Constipation after hysterectomy: Fact or fiction?

Hysterectomy is responsible for numerous postoperative complications largel y urological, but sometimes of sexual or colorectal function. The latter in volve modifications of bowel function resulting in constipation as a result of delayed transit, infrequent evacuations and greater difficulty in expel ling faeces. We have reviewed the topic, and consider the various hypotheses whereby the se modifications may result from hormonal alterations, iatrogenic causes, o r variations in recto-bladder sensitivity. Any of these could justify the m odifications in bowel function detected in these patients. The studies carried out so far provide no clear information about the type of constipation that develops after hysterectomy, as we lack prospective st udies that compare bowel function before and after operations. Nor is it cl ear whether we are dealing with constipation as a result of delayed transit or obstructed defaecation, nor which pathogenetic mechanisms are involved. In view of the large number of hysterectomies that are done, sometimes pro phylactically, controlled prospective studies are warranted to address thes e issues more fully.