What to do when you’re leaking urine after hysterectomy

As if surgery wasn’t enough, now you have to contend with a leaky bladder. Just great.

But you’d be surprised to know how many women suffer from urinary incontinence. In this US alone, it is estimated that over 18 million women experience some degree of incontinence.

This means that you could walk past a woman with incontinence every single day without having the slightest clue that she experiences leaks. How does she do it? How does she manage to go about her daily life without embarrassing water spots or get home to soaking wet underwear?

The answers to these questions are pretty simple. We’ll let you on those secrets in just a sec but we’ve got to talk about why your hysterectomy has this annoying and sometimes embarrassing side effect.

What’s a hysterectomy?

 

If you’ve already had your hysterectomy then you can skip this part. If anyone should know what a hysterectomy is, it’s you.

For those who are reading out of curiosity, a hysterectomy is a surgical procedure in which a part of or the entire uterus (womb) is removed.

A woman can undergo this procedure for different reasons. One common reason is to prevent the spread of gynecological cancers. Another common reason is as a permanent solution for fibroids which can be quite painful for some women.

Uterine prolapse is another common reason women undergo hysterectomies, depending on the severity of the prolapse of course, and is usually a last resort when other treatments have failed.

Some other reasons women have their uterus removed are:

  • Endometriosis
  • Chronic pelvic pain
  • Abnormal vaginal bleeding
  • Adenomyosis

Depending on the issue , only the upper part of the uterus may be removed (supracervical hysterectomy) or perhaps the entire uterus and cervix are removed (total hysterectomy). If the ovaries and tubes are removed as well it is termed a  hysterectomy and bilateral salpingectomy-oophorectomy. In the case of gynecological cancers, the entire uterus along with all its tissue, the cervix and top part of the vagina are taken out in what is known as a radical hysterectomy.

How does a hysterectomy cause incontinence?

 

In one study , over 165,000 Swedish women who had hysterectomies were compared to over 479,000 women who didn’t have a hysterectomy for a duration of 30 years. At the end of the duration, it was discovered that the women who had hysterectomies were twice as likely to develop incontinence than the women who didn’t regardless of surgical technique. Why was this?

Doctors can’t seem to agree on what about the hysterectomy causes a woman to experience incontinence, but they can agree that it does happen. Here are some of the most plausible theories:

Stress incontinence

Stress incontinence occurs because of pressure or stress on the pelvic floor. This causes a loss of control over bladder function. A woman may experience leaks when she coughs, laughs or sneezes because these actions place additional stress on the pelvic floor.

This is not uncommon after a hysterectomy as there is considerable trauma to the pelvic floor which can weaken it. The connective tissue, ligaments and muscles in your pelvic floor are displaced and therefore the support it gives to your bladder, vagina and rectum can be impaired.

Urge incontinence
Urge incontinence can be described as a sudden, unbearable urge to urinate without the means to suppress these feelings. In other words, urge incontinence is where you want to pee really badly, you want to hold it, but you can’t long enough to go to the bathroom.

A hysterectomy can cause the bladder to become overactive as the muscles responsible for helping you hold the pee are severely weakened, damaged or even removed. It can also happen if there is nerve damage to the bladder which is in close proximity to the uterus.

Fistula
While this is unlikely, it is a possibility . This happens when a connection between the bladder or urethra is formed leading to continuous leakage of urine.

What can I do about it?

 

The good news about this is that it is completely manageable and treatable. Here are 7 ways to deal with urinary incontinence after having a hysterectomy.

  1. Kegel exercises

It isn’t unusual for pelvic floor muscles to be weakened after a hysterectomy and its likely that your doctor already introduced you to this treatment method.

Doing Kegels is all about finding the right muscles. One way to find them is by simply pretending to hold your urine or feces. The muscles that were used are the pelvic floor muscles. Then, contract these muscles for about in sets of 10-15 about 3 times daily.

The beauty of this exercise is that there is no need for equipment and it is very discrete. You can incorporate Kegels into your daily life , by performing standing Kegels at your counter or bathroom mirror while you get ready in the morning. You can do them sitting down while you’re in bed or make them a part of your workout routine with the bird dog kegel or bridge kegel.

For more advanced Kegels, feel free to add kegel weights. There are many different weights to choose from, of different weights, sizes, shapes, and colors. Finding the right ones to do your Kegels shouldn’t be difficult. When choosing Kegel weights, be sure to read the reviews since many are of poorer quality than others and can end up doing more harm than good.

2.  Incontinence products

Before you gloss over this option because there is no way in hell you’re going to the pharmacy to pick up adult diapers, take a minute to look at all these other options .

Incontinence pads:  These are similar in function and appearance to period pads. The difference is that they were designed specifically to hold urine and to wick it away from the surface of the skin where it could cause odor and irritation. Incontinence pads also come as panty liners and are perfect for women who only experience a few leaks here and there but still want to be protected.

Incontinence panties: Again, these are similar to period panties and look just like regular panties. They come in different styles and colors and are designed to absorb the quick flow of urine without spills. After use, they can be washed, dried and worn again.

Incontinence underpads: Underpads are not a new invention and have been used in hospitals and nursing homes for years to protect bedsheets from becoming soiled by urine. They can also be used around the house on chairs and other absorbent furniture to protect them from being soiled, especially since you can’t toss furniture in the washing machine.

With that being said, diapers offer maximum coverage despite being uncomfortable and embarrassing. They are however wasteful and bad for the environment.

3. Lifestyle changes

While you may not be able to control your bladder sometimes, you can control all the things you do that contribute to leaks. This means you will have to make certain lifestyle changes .

For starters, your diet may be the culprit. Did you know that certain foods send you to the bathroom more often than others? These are called diuretics and we don’t just mean drinking a lot of water.

Spicy foods like curries and jalapenos, caffeinated beverages like coffee and soda, and citrus fruits and products like lemons, oranges, and grapefruits make you pee more since they irritate the bladder. Stay away from alcohol as much as possible, as well as tomato-based products and chocolate.

If you’re a smoker who’s been trying to quit, you should note cancer isn’t your only worry. Smoker’s cough can have a pretty big impact on the pelvic floor in terms of weakening it and it may be the very thing causing your leaks.

If you’re chubby around the tummy, this is the time where you should take fitness and weight loss seriously. All that extra weight on your abdomen is just bearing down on your pelvic floor. This stress weakens it, and as you may have already figured out by now, it causes you to leak. If your hysterectomy was recent, then you’ll need the green light from your doctor before you start working out since you may end up hurting yourself in the process. If it has been a while since your surgery, you can work out but don’t overdo it. Stick to low impact exercises and cardio .

4. Injectable implants

If your incontinence is moderate, meaning it is bad enough for medical treatment, but not too severe that it requires surgery, you can get injectable implants .

This treatment method involves the use of bulking agents such as collagen to increase the amount of resistance to urinary flow. In other words, it helps to stop urine from leaking out.

This type of treatment is permanent and is currently done with brands like Coaptite and Macroplastique. This minimally invasive procedure lasts approximately 30 minutes and involves injecting either product from a needle into the walls of the urethra which then causes them to bulk up or tighten.

The effects of this procedure can be fully felt about a month after and you may need to use a catheter to empty your bladder for a few days since it will become harder to release urine. This problem goes away with time however you may need future injections if the implant migrates.

5.  Medications

Medication for urinary incontinence is typically prescribed for urge incontinence. They are not sold over the counter, so your doctor will have to determine if you are a suitable candidate, especially since they come with certain side effects.

Anticholinergic medications work by blocking the chemical messenger that causes the bladder to contract, even when it isn’t full. They come in pill form and also creams and patches that are used on the skin. Anticholinergic drugs can take as many as 3 months to show signs of improvement and may cause constipation, dry mouth, or skin irritation. Other less common side effects include blurry vision, heartburn, urinary retention, memory loss, and confusion.

Mirabegron is a medication that helps to relax the bladder, allowing it to empty fully. It may also increase the amount of urine it can hold and increase the amount of time between bathroom breaks. This medication can interact with other drugs negatively and may also cause an increase in blood pressure, nausea, diarrhea, constipation, dizziness, and headaches.

Onabotulinumtoxin type A or Botox is sometimes administered to paralyze the bladder muscle and treat the symptoms of an overactive bladder. This treatment is highly effective however there may be a chance that it increases the risk of urinary tract infections.

Estrogen is used to compensate for the losses experienced by women who are experiencing menopause or a drop in estrogen levels. Estrogen is responsible for keeping the tissues of the bladder and urethra healthy and can rejuvenate them when ingested or used topically.

Imipramine is used to treat mixed incontinence as it causes the bladder muscles to relax while causing the muscles at its neck to contract. It is especially useful for persons who suffer from nighttime incontinence, however, it may cause drowsiness and is best administered at nighttime. Imipramine may also cause dry mouth, blurry vision, constipation, and irregular heartbeat.

6.  Sling operations

Sling operations are usually performed in cases of severe prolapse or when other treatment methods have failed. This procedure involves making a sling out of mesh or tissue and placing it under the urethra. This sling lifts and supports the urethra and bladder while closing it slightly to minimize leaks.

After this procedure, you will experience bleeding and it will take several weeks for the stitches and glue to be dissolved into your body. It may even take up to 3 months before you’re cleared for intercourse.

7. Closing the fistula

If the fistula is small and is surrounded by healthy tissue, it may heal with the assistance of your doctor. However, most require surgery which involves removing damaged tissue and other material that can prevent healthy tissue from growing and closing the fistula.

Summary

Leaking urine after a hysterectomy is not uncommon, but it can be managed and treated. Here are some options to consider:

  • Doing kegel exercises to strengthen the pelvic floor
  • Wearing incontinence products to prevent wet marks in public, and to avoid soiling clothing and furniture
  • Making lifestyle changes such as diet and exercise to reduce leaking incidents
  • Getting injectable implants to bulk up the urethra
  • Taking medication to regain bladder control
  • Undergoing a sling operation to support the bladder and urethra
  • Having your fistula closed

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