Why do so many women complain about bowel problems after hysterectomy?
Hysterectomy appears to have a high occurrence of interrupted bowel function and changed bowel habits.
It is not strange that women have bowel issues after hysterectomy. After surgery the bowel fills up the empty space where the uterus was.
When the bowel moves downward it sometimes pulls the sigmoid colon and rectum down and it forms what we name a rectocele (bulging of the bowel).
Some women can feel bowel pressure after hysterectomy because they can actually feel the pressure of the bowel filled with stool push against the vaginal wall.
Post hysterectomy gastrointestinal problems
For every vaginal or abdominal hysterectomy surgery proper bowel preparation is very important. During the surgery the contractions (peristaltic) of the bowel will slow down. The cleaner the bowels are before surgery, the sooner normal activity will return. When the bowel is not well prepared, hard stool may cause abdominal or rectal pain, inability to pass gas and bloating. Women may also feel nauseous and not tolerate food.
A complication that can occur is that bowel activity does not return. When the doctor suspects an obstruction or partial obstruction, a woman will get intravenous fluids and is not allowed to eat or drink until bowel activity returns.
Chronic constipation after hysterectomy surgery
One study reports that women have fewer and harder bowel movements and use laxatives more often following a hysterectomy, than women in the same age group who haven’t had this surgery.
The cause for chronic constipation after hysterectomy is not fully understood but is often reported for the following reasons.
- Neurological – When they injure a woman’s autonomic nerves during the hysterectomy, her bowel is often affected.
- Anatomical – A rectocele, as mentioned above, may cause difficulties with defecation.
- Hormonal – Possibly a drop in estrogen may affect bowel function.
- Pharmacological – The use of iron and non-steroidal anti-inflammatory medications can cause constipation.
- Psychological – Though the effect of the psyche on the bowel is still unclear. Depression and anxiety may cause bowel problems after hysterectomy.
How can abdominal adhesions cause bowel problems after hysterectomy?
Painful bowel movements after hysterectomy are often due to adhesions. Adhesions are fibrous bands that connect organs that normally would smoothly slide past one another.
Adhesions are often the result of tissues and organs being injured, of tissue drying out and of contact with foreign substances during surgery. But also an abdominal infection after surgery can cause adhesions.
Adhesions can entangle the intestines and pull them out-of-place. They can make it difficult and sometimes impossible for food or stool to pass through the bowel.
How are hysterectomy adhesions and bowel problems treated? When adhesion cause severe pain and bowel obstruction, than surgery to remove them is often necessary. Mild symptoms are usually left alone as adhesions tend to reform, once they are surgically removed.
Bowel injury during hysterectomy
Injury to small bowel or colon can happen during a hysterectomy. This can become a serious complication if it is not quickly recognized and bowel contents spill in the woman’s pelvis.
A woman’s chance of bowel injury (enterotomy) is about o.4%. This is most common during a laparoscopically-assisted abdominal hysterectomy.
When bowel injuries are not noticed and repaired during surgery, women will soon complain about fever and painful, tense and swollen abdomen. Untreated bowel injuries may lead to a life-threatening condition called peritonitis.
Bowel problems after hysterectomy due to endometriosis
Many women have bowel problems after hysterectomy due to endometriosis. Pelvic pain, diarrhea, constipation and pain during sex are common complaints of endometriosis that will not necessary be solved with a hysterectomy.
Endometrial cells not only grow in the pelvic organs but can also exist in areas outside the uterus.
Sometimes endometrial implants exist on the pelvic floor and on the front wall of the bowel. So if they are not removed along with the uterus, their hormonal activity will continue to cause bleeding, scaring and pain.
Bowel problems after hysterectomy are often a part of the healing process. But when your bowels don’t get back to normal and these issues insist months after surgery you better contact your doctor and have this checked out.