Having a hysterectomy doubles the risk of needing surgery for stress incontinence, a study finds
Publication Date:26/10/2007
Introduction
A study has found that women who have a hysterectomy are more than twice as likely to need an operation for stress incontinence in the next 12 years as women who don't have a hysterectomy. If you've been told you need a hysterectomy for a problem such as heavy periods or fibroids, you may want to find out what other treatments are available first.
What do we know already?
Hysterectomy is one of the most common operations among women. It's an operation to remove the womb (uterus). It is used to treat many conditions. For some conditions, such as cancer of the uterus, hysterectomy is the only option. But for less serious problems, such as heavy periods and fibroids, other treatments are usually tried first. Hysterectomy is a big operation and it can take many weeks to recover.
The National Institute for Health and Clinical Excellence (NICE), which advises the government on healthcare, says that in the past too many women had hysterectomies. In the early 1990s for example, 6 in 10 women who went to their GP with heavy periods had a hysterectomy. Since then the number of women having hysterectomies has fallen, but it is probably still too many.
There has been a lot of research into how a hysterectomy affects a woman's ability to control her bladder. But the results have been mixed. Some studies have found that a woman's bladder control is no worse after a hysterectomy, while others have found that a hysterectomy helps improve bladder control.
The current study looked at whether a hysterectomy increased a woman's risk of needing surgery for stress incontinence. This type of incontinence causes leaking of urine when you cough, sneeze, exercise or laugh. It's common after having children. You would only have surgery for stress incontinence if it was very bad and other treatments, such as pelvic floor exercises, hadn't helped.
What does the new study say?
The study found that women who had a hysterectomy were more than twice as likely as those who didn't have a hysterectomy to need an operation for stress incontinence years later. The women who had a hysterectomy were being treated for conditions such as fibroids, heavy periods or a prolapsed womb.
Overall, 2 in 100 women who had a hysterectomy needed surgery for stress incontinence in the 12 years after their operation. Out of those who did not have a hysterectomy, 1 in 100 women needed surgery for stress incontinence.
There are lots of different ways to do a hysterectomy. The study found that all the different operations carried the same risk.
Tell me more about the study's findings
Having children, especially by a normal vaginal birth, also increases the chances of women needing surgery for stress incontinence.
In the study, women who had given birth to at least four children, and who later had a hysterectomy, were 16 times more likely to need an operation for stress incontinence than women who had no children by vaginal delivery and did not have a hysterectomy. Women who gave birth to four children but didn't have a hysterectomy were six times more likely to need surgery for stress incontinence.
Where does the study come from?
The study was done by researchers from the Karolinska Institute and Karolinska University Hospital in Stockholm, Sweden. It was published in the Lancet medical journal, owned by a media company called Elsevier.
How reliable are the findings?
This was a large study. It looked at what happened to more than 165,000 women who had a hysterectomy in Sweden between 1973 and 2003. The women were matched to three other women the same age and from the same country but who had not had a hysterectomy. So altogether the researchers had information on more than 650,000 women and whether they had surgery for stress incontinence.
Although this is a good type of study it is not the same as looking at what happens to women in real time. For that, the researchers would need to select a group of women who were having hysterectomies and follow them up for many years, along with a similar group of women with the same type of symptoms who were not having a hysterectomy. Also, the researchers did not take into account other things that can increase the risk of stress incontinence, such as weight, smoking and doing strenuous work.
The researchers didn't look at whether the reasons the women were having hysterectomies (for example prolapsed womb, fibroids) might have increased their risk of incontinence. So we don't know for sure that the hysterectomy caused the increased risk, and not the condition that the hysterectomy was treating.
What does this mean for me?
If you're thinking about having a hysterectomy for something other than cancer, for example, heavy periods, fibroids or a prolapse, you may want to see what other treatments are available. There are lots of alternative treatments for these conditions now. If you are considering a hysterectomy, the increased risk of incontinence is just one of the things you'll need to consider. You also need to be sure that you don't want to have children in future, that you understand the risks of the operation, and that you know how long it will take to recover.
What should I do now?
If you're considering a hysterectomy, but you would like to find out about other treatments, ask your doctor.
If you have fibroids, you may be able to have an operation that just removes your fibroids without taking out your womb. And if you have heavy periods you may want to try having a special type of coil (IUS, or intrauterine system) that could make your periods lighter. There are also drugs you can try for heavy periods and a smaller operation that involves removing the lining of your uterus. NICE says that for heavy periods hysterectomy should be used as a last resort, only after other treatments haven't helped.
However, NICE does say that, for some women, hysterectomy may be the right choice. You need to be sure it's right for you before you go ahead.
From:
Altman D, Granath F, Cnattingius S, Falconer C. Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet 2007; 370: 1494–1499.
To find out more, see our information on hysterectomy, fibroids, stress incontinence and heavy periods.
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This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
