title: Changes in bowel function after hysterectomy.
abstract: OBJECTIVE
  It has been suggested that hysterectomy has a disturbing influence on bowel function. To assess the incidence and nature of these changes, we performed a retrospective study.
  
  
  METHODS
  A retrospective study was performed in all 593 women who had undergone hysterectomy between 1989 and 1993. A control group consisted of 100 women who had undergone laparoscopic cholecystectomy.
  
  
  RESULTS
  The response rate was 90 percent (n = 531; median age, 45 (range, 18-84) years). Of the responding women, 315 patients (59 percent) indicated a normal defecation pattern before hysterectomy. Of these women, severe deterioration in bowel function was reported by 98 patients (31 percent), whereas 36 women (11 percent) mentioned a moderate change after hysterectomy. Most frequent symptoms were severe straining (90 patients), incomplete and/or digital evacuation (83 and 50 patients, respectively). According to most patients, the changes in bowel function were reported to have started within one month after hysterectomy. With advancing age, fewer complaints were recorded (P = 0.008). No significant difference was found in the incidence of disturbed bowel function between the different types of operation (abdominal, vaginal, supravaginal, or radical hysterectomy). In the control group, the response rate was 96 percent. Median age of these women was 46 (range, 25-78) years. Fifty-eight patients (60 percent) reported normal bowel function before laparoscopic cholecystectomy. In this group of patients, disturbed bowel function after surgery was reported by five women (9 percent), which figure is significantly (P < 0.001) lower compared with that in the corresponding hysterectomy group.
  
  
  CONCLUSIONS
  Hysterectomy seems to play an important role in the pathogenesis of disturbed defecation.
authors.affiliation: Department of General Surgery, University Hospital Dijkzigt, Rotterdam, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: van Dam
authors.forename: M J
authors.initials: MJ
authors.lastname: Gosselink
authors.forename: A C
authors.initials: AC
authors.lastname: Drogendijk
authors.forename: W C
authors.initials: WC
authors.lastname: Hop
authors.forename: W R
authors.initials: WR
authors.lastname: Schouten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D003248:Constipation / Q000209:etiology; D003672:Defecation; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D012002:Rectal Diseases / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology; D014591:Uterine Diseases / Q000628:therapy