PURPOSE: This study was designed to evaluate the risk on development and persistence of constipation after hysterectomy.
METHODS:We conducted a prospective, observational, multicenter study with three-year follow-up in 13 teaching and nonteaching hospitals in the Netherlands. A total of 413 females who underwent hysterectomy for benign disease other than symptomatic uterine prolapse were included. All patients underwent vaginal hysterectomy, subtotal abdominal hysterectomy, or total abdominal hysterectomy. A validated disease-specific quality-of-life questionnaire was completed before and three years after surgery to assess the presence of constipation.
RESULTS:Of the 413 included patients, 344 (83 percent) responded at three-year follow-up. Constipation had developed in 7 of 309 patients (2 percent) without constipation before surgery and persisted in 16 of 35 patients (46 percent) with constipation before surgery. Preservation of the cervix seemed to be associated with an increased risk of the development of constipation (relative risk, 6.6; 95 percent confidence interval, 1.3-33.3; P=0.02). Statistically significant risk factors for the persistence of constipation could not be identified.CONCLUSIONS: Hysterectomy does not seem to cause constipation. In nearly half of the patients reporting constipation before hysterectomy, this symptom will disappear.KEY WORDS: Hysterectomy; Constipation; Defecation; Prognostic factor; Prospective study.H ysterectomy is the most performed gynecologic operation. This procedure has been proven to be safe and highly effective. 1,2 However, because the majority of hysterectomies are performed to improve the patient's quality of life rather than to cure life-threatening conditions, associated morbidity is poorly tolerated by both the patient and the doctor. Hysterectomy disrupts the pelvic anatomy and the local nerve supply in the pelvic. Therefore, it is conceivable that hysterectomy induces micturition and defecation symptoms. [3][4][5][6][7] Several authors have addressed the effect of hysterectomy on the occurrence of constipation. [5][6][7] However, the theory of damage to the pelvic plexus that innervates the left colon and the rectum was refuted by Prior and coauthors 8 who found after hysterectomy evidence of increased rectal sensitivity, which, by definition, is the reverse of autonomic denervation. Because most of the studies relating constipation to hysterectomy have a retrospective design, it is not clear whether hysterectomy truly induces constipation or whether constipation was already present before the hysterectomy. Furthermore, little is known about potential risk factors for the development of constipation after hysterectomy. The lack of data on this subject bothers the gynecologist with the difficult task to inform the patient about her individual risk to develop constipation after hysterectomy.We present the data of a prospective, multicenter study performed to evaluate the long-term effects of hysterectomy on constipation and to identify predictors of constipa...