CHANGES IN BOWEL FUNCTION AFTER HYSTERECTOMY

PURPOSE: It has been suggested that hysterectomy has a disturbing infl uence on bowel function. To assess the incidence and nature of these c hanges, we performed a retrospective study. METHODS. A retrospective s tudy was performed in all 593 women who had undergone hysterectomy bet ween 1989 and 1993. A control group consisted of 100 women who had und ergone laparoscopic cholecystectomy. RESULTS: The response rate was 90 percent (n = 531; median age, 45 (range, 18-84) years). Of the respon ding women, 315 patients (59 percent) indicated a normal defecation pa ttern before hysterectomy. Of these women, severe deterioration in bow el function was reported by 98 patients (31 percent), whereas 36 women (11 percent) mentioned a moderate change after hysterectomy. Most fre quent symptoms were severe straining (90 patients), incomplete and/or digital evacuation (83 and 50 patients, respectively). According to mo st patients, the changes in bowel function were reported to have start ed within one month after hysterectomy. With advancing age, fewer comp laints were recorded (P = 0.008). No significant difference was found in the incidence of disturbed bowel function between the different typ es of operation (abdominal, vaginal, supravaginal, or radical hysterec tomy. In the control group, the response rate was 36 percent. Median a ge of these women was 46 (range, 25-78) years. Fifty-eight patients (G O percent) reported normal bowel function before laparoscopic cholecys tectomy. In this group of patients, disturbed bowel function after sur gery was reported by five women (9 percent), which figure is significa ntly (P < 0.001) lower compared with that in the corresponding hystere ctomy group. CONCLUSION: Hysterectomy seems to play an important role in the pathogenesis of disturbed defecation.