Long-term Effects of Hysterectomy

A Focus on the Aging Patient

Catharina Forsgren; Daniel Altman


Aging Health. 2013;9(2):179-187. 

In This Article

Bowel Dysfunction

Bowel dysfunction is common in the female general population,[47] and is particularly common among women with gynecological symptoms.[82,83] Bowel dysfunction includes a wide range of symptoms and diagnoses, such as constipation, irritable bowel syndrome, bowel emptying difficulties and anal incontinence. The comorbidity between bowel dysfunction and other pelvic organ disorders is considerable.[84] The most commonly investigated bowel dysfunctions expressed in relation to hysterectomy are constipation and anal incontinence. Anal incontinence is a socially embarrassing and physically disabling condition. Anal incontinence becomes increasingly common with age, and in community-dwelling adults over 65 years of age the prevalence is reported to be as high as 12%.[85] Anal incontinence may result from damage to the anal sphincter complex, idiopathic (senile) degeneration of the sphincter, neurological disease or nonsphincter causes (e.g., diarrhea and dementia). Studies investigating the association between hysterectomy and anal incontinence are few, however a 3-year prospective study in 120 women showed that hysterectomy increased the risk of mild anal incontinence symptoms, and patients with a reported history of obstetric sphincter injury were at particular risk for posthysterectomy fecal incontinence.[33]

Many women date the onset of bowel dysfunction to a hysterectomy, although there is no conclusive evidence to indicate causation. Several studies also attribute alterations of bowel function to a previous hysterectomy,[86,87] usually resulting in constipation and rectal emptying difficulties.[88] Nevertheless, there is no agreement among researchers, and several studies and reviews have found no association between hysterectomy and bowel dysfunction.[33,53,89] Some of the studies showing an association between hysterectomy and bowel dysfunction have been criticized for their retrospective nature and for not stratifying bowel dysfunction according to type of hysterectomy.[53]

In a recent prospective multicenter study from The Netherlands, 430 women were followed-up with questionnaires for 10 years.[31] A decade after hysterectomy, more women appeared to have bothersome defecation symptoms after vaginal hysterectomy compared with abdominal hysterectomy, explained by an increased prevalence of flatus incontinence and fecal incontinence after vaginal hysterectomy. However, after correction for differences in age, vaginal delivery, uterine descent and indication for hysterectomy, the differences were not statistically significant.