A hysterectomy can be used to treat multiple conditions such as uterine fibroids, endometriosis, or cancer that affects the uterus, ovary, cervix, or uterine lining. While this procedure can be life-saving or improve quality of life, it still carries risks and potential complications. Some of these can include bleeding, developing blood clots, bladder damage, infection, or damage to the ureter. Although damage to the bladder can lead to incontinence, some people experience this issue once they’ve had a hysterectomy. Black American women, in particular, have to consider that risk as they may be more likely to undergo hysterectomies to treat benign conditions like fibroids instead of less invasive procedures. Here’s what you need to know.
The Link Between Hysterectomies and Incontinence
Hysterectomies can damage different parts of the body, such as the urinary tract, digestive tract, and nervous structures, which can lead to many complications. One of these is urinary incontinence. Even with those risks, though, researchers are still unsure why the surgery can lead to incontinence even when there’s no evidence that the patient’s urinary structures changed after the procedure.
Even so, a 2025 systematic review and literature analysis showed a significantly higher risk of developing urinary incontinence of all types within 10 years of a hysterectomy. Additionally, those who had the procedure were more likely to develop issues like pelvic organ prolapse and stress urinary incontinence beyond 10 years afterward.
When researchers assessed 60 studies, they analyzed data from 3,567,848 participants. According to these data, in the first 10 years, a hysterectomy was associated with a higher likelihood of (nonspecific) urinary incontinence in 25 studies, stress urinary incontinence in 14 studies, overactive bladder in 16 studies, and mixed urinary incontinence in three studies. After the 10-year mark, having a hysterectomy was associated with a higher likelihood of pelvic organ prolapse in six studies and stress urinary incontinence in five studies.
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What You Can Do About It
If you’re dealing with incontinence, you can start by using a few non-medical measures to address it. Start with lifestyle changes. Your doctor may have a detailed list of recommendations, but reducing your caffeine intake may decrease how often you need to use the bathroom. The same is true if you modify how much liquid you drink daily.
If you’re overweight, it may also help to reduce your symptoms. Because weight management looks different for everyone, it’s best to talk to your doctor about the way forward.
Apart from changing your diet, it’s a good idea to try pelvic floor muscle training. Your pelvic floor muscles surround the bladder and urethra, which is the tube that carries urine from your bladder out of your body, and control your flow of urine. When these muscles are weak or damaged, you can experience urinary incontinence. That’s why doctors usually recommend doing exercises to strengthen them.
While your doctor will be able to guide you on how to do these exercises, these are the general instructions:
- The next time you have to urinate, start to go and then stop.
- Feel the muscles in your vagina, bladder, or anus get tight and move up. These are the pelvic floor muscles. If you feel them tighten, you have done the exercise right.
- Do not make it a habit to do the exercises each time you urinate. Once you can comfortably identify the muscles, perform the exercises while seated, but NOT when you are urinating.
If you are still not sure whether you’re doing it right, there’s a way for you to check. Insert a finger into your vagina and then tighten the muscles as if you are holding in your urine. After that, let go. If done properly, you should feel the muscles tighten and move up and down.
Your next option is to try bladder training. This is typically effective for persons who are dealing with urge incontinence or a mixture of urge and stress incontinence. This training includes learning techniques to increase how long you can wait between feeling the urge to urinate and going to the bathroom. The National Association for Continence has a six-week bladder training guide that can help.
RELATED: 10 Facts Most Women Don’t Know About Their Bladder (But Should)
When to See a Doctor
Although lifestyle changes and pelvic floor exercises can ease your symptoms, sometimes they’re not enough. If you’ve tried alternatives and seen little to no improvement, then it’s time to talk to your doctor. Your doctor can recommend treatment options that can help. Where medications are concerned, your doctor may choose to prescribe:
- anticholinergics
- beta-3 agonists
- tricyclic antidepressants
Sometimes, injecting Botox into the bladder can help, but that’s something your doctor will discuss.
Medical devices can also help to alleviate your symptoms, depending on the type of incontinence you’re dealing with. Catheters can be used to empty your bladder if you have overflow incontinence. However, your doctor will need to show you how to use the device and what proper hygiene looks like so you don’t risk developing a bladder infection.
For stress incontinence, devices like a pessary or a bulking agent can alleviate the symptoms by putting pressure on the urethra. This pressure can then reduce your risk of leaking. While devices are usually inserted, bulking agents are gels or pastes that are injected near the urinary sphincter.
If medication doesn’t help, then electrical nerve stimulation is another possibility. In this procedure, mild electrical pulses stimulate the nerves that control the bladder and sphincter muscles. The goal is for the electrical pulses to change your bladder’s reflexes and ease your symptoms.
Finally, your doctor may discuss surgery if none of the earlier treatment methods help. The most common surgery for women is known as sling surgery, and it’s usually used for stress incontinence. In this procedure, a surgeon goes through the vagina and inserts a strip of material between the vagina and urethra. This material supports weakened or damaged tissue. You can also have surgery to enlarge your bladder so that there’s more room to hold urine.
As with all surgeries, these procedures carry risks. As such, it’s best to discuss the details with your doctor so you can make the best decision.
Although a hysterectomy can be life-changing, it can also lead to complications you didn’t expect. One potential complication is incontinence. If this happens, you can try different lifestyle changes and exercises to ease your symptoms. If you don’t see improvement, talk to your doctor immediately. They can recommend other options to help.