Gynecologic surgeries, particularly hysterectomy (uterus removal), oophorectomy (ovary removal) and C-section, are the top overused procedures in the U.S. Only a small percentage of hysterectomies and oophorectomies are considered necessary since gynecologic cancers are rare. According to this JAMA Surgery article on 2007 inpatient procedures, “Two operations on the female genital system, hysterectomy and oophorectomy, accounted for a total of 930,000 procedures (89.3% and 84.6%, respectively, were elective).” These figures do not include the roughly 300,000 outpatient hysterectomies and oophorectomies done in 2007. This graph (graph B) of indications for hysterectomy is a good visual of how few are done for cancer (~50,000) indicated by the gray line. However, it is misleading in that it appears that hysterectomies have steadily declined since it only includes inpatient procedures. Outpatient hysterectomies have steadily increased since about 2002 and reached 40% of these surgeries in 2012, the last year for which I could find data. The 89.3% “elective” rate would indicate that these surgeries are “restorative” or at least harmless, but medical literature and women’s experiences prove otherwise.
A few years ago, I began writing for Hormones Matter about the consequences of hysterectomy and oophorectomy. Year after year, these posts generate tens of thousands of views and hundreds of comments. The comments inevitably follow the same pattern of unwarranted removal of organ(s), sometimes without informed consent, and ensuing declining health. We are publishing a series of articles highlighting women’s comments. This is the third of the series. The first article is about the lack of informed consent and can be found here. The second one talks about how our “exterior” settles / collapses after the uterus is removed leading to an altered figure and back, hip, and leg problems in the long run.
Bladder and Bowel Problems
Bladder and bowel problems are common after hysterectomy and usually permanent and progressive. A number of mechanisms seem to be at play – organ displacement, severed nerves and blood vessels, adhesions. Prolapse and risk of urinary and fecal incontinence are increased especially in the long-term. Bowel obstructions can occur many years after hysterectomy due to displacement of the bowel as well as adhesions which, according to this article, develop in 93% to 100% of patients who undergo abdominal surgery. This article cites “matted” versus “band” adhesions as more likely to develop after surgeries done via a vertical incision as well as colorectal surgeries. Matted adhesions are more apt to cause obstruction recurrences than are band adhesions. Here is my article that addresses the impact of hysterectomy on the pelvic floor and bladder and bowel function.
The non-profit HERS Foundation did a survey of 1,000 hysterectomized women. Urinary and bowel problems were frequently reported. The five complaints below were the most commonly cited:
- constipation = 43.8%
- urinary frequency = 39.5%
- urinary incontinence = 31.1%
- bladder infection = 24.5%
- diarrhea = 20.8%
There are quite a few other complaints related to urinary, bowel and digestive issues as well as many other problems. Here is the complete list broken out by hysterectomy only, hysterectomy with one ovary removed, and hysterectomy with both ovaries removed.
Dysfunction of Other Organs / Glands
Studies have shown that other organs are negatively impacted by hysterectomy. Multiple studies show an increased risk of renal cell cancer after hysterectomy. This article states that risk to be “nearly 2-fold” and conjectures unintentional damage to ureter(s) as the primary mechanism. Thyroid cancer risk is also elevated regardless of whether or not ovaries are removed. According to this Finnish study, both rectal and thyroid cancer risks are increased in hysterectomized women.
Gallbladder disease seems to be fairly common after hysterectomy. However, according to this article exogenous estrogen (estrogen replacement) is the culprit.
Contrary to what many women are told or led to believe, ovarian function is oftentimes compromised once the uterus is removed and even more so if one ovary is removed. This makes sense when one considers that the uterus, ovaries, and Fallopian tubes work together as a system. This study determined that 39% of hysterectomized women showed signs of ovarian failure. This cohort study showed a nearly 2-fold increased risk when both ovaries were preserved and nearly 3-fold when only one was preserved.
The main purpose of this article is to report women’s experiences with bladder and bowel changes after hysterectomy. As such, below are comments from some of my articles that are evidence of these problems.
F De wazieres writes:
“…prolapsed bowl, severe constipation… the list is endless…”
“…. Most recently I’m having bladder issues…”
“I had a total hysterectomy August 13, 2007 a few weeks later I kept getting nauseous. I suffer from IBD and I fluctuate between constipation and diarrhea.”
“hysterectomy on 6th February 2014 recovery ok. Sex life non-existent major loss of feeling, weak pelvic floor – leaking pee when exercise, sneeze, rarely laugh”
“I have also had some bad kidney infections.”
“I had a total hysterectomy and ureter repair two days later. This was 3 years ago. I have pain in my right side from time to time. I also experience problems urinating. I go ALL the time. I think I am finished, I wipe and when I stand up, I have leakage.”
“After surgery I began getting chronic UTI’s, experiencing severe lower back pain, diarrhea and weight loss.”
“Everyday is a struggle with bladder pain, constipation and pelvic blood vessel pain.”
“urinary & bowl issues. … I even had an InterStim device placed in my upper buttocks with the hope that it would help with urinary issues and pain (it didn’t).”
“my bowel movements changed forever it’s never been the same.”
“I certainly feel and experience of incontinence and leakage of urine and stool.”
“urinary & bowl issues”
“I can relate i had a hysterectomy in 2006. Today I’m experiencing pain in my stomach that takes my breath away.then i have pressure when i urinate.”
“When I work on my feet I have to be aware of holding my muscles tight so I don’t have incontinence!”
“I had my partial in 2003 and since then I’ve had constant bloating and lack of bowel elimination at times it never donned on me until now that it may be from my hysterectomy, I’ve tried practically everything to ease the discomfort but nothing is working.”
“I have had hundreds of problems with my bladder, have to use my hands as a sphincter muscle otherwise the poo doesn’t come out and I have stomach pain for hours and cant sleep.”
“I had a hysterectomy in 2004 and I have suffered with swelling in my stomach ever since I look like I’m 9 months pregnant, have trouble going to the bathroom had my gallbladder removed since then i stay in pain my stomach…”
“I had a hysterectomy in 2007 and my health has slowly declined ever since to the point that the last few yrs. have been debilitating. My first symptom was constipation, then came…. I can’t go to the bathroom with out some sort of laxative and now they don’t even work at times. I have on and off pain under my right rib, have been to every doctor I can think of.”
“I had a hysterectomy Aug 30th and now my gallbladder is acting up have to go see a surgeon tomorrow”
“The first thing that became a problem post-op was chronic constipation. No matter what I do, I am always constipated and so much so that I always have a build up of and pass a huge amount of mucus (sometimes just mucus). This has affected my entire gastrointestinal tract of course and I have intermittent issues with enough gas to float a blimp, nausea, heartburn, etc. Over the last two years, I have definitely noticed my intestines shifting down and I may have a rectal prolapse as a result.”
Julie in Texas:
“My grandmother had a hysterectomy sometime in the mid to late 60’s. She had already undergone menopause. She was so humiliated by it that she didn’t speak about it for nearly 20 years. I do not know when her complications set in… she apparently experienced all the horrors of pelvic organ prolapse. …I remember that she had multiple bladder stapling surgeries, one of which I swear was reported to have been to staple it to her backbone! What she didn’t confess until years later was that her doctor, frustrated by these many surgeries on what he considered to be just some ancient, obese woman, decided that the best way to treat her organ prolapse, pelvic floor problems, incontinence, etc., was to sew up her vagina! He did not discuss this with her beforehand.”
“LAST 3 YEARS I HAVE HAD STRESS INCONTINENCE AND OCCASIONAL PROBLEMS TRYING TO POO AS ITS HARD TO PUSH OUT DUE TO BOWELL PRESSING ON MY VAGINA. Gynecologist told me a month ago that normally the uterus holds the bladder the vagina and the bowel in place as they are all connected. He said when uterus is removed the other organs often become unstable often swinging in the wind and after on average 6 years after hysterectomy women start having problems. I am a week out of major surgery after having a bladder sling repair and an anterior and posteria vagina repair. If I hadn’t had a hysterectomy I wouldn’t have needed this surgery as I was very fit and every thing was where it should have been. If I knew what I know now i would have just had the one ovary removed.”
“Hysterectomy in 2007. Chronic constipation ever since. Now laxatives aren’t even working…. My life has been horrible since.”
“I am 13 weeks post hysterectomy and I am sorry I had it done. I was a very active women, always running around from 6am till 9pm. It has slowed me down I am incapable of standing for too long and sitting down hurts me as I constantly feel there is something stuck in my rectum.”
“Lisa, in my case it also improved a lot, though I experienced some incontinence for a while. But the improvement lasted exactly three years and since then its got worse and my life is devastated, not only sexually. I am now in the 6th year post.”
“It’s been a year since my surgery. Most recently I’m having bladder issues and….”
“I had a complete hysterectomy (including both ovaries) when I was 30 yrs old (am now 49)…. since then have had loose stools and bowel problems w/ pain in stomach, also had my gall bladder out 8 yrs ago, now I have more bowel issues…. now I am having constant pain in flank area all the way around on both sides burning & cool sensations in back around kidney area and tenderness in my belly area, fullness/bloating under my rib cage on both sides after I eat.”
“I had TAH kept my ovaries (boy, that was a battle)… had it Aug 2013. I have had so many problems since. … I have been having issues since day 4 post hysterectomy…. I also have severe rib pain right and left. I have bowel problems too and the nausea and fatigue is hell. … It’s interesting talking about loose stools because that has been happening….”
“I have had a Laparoscopic hysterectomy in February with just my uterus taken out. Since my surgery, I have been nauseous and have bowel problems. I have had every test they can possibly do and no one can figure out what is causing this.”
“I had cervical cancer…. I have my ovaries tacked up high,it hurts, had bladder surgery after that did not work suffered terribly, I have lbaf constipation.”
“7 years ago I had a full hysterectomy. (Cervix, Fallopian tubes, uterus and left ovary) during this surgery I also had a bladder suspension. Three years ago I had to have a bladder sling. The suspension lifted my bladder. And the most recent was the sling which pulled my bladder forward. So right now I currently have both the suspension and the sling. As of now I have developed vaginal prolapse to the point where my intestines bulges out from my vagina and I have to push it back in. If I walk for more then half our or so my insides feel like they are just hanging inside. To the point where it hurts and I have to lay down on my back. I can’t explain it any other way then it feels like I have to push as though I am in labor. The pressure on the pubic bone and the pressure on my pelvic floor.”
“I’ve had pain in my upper stomacher ever science the server. I had the belly button one done on me.I’ve had like a big rock in my upper ABS but now its huge and I’m bleeding from vagina.I’m so scared.”
“I had partial hysterectomy in 2008 ,I was 32yrs old I was ok till 4 months back am having severe lower abdominal pain and candida which is getting worse I consulted the dr with no effect I am so confused what is wrong with me?”
“I also developed rather severe diarrhea.”
I caution any woman who is told she needs a hysterectomy and/or oophorectomy or is considering one to heed these comments. With the gross overuse of these surgeries, chances are she’s being sold a false bill of goods. It’s not always a good idea to rely solely on your doctor’s advice as Someone Who Cares cautions:
“After 40 years of enduring this “disabled” existence, it breaks my heart that no matter how many of us try to warn other women, in various ways, the number of these destructive surgeries continues to increase, not decrease.”
A complete list of my articles can be found here. The HERS Foundation is a good resource for understanding the lifelong functions of the female organs. It also has information about gynecologic conditions and treatment options. These two sites, Ovaries for Life and Gyn Reform (especially the studies/citations link), are excellent resources about the gross overuse and harm of ovary removal or loss of ovarian function after hysterectomy.