Urinary Incontinence
Urinary incontinence may negatively affect quality of life with a wide range of social implications causing distress, embarrassment and loss of self assurance.[72] 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.[28] The prevalence of both urge urinary incontinence and mixed urinary incontinence is thought to increase with age.[73] Pelvic floor muscle training,[74] midurethral polypropylene vaginal tape procedures[75] and pharmacologic treatment[76] 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.[73] 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.[4] The risk was highest in the first years after hysterectomy, but was sustained at 10-year follow-up (Figure 1).
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 [4].
Aging Health. 2013;9(2):179-187. © 2013 Future Medicine Ltd.
