
And Gratkins emphasizes that women should discuss all conservative treatment options with their doctors before resorting to hysterectomy, and, if they need surgery, they should discuss the possibility of simultaneous repairs.