Abstract
PURPOSE: It has been suggested that hysterectomy has a disturbing influence on bowel function. To assess the incidence and nature of these changes, we performed a retrospective study. METHODS: A retrospective study was performed in all 593 women who had undergone hysterectomy between 1989 and 1993. A control group consisted of 100 women who had undergone laparoscopic cholecystectomy. RESULTS: The response rate was 90 percent (n=531; median age, 45 (range, 18–84) years). Of the responding women, 315 patients (59 percent) indicated a normal defecation pattern before hysterectomy. Of these women, severe deterioration in bowel function was reported by 98 patients (31 percent), whereas 36 women (11 percent) mentioned a moderate change after hysterectomy. Most frequent symptoms were severe straining (90 patients), incomplete and/or digital evacuation (83 and 50 patients, respectively). According to most patients, the changes in bowel function were reported to have started within one month after hysterectomy. With advancing age, fewer complaints were recorded ( P =0.008). No significant difference was found in the incidence of disturbed bowel function between the different types of operation (abdominal, vaginal, supravaginal, or radical hysterectomy). In the control group, the response rate was 96 percent. Median age of these women was 46 (range, 25–78) years. Fifty-eight patients (60 percent) reported normal bowel function before laparoscopic cholecystectomy. In this group of patients, disturbed bowel function after surgery was reported by five women (9 percent), which figure is significantly ( P < 0.001) lower compared with that in the corresponding hysterectomy group. CONCLUSION: Hysterectomy seems to play an important role in the pathogenesis of disturbed defecation.
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Gijsbers van Wijk CM, Kolk AM, Groot RP, Bleker OP, Ketting BW, Lamming FB. Psychische en seksuele gevolgen van uterusextirpatie. Neth J Med 1987;131:587–62.
Oates M, Gath D. Psychological aspects of gynaecological surgery. Clin Obstet Gynaecol 1989;3:729–49.
Gath D, Cooper P, Day A. Hysterectomy and psychiatric disorder: levels of psychiatric morbidity before and after hysterectomy. Br J Psychiatry 1982;140:335–42.
Coppen A, Bishop M, Beard RJ, Barnard GJ, Collins WP. Hysterectomy, hormones and behaviour: a prospective study. Lancet 1981;17:126–8.
Fraser AC. The late effects of Wertheim's hysterectomy on the urinary tract. J Obstet Gynaecol Br Commonw 1966;73:1002–7.
Fraser AC. Cystometry after Wertheim's hysterectomy. J Obstet Gynecol Br Commonw1967;74:746–8.
Carenza L, Nobili F, Giacobini S. Voiding disorders after radical hysterectomy. Gynecol Oncol 1982;13:213–9.
Farquharson DI, Shingleton HM, Orr JW, Hatch KD, Hester S, Soong SJ. The short term effect of radical hysterectomy on urethral and bladder function. Br J Obst Gynaecol 1987;94:351–7.
Fishman IJ, Shabsigh R, Kaplan AL. Lower urinary tract dysfunction after radical hysterectomy for carcinoma of the cervix. Urology 1986;28:462–8.
Scotti RJ, Bergman A, Bhatia NN, Ostergard DR. Urodynamic changes in urethrovesical function after radical hysterectomy. Obstet Gynecol 1986;68:111–20.
Lewington W. Disturbances of micturition following Wertheim hysterectomy. J Obstet Gynaecol Br Commonw 1956;63:861–7.
Smith PH, Turnbull GA. The urological complications of Wertheims hysterectomy. Br J Urol 1969;41:685–8.
Low JA, Maugner GM, Carmichel JA. The effect of Wertheim hysterectomy upon bladder and urethral function. Am J Obstet Gynecol 1981;139:826–34.
Farghaly SA, Hindmarsh JR, Worth PH. Posthysterectomy urethral dysfunction: evaluation and management. Br J Urol 1986;58:299–302.
Forney JP. The effect of radical hysterectomy on bladder physiology. Am J Obstet Gynecol 1980;138:374–82.
Kristensen GB, Frimodt-Moller PC, Poulsen HK, Ulbak S. Persistent bladder dysfunction after surgical and combination therapy of cancer of the cervix uteri stages 1b and 2a. Gynecol Oncol 1984;18:38–42.
Tamussino RG, Lichtenegger W. Urological complications after radical abdominal hysterectomy for cervical cancer: operative treatment of cervical cancer. Clin Obstet Gynaecol 1988;2:943–52.
Jequier AM. Urinary symptoms and total hysterectomy. Br J Urol 1976;48:437–41.
Vervest HA, Kiewiet de Jonge M, Vervest TM, Barents JW, Haspels AA. Micturition symptoms and urinary incontinence after nonradical hysterectomy. Acta Obstet Gynecol Scand 1988;67:141–6.
Heaton KW, Parker D, Cripps H. Bowel function and irritable bowel symptoms after hysterectomy and cholecystectomy-a population based study. Gut 1993;34:1108–11.
Prior A, Wilson PJ, Faragher EB. Irritable bowel syndrome in the gynecological clinic: survey of 798 new referrals. Dig Dis Sci 1990;35:1820–4.
Taylor T, Smith AN, Fulton M. Effects of hysterectomy on bowel and bladder function. Int J Colorectal Dis 1990;5:228–31.
Gurnari M, Mazziotti F, Corazziari E,et al. Chronic constipation after gynaecological surgery: a retrospective study. Br J Gastroenterol 1988;20:183–6.
Preston DM, Lennard-Jones JE. Severe chronic constipation of young women: idiopathic slow transit constipation. Gut 1986;27:41–8.
Thompsom WH, Dawes RF, Carter SS. Abdominal wall tenderness: a useful sign in chronic abdominal pain. Br J Surg 1991;78:223–5.
Longstreth GF, Preskill DB, Youkeles L. Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy: relation to gynecologic features and outcome. Dig Dis Sci 1990;35:1285–90.
Prior A, Stanley KM, Smith AR, Read NW. Relationship between hysterectomy and the irritable bowel: a prospective study. Gut 1992;33:814–7.
Prior A, Stanley K, Smith AR, Read NW. Effect of hysterectomy on anorectal and urethrovesical function. Gut 1992;33:264–7.
Long DM Jr, Bernstein WC. Sexual dysfunction as a complication of abdominoperineal resection of the rectum in the male: an anatomic and physiologic study. Dis Colon Rectum 1959;2:540–8.
Singh S, Poulsom R, Langman MJ, Sheppard MC, Wright N, Kumar D. Cyclicical constipation, is it mediated by sex steroids? Gastroenterology 1992;102:A515.
Kamm MA, Farthing MJ, Lennard-Jones JE. Bowel function and transit rate during the menstrual cycle. Gut 1989;30:605–8.
Wald A, Van Thiel DH, Hoechstetter L,et al. Gastrointestinal transit: the effect of the menstrual cycle. Gastroenterology 1981;80:1497–500.
Rees MC, Anderson AB, Demers LM, Turnbull AC. Endometrial prostaglandin release during the menstrual cycle in relation to menstrual blood loss. J Clin Endocrinol Metab 1984;58:813–8.
Kulkinen MO. Prostaglandins and the non-pregnant uterus. Acta Obstet Gynecol Scand Suppl 1983;113:63–7.
Nichols DH, Genadry RR. Pelvic relaxation of the posterior compartment. Curr Opin Obstet Gynecol 1993;5:458–64.
Green TH. Total prolapse of the vagina. In: Hafez ES, Evans TH, eds. The human vagina. Amsterdam: North Holland Med Press Elsevier, 1978:321–32.
Alexander DA, Naji AA, Pinion SB,et al. Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychsocial aspects. BMJ 1996;312:280–4.
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van Dam, J.H., Gosselink, M.J., Drogendijk, A.C. et al. Changes in bowel function after hysterectomy. Dis Colon Rectum 40, 1342–1347 (1997). https://doi.org/10.1007/BF02050820
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DOI: https://doi.org/10.1007/BF02050820