Hysterectomy: What are the risks?

In a recent article by Forsgren et al., researchers assessed the risk for women in having pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery following a vaginal hysterectomy. They looked at histories of over 118,000 women in Sweden who had experienced a vaginal hysterectomy versus over 579,ooo women who had not had a hysterectomy. The research concludes that having a vaginal hysterectomy, for purposes of a prolapse correction or otherwise, significantly increases the risk of having POP or SUI surgery.

The same primary researcher, Dr. Forsgren, has authored other articles addressing risk factors for hysterectomy. In 2010, this article looked at the increased risk of developing pelvic organ fistula following a hysterectomy surgery. Risk factors for developing a fistula after hysterectomy include smoking, increased age, diverticulitis, and pelvic adhesions. In another article investigating the incidence of bowel dysfunction following hysterectomy, Forsgren et al found that in women who had a hysterectomy with sacral colpopexy performed, the women had a higher risk of defecation issues including incomplete emptying, use of enemas, and having to assist digitally with rectal emptying.

What message does this give to us or to our patients? Some patients are quick to sign up for surgery with the notion that hysterectomies are common and without significant risk, yet we must also help caution the patient against some of the potential risk factors towards pelvic dysfunction. I still occasionally hear that a provider has stated to a patient something on the order of "well, you've had children, you are not using your uterus anymore." Clearly, most providers do not have such a cavalier attitude about a major surgery, and some patients really have surgery as their best option, but information such as the above articles can help inform the pelvic rehab provider as well as our patients about some of the potential risks of hysterectomies.