Urinary Incontinence After Hysterectomy: Here’s The Solution

Urinary incontinence after hysterectomy is a common problem that can be very frustrating for women. Surgery to remove the uterus and cervix – a hysterectomy – can cause stress urinary incontinence (SUI), particularly after vaginal surgery.

When you have SUI, urine leaks from your bladder as a result of physical activity such as laughing, sneezing, or exercising. In most cases, it doesn’t happen during everyday activities, such as walking.

Some women can’t control their urine at all, but others may only leak a few drops every once in a while. It’s not uncommon to leak urine right after having sex or during menstruation. Over time, the muscle and tissue around the bladder and urethra (the tube that carries urine out of your body) may stretch and weaken.

Is urinary incontinence normal after hysterectomy?

The most common after-hysterectomy problem is pelvic floor dysfunction. However, the most common type of pelvic floor dysfunction is urinary incontinence, and often after the surgery.  But not all women suffer from it – only about 30% or so experience one or more symptoms of post-surgical SUI/stress voiding.

Hysterectomy does not cause urinary incontinence. Loss of support for the bladder neck and urethra is what causes it.

The incidence of urinary incontinence after hysterectomy varies depending on which surgical technique is used. The highest incidence is after vaginal hysterectomies because these procedures disrupt supporting structures of the bladder more than abdominal procedures.

About half of patients who have vaginal hysterectomy experience urinary incontinence after their surgery, most often due to injury to the urethra or bladder neck during the procedure.

After an abdominal hysterectomy, about 10-20 percent of women will experience stress-related urinary incontinence, but the risk seems to increase to 40-50 percent when combined with other pelvic surgery such as bladder or vaginal surgery.

What are the possible causes of urinary incontinence after hysterectomy?  

Hysterectomy surgery can disrupt the supporting structures around the bladder neck and urethra, leading to stress urinary incontinence. SUI is a common problem after all types of hysterectomy surgery, but vaginal surgery is particularly likely to cause incontinence because it disrupts the muscles, nerves, and ligaments that support the urethra.

There are several reasons this happens:

Nerve damage. The pelvic floor muscles are controlled by nerves that come from the lower back, pelvis, and abdomen. When you have a hysterectomy, these nerves can be damaged or cut during surgery. Most nerve damage occurs in the vaginal hysterectomy because of the proximity to major nerve trunks coming out of the lower back.

The bladder neck and urethra can also be damaged if they are stretched or torn during surgery. The urethral sphincter is a small muscle at the opening of the urethra, which helps control urination. In some cases, it may not contract properly after surgery, causing incontinence.

Intestinal surgery. Your bladder and urethra rely on strong muscles that run up and down your abdomen to support them. When these abdominal muscles are weakened by surgery, the supporting structures of the bladder and urethra may become stretched and damaged.

Loss of vaginal support. When your uterus is removed via a vaginal hysterectomy, the top part of the vagina may stretch and weaken during this procedure if it’s done too quickly or with excessive pulling on tissue.

The following factors may also contribute to or worsen urinary incontinence:

• Anatomical factors, including insufficient support of the bladder neck and urethra.
• Neurological factors, such as loss of nerve supply to the pelvic floor muscles or damage to the spinal nerves that control those muscles.
• Behavioral factors, such as smoking and obesity.  
• Age is also often cited as an important factor in the development of urinary incontinence.

How long does it take for bladder to heal after hysterectomy?

After a hysterectomy, you can usually go home the same day. But it takes at least 4 to 6 weeks for the incision to heal after both vaginal and abdominal surgery, and longer in older people or those who have health problems.

Incision care is important during this time because your wound will be more susceptible to infection.

You must also make sure your bladder does not become overfull. This can be a problem if you have a condition that causes rapid or large amounts of urine, such as urinary infection

How do you prevent a prolapsed bladder after a hysterectomy?

To avoid bladder problems after a hysterectomy, drink plenty of fluids to avoid dehydration. Avoid alcohol and caffeine, which can irritate your bladder.

You can Try the Pelvic Floor Strong program to recover quickly from post-operative complications and get back to your normal routine.

About Pelvic Strong Program

Pelvic Floor Strong is a fitness program designed to help you recover from common postoperative complications and get back to your normal routine. The exercises focus on the pelvic floor – the hammock of muscles, connective tissues, and ligaments that support your uterus, bladder, cervix, vagina, and rectum – because this is the most common site of bladder problems after hysterectomy.

Alex Miller, an expert in pelvic floor disorders, has helped thousands of women get back to normal with her proven “Pelvic Floor Rx” approach for treating SUI, prolapse, and incontinence.

See Pelvic Floor Strong Program>>