What is a hysterectomy?

The bladder sits above the uterus and behind the pubic bone. The back wall of the bladder and the lower part of the uterus called the cervix are directly next to each other, separated by a thin membrane.  During a hysterectomy, this membrane must be cut to make sure the bladder and ureters are not in harm’s way. Because there are neighboring nerves supplying both the bladder and the uterus, damage can occur during a hysterectomy.

A hysterectomy is the surgical removal of the uterus and cervix. It may or may not involve the removal of the tubes and ovaries. It involves either a horizontal, vertical skin incision or multiple smaller incisions. 

Reasons for a hysterectomy

The primary reason for hysterectomies is abnormal and excessive bleeding that has not been adequately managed with medication or other therapies. The cause of the bleeding is generally from fibroid tumors which are benign muscle growths that can press into the cavity of the uterus.

One study shows that while 70% of women have asymptomatic fibroids, others experience pelvic pain, dysmenorrhea, and abnormal uterine bleeding, which can cause iron-deficiency anemia. Another shows that in women who experience heavy vaginal bleeding, 59.8% have fibroids only 37.4% do not. Fibroids are also associated with gastrointestinal disturbances, urinary problems, infertility, and obstetrical complications including miscarriages, preterm delivery, and cesarean sections.

Endometriosis is another disease that may lead to a hysterectomy. It is the result of the endometrial (uterine lining) tissue growing in places outside of the uterus such as the fallopian tubes, ovaries, bladder, bowel, even distant places like the lung. The cause is unknown, but hereditary factors and the immune system may contribute. The mechanism of this abnormal growth known as endometrial implants is thought to be the result of the backward flow of blood during menstruation. Once the lining implants on another surface, it undergoes thickening each month as a result of hormones from the ovary.

Hormones cause microscopic internal bleeding that causes an inflammatory response, make tiny blood vessels grow, and cause scar formation that is responsible for the clinical consequences of this disease. 

Types of hysterectomy

Total abdominal hysterectomies, laparoscopic hysterectomies, and vaginal hysterectomies are the most common types of hysterectomies. Recently, there are robot-assisted hysterectomies. All types involve incisions. In the case of a vaginal hysterectomy, the incision is inside the vagina.

Bladder function after a hysterectomy

It is not uncommon that women complain about bladder problems after hysterectomy. Some of these problems include lack of bladder control, bladder spasms, a burning feeling and frequent visits to the bathroom.

A hysterectomy is a major operation that can weaken the pelvic ligaments or damage supporting structures. After the hysterectomy, your bladder will miss the support it had from your uterus and its position in the pelvis will be different. During your hysterectomy recovery period, the pelvic tissues will heal, and your feeling and control of the bladder will gradually return.

Studies show us that bladder injuries are rare, as they happen in only 2% of all hysterectomies. In the US, 600,000 hysterectomies are performed annually which means that 12,000 women will suffer bladder injury.

Potential bladder problems during or after hysterectomy

1. Bladder injury

With every operation, there is a risk of complications. One of the risks of a hysterectomy is that the surgeon can accidentally injure the bladder with one of the instruments. Usually, when this happens the surgeon will repair it. But if the injury goes unnoticed, you may suffer very uncomfortable complications.

For instance, when urine is leaking from the bladder into the abdomen, peritonitis (inflammation of the lining of the abdomen) may occur which is a life-threatening condition.

If your bladder problems begin with urine leaking from the vagina, it is likely that a hole (fistula) exists between the bladder and the vagina. Such a vesicovaginal fistula is often the result of an untreated bladder injury, and rarely closes spontaneously. This means the woman will need a second surgery to close this abnormal passage and a catheter to drain the bladder so that the leakage can be contained.

2. Overactive bladder problems after hysterectomy

Sometimes nerve damage or infections are the reason for an overactive bladder after surgery. This annoying, unstoppable feeling that of having to go to the toilet, even if you have little or no urine in the bladder is due to a malfunctioning of the bladder’s Detrusor muscle. The Destruser is the muscle that contracts to force urine out of the bladder into the urethra.

Overactive bladder problems after hysterectomy include frequent visits to the bathroom, even during the night (nocturia) and leaking urine.

What can you do about it?

  • Strengthen the pelvic muscles with Kegel exercises.
  • Avoid substances that will irritate the bladder like coffee, alcohol, carbonated drinks and spicy meals.
  • Get rid of the extra pounds as it can have a notable impact on the pelvic floor muscles that support your bladder.
  • There are several medications (anticholinergics) that can help to relax the Detrusor muscle. Common side effects of these medications are a dry mouth, constipation and sometimes confusion.

3. Weak bladder

The inability to hold urine when you cough or laugh is called stress urinary incontinence (SUI), or as many women call it; a weak bladder.

In fact, SUI is a weakness of the muscles and the tissues that support the bladder resulting in excess mobility of the urethra. These are better known as the pelvic floor muscles.

During a hysterectomy, there is an increased risk of damage to pelvic floor supportive structures. If during surgery they remove the ovaries, estrogen levels in the body will drop. Low estrogen levels weaken the tissues in the pelvic area.

A Swedish study shows that women who underwent a hysterectomy were 2.7 times more at risk of having urinary incontinence surgery within the next 5 years. 

4. Bladder infection

Infections are common bladder problems after a hysterectomy and are known as urinary tract infections (UTIs). Usually, they insert a catheter before hysterectomy begins. With catheterization comes an increased risk of bacteria entering the urinary tract. This may cause an infection of the urethra or bladder which can, if not taken care of, eventually spread to the kidneys.

Normally the catheter stays in for one or two days after surgery when they remove it before you go home. It is not uncommon for women to develop a bladder infection after they have gone home. Early signs that show you may have a urinary tract infection are:

  • A burning feeling or pain when urinating.
  • A feeling you need to urinate but you can’t.
  • Urinating more often than usual.
  • Dark/cloudy urine that smells bad.

Most common bladder problems after hysterectomy are recurring urinary tract infections. The sudden drop in the hormone estrogen is responsible for weakening of the tissues of the urethra and vagina, making women more susceptible to UTIs. Low dose vaginal creams containing estrogen seem to be beneficial in recurring infections.

CompactCath can help!

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