Overactive bladder after hysterectomy

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In some cases, hysterectomies may directly cause OAB or other bladder problems. This can happen if the surgery damages muscles or nerves that regulate bladder function.

Additionally, if a person undergoes a hysterectomy with oophorectomy, this involves removing the ovaries as well as the uterus. The ovaries produce estrogen, and without them, estrogen levels decline.

Lower estrogen levels can lead to vaginal atrophy and inflammation of the urethra, which may lead to reversible incontinence. Vaginal atrophy involves thinning, drying, and inflammation of the walls of the vagina.

However, some people develop OAB after a hysterectomy for less clear reasons. Scientists are still learning about why this is. However, the following factors may raise the risk:

• older age
• a higher body mass index
• a history of pregnancy or multiple cesarean deliveries
• having stress incontinence, which is when physical stress on the bladder causes leaking, before surgery
• undergoing a procedure to fit a suburethral sling, a device that stabilizes pelvic organs, in the same surgery
• urinary catheterization after surgery

In some cases, hysterectomies can damage the bladder. However, OAB is not a symptom of bladder injury.

A person who develops persistent OAB after a hysterectomy will require treatment to help with symptoms. In some cases, the symptoms may completely resolve. In others, there may be a more marginal improvement in the condition, as peoples’ responses to treatment can vary.

However, if the urinary symptoms result from bladder spasms, they may go away entirely without treatment in several weeks. Bladder spasms do not always indicate OAB, although they may feel similar.

The symptoms of OAB include:

• urinating more frequently than usual, despite having a typical fluid intake
• frequently urinating at night
• sudden intense urges to urinate, especially if those urges produce only small quantities of urine

Bladder spasms after a hysterectomy can also cause urgency, as well as pain when a person finishes emptying their bladder. However, these symptoms should gradually resolve, whereas OAB will continue.

Some people with OAB develop urge incontinence. This means that when the urge to urinate occurs, the person experiences leaking.

Urge incontinence can occur alongside other types, such as stress incontinence. Examples of stress incontinence include leaks that happen when a person coughs, sneezes, or laughs.

Doctors diagnose OAB by asking a person about their symptoms. They may also ask a person to keep a bladder diary for a certain period to track how often they urinate and at what times of day or night.

A doctor may be able to diagnose OAB based on this alone. In other cases, they may perform additional tests to rule out other causes. For example, they may:

• test for urinary tract infections (UTIs)
• scan the bladder and urinary tract
• perform urodynamic testing, which tests the function of the bladder

Treatments that may help with OAB after a hysterectomy include:

• Behavioral changes: This could include urinating on a schedule or reducing caffeine intake. Double voiding, which involves emptying the bladder twice, may help people who have trouble completely emptying the bladder.
• Exercises: Strengthening the pelvic floor and bladder muscles with exercises may help with symptoms. This can include Kegels.
• Estrogen: There is some evidence that vaginal estrogen may help with OAB. Systemic estrogen, which involves taking tablets or applying patches to the skin, may not have the same benefits.
• Medication: There are medications for OAB that can help reduce urine output or the urge to urinate.
• Botox: Botox injections can help relax the bladder muscles to prevent them from contracting, which causes the feeling of urgency in OAB.
• Surgery: If a person has injuries, such as damage to the bladder, surgical repair may help with incontinence if other treatments do not.

It is best to contact a doctor if a person develops any new or persistent symptoms after surgery, including more frequent or urgent urination. These symptoms can be signs of several conditions, such as OAB, UTIs, or bladder injury. A doctor can determine the cause and recommend the best treatments.

Several effective treatments for OAB are available. Speak with a doctor for advice and support in managing the symptoms.

Hysterectomies may make overactive bladder (OAB) more likely in several ways. The surgery itself may injure muscles or nerves that control urination. In other cases, a combination of factors such as older age, additional surgical procedures, and a history of pregnancy or cesarean deliveries may lead to the development of OAB.

OAB can be inconvenient and affect quality of life. A person may feel that they have to plan their schedule around bladder urges. However, with the right treatment, people can regain control and experience significant improvement in their condition.

It is best to speak with a doctor about any bladder symptoms that appear following a hysterectomy.