Is hysterectomy a risk factor for urinary incontinence?


  • Maria C. Alexander Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • Vaibhav Londhe Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • Emily D. Ebenezer Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • Aruna N. Kekre Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • Visalakshi Jeyaseelan Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India



Menopause, Metabolic syndrome, Obesity, Urinary incontinence


Background: Hysterectomy is the most common gynecological surgery performed. There are few studies evaluating hysterectomy as a risk factor for urinary incontinence. If hysterectomy is found to be a risk factor for developing urinary incontinence, women undergoing hysterectomy can be well informed prior to the procedure regarding the same. The objective of the present study was to study the prevalence of urinary incontinence in post-menopausal women and its relationship to hysterectomy. To evaluate the association of metabolic syndrome, to urinary incontinence.

Methods: This study was a prospective cohort study done in Christian Medical College and Hospital, Vellore, Tamil Nadu between December 2016- December 2017. Postmenopausal women both with natural and surgical menopause, were enrolled into the study after an informed consent. The UDI-6 questionnaire was used to assess urinary incontinence. The categorical variables were presented using frequencies and percentages. The comparison of categorical variables was done using Fisher's exact test. The odds ratio and confidence interval were calculated for the prevalence. P value < 0.05 was considered to be statistically significant.

Results: A total of 600 women were enrolled into the study with 300 women having attained natural menopause and 300 women with a surgical menopause. The prevalence of urinary incontinence among these post-menopausal women was 46.24%. The prevalence of urinary incontinence amongst the women with natural menopause was 47.3% and amongst the women with surgical menopause was 45% (p = 0.566). Women with metabolic syndrome suffered from urinary incontinence more than their counterparts without metabolic syndrome (55.8% vs. 36%, p <0.0001).

Conclusions: The prevalence of urinary incontinence in the natural menopause and surgical menopause groups was similar, thus proving that hysterectomy is not a risk factor for developing urinary incontinence. However, metabolic syndrome was found to be associated with urinary incontinence.



Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT. Epidemiology and natural history of urinary incontinence. Int Urogynecol J. 2000;11(5):301-19.

Chmel R, Novácková M, Pastor Z, Vlk R, Horcicka L, Pluta M, et al. Abdominal hysterectomy--risk factor in development of urinary incontinence? Results of a questionnaire study. Ceska Gynekol. 2005;70(1):53-6.

de Tayrac R, Chevalier N, Chauveaud-Lambling A, Gervaise A, Fernandez H. Is vaginal hysterectomy a risk factor for urinary incontinence at long-term follow-up? Eur J Obstet Gynecol Reprod Biol. 2007;130(2):258-61.

Brown JS, Sawaya G, Thom DH, Grady D. Hysterectomy and urinary incontinence: a systematic review. The Lancet. 2000;356(9229):535-9.

Duru C, Jha S, Lashen H. Urodynamic outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis. Obstet Gynecol Surv. 2012;67(1):45-4.

Hsieh CH, Chang WC, Lin TY, Su TH, Li YT, Kuo TC, et al. Long-term effect of hysterectomy on urinary incontinence in Taiwan. Taiwan J Obstet Gynecol. 2011;50(3):326-30.

Miller J-JR, Botros SM, Beaumont JL, Aschkenazi SO, Gamble T, Sand PK, et al. Impact of hysterectomy on stress urinary incontinence: an identical twin study. Am J Obstet Gynecol. 2008 May;198(5):565.e1-4.

Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Neurourol Urodyn. 2011;30(1):2-12.

Van der VCH, Van der BJG, de Leeuw JR. J., Roovers J PWR, Heintz APM. The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms. BJOG Int J Obstet Gynaecol. 2002;109(2):149-54.

Gustafsson C, Ekström A, Brismar S, Altman D. Urinary incontinence after hysterectomy--three-year observational study. Urology. 2006;68(4):769-74.

Kudish BI, Shveiky D, Gutman RE, Jacoby V, Sokol AI, Rodabough R, et al. Hysterectomy and urinary incontinence in postmenopausal women. Int Urogynecol J. 2014;25(11):1523-31.

Hillard T. The postmenopausal bladder.Menopause 2010;16(2):74-80.

El-Toukhy TA, Hefni MA, Davies AE, Mahadevan S. The effect of different types of hysterectomy on urinary and sexual functions: a prospective study. J Obstet Gynaecol. 2004;24(4):420-5.

Li PC, Huang HK, Ding DC. Hysterectomy associated with de novo lower urinary tract symptoms in a Taiwanese population: a nationwide, population-based study. Int Urogynecol J. 2018:1-7.

Bunn F, Kirby M, Pinkney E, Cardozo L, Chapple C, Chester K, et al. Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies. Int J Clin Pract. 2015;69(2):199-217.

Gorbachinsky I, Akpinar H, Assimos DG. Metabolic Syndrome and Urologic Diseases. Rev Urol. 2010;12(4):e157-80.

He Q, Wang Z, Liu G, Daneshgari F, MacLennan GT, Gupta S. Metabolic syndrome, inflammation and lower urinary tract symptoms–Possible translational links. Prostate Cancer Prostatic Dis. 2016;19(1):7.

Hong GS, Shim BS, Chung WS, Yoon H. Correlation between metabolic syndrome and lower urinary tract symptoms of males and females in the aspect of gender-specific medicine: a single institutional study. Korean J Urol. 2010;51(9):631-5.

Otunctemur A, Dursun M, Ozbek E, Sahin S, Besiroglu H, Koklu I, et al. Impact of metabolic syndrome on stress urinary incontinence in pre- and postmenopausal women. IntUrolNephrol. 2014;46(8):1501-5.

Tai HC, Chung SD, Ho CH, Tai TY, Yang WS, Tseng C-H, et al. Metabolic Syndrome Components Worsen Lower Urinary Tract Symptoms in Women with Type 2 Diabetes. J Clin Endocrinol Metab. 2010;95(3):1143-50.

Uzun H, Zorba OÜ. Metabolic Syndrome in Female Patients with Overactive Bladder. Urol. 2012;79(1):72-5.

Kirss F, Lang K, Toompere K, Veerus P. Prevalence and risk factors of urinary incontinence among Estonian postmenopausal women. Springerplus. 2013;2(1):524.

Brown JS, Grady D, Ouslander JG, Herzog AR, Varner RE, Posner SF. Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Obstet Gynecol. 1999;94(1):66-70.

Singh A. Incidence and epidemiology of urinary incontinence in women. J Obstet Gynaecol India. 2007;57(2):155-7.

Danforth KN, Townsend MK, Lifford K, Curhan GC, Resnick NM, Grodstein F. Risk factors for urinary incontinence among middle-aged women. Am J Obstet Gynecol. 2006;194(2):339-45.

Liu B, Wang L, Huang S-S, Wu Q, Wu D-L. Prevalence and risk factors of urinary incontinence among Chinese women in Shanghai.Int J Clin Exp Med. 2014;7(3):686-96.

Schreiber PL, Lose G, Høybye MT, Elsner S, Waldmann A, Rudnicki M. Prevalence of urinary incontinence among women and analysis of potential risk factors in Germany and Denmark. Acta Obstet Gynecol Scand. 2017;96(8):939-48.

Hock M, Tóth S, Hartmann G, Hartmann T, Bódis J, Garai J. Quality of Life, Sexual Functions and Urinary Incontinence After Hysterectomy in Hungarian Women. Am J Health Res. 2015;3(6):393-8.

Zacche MM, Giarenis I, Thiagamoorthy G, Robinson D, Cardozo L. Is there an association between aspects of the metabolic syndrome and overactive bladder? A prospective cohort study in women with lower urinary tract symptoms. Eur J Obstet Gynecol Reprod Biol 2017;217:1-5.






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