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Q: I may need a complete hysterectomy. I am 48 years old. Can a complete hysterectomy cause issues later in life with (urinary) incontinence?
A: You pose a very important question, but the answer is still up for debate.
Many studies attempting to address this issue have been published, but the results vary. Some show no effect of hysterectomy on the risk of developing incontinence. Others show an increase. One of the largest studies, however, did suggest that the risk of developing urinary incontinence goes up after a hysterectomy.
These are the well-known risk factors for urinary incontinence:
1. Child bearing
2. Increased age
3. Pelvic floor prolapse
But there are good reasons to suspect hysterectomy may also increase the risk. Here's why: The uterus and bladder are located right next to each other in the pelvic cavity. When the uterus is removed, the bladder nerves and support structures can be damaged. Fortunately, the vast majority of women do not develop bladder problems after hysterectomy.
So why is it so hard to prove that a hysterectomy might cause an increase in the risk of urinary incontinence?
Part of the answer is that a hysterectomy is performed for so many different reasons. In addition, urinary incontinence is very common -- it occurs in up to 30 percent of women. And it's hard to study the effect of the surgery without considering other factors that also influence risk. In fact, hysterectomy may actually improve bladder control in some women with large fibroids when the uterus causes pressure on the bladder.
If you're considering hysterectomy, you should weigh all the risks and benefits with your doctor. If you decide the procedure is the best option for your situation, know that even if your risk for incontinence goes up, the effect is small. And if you do develop bladder control problems later for whatever reasons, excellent treatments are available.
(Joan Marie Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital, Boston, Mass.
(For additional consumer health information, please visit www.health.harvard.edu.)