Urinary incontinence may negatively affect quality of life with a wide range of social implications causing distress, embarrassment and loss of self assurance. Incontinence can also be a major hygiene problem. Symptoms of urinary incontinence are especially common among the elderly and afflict 17–46% of woman over 60 years old. The prevalence of both urge urinary incontinence and mixed urinary incontinence is thought to increase with age. Pelvic floor muscle training, midurethral polypropylene vaginal tape procedures and pharmacologic treatment are primary management options depending on the type and severity of incontinence.
Risk factors associated with urinary incontinence include childbirth, increasing age, overweight and obesity, and other comorbidities. The association between hysterectomy and the development of urinary incontinence has been a subject of much debate with a lack of data establishing causality.
There are a few randomized clinical trials studying the short-term association between hysterectomy and urinary incontinence (Table 1), but none have investigated the long-term effects. Furthermore, evidence from randomized clinical trials and prospective clinical cohort studies has been limited by the lack of nonhysterectomized control groups.[77,78] There are also discrepancies between studies using self-reported questionnaires to describe lower urinary tract function and studies using objective measures, such as urodynamics, this is a well known phenomenon and has been reported in several studies.[49,79] In several observational studies, hysterectomy is associated with a deterioration of bladder function.[4,27,28,30,31,80,81] In a nationwide study by Altman et al., there was a doubled risk for surgically managed stress incontinence subsequent to hysterectomy. The risk was highest in the first years after hysterectomy, but was sustained at 10-year follow-up (Figure 1).
Hysterectomy and rate of incontinence surgery. Age-specific rates are shown with 95% CIs. Age intervals show attained age during follow-up period. Reproduced with permission from .
Aging Health. 2013;9(2):179-187. © 2013 Future Medicine Ltd.