title: Effects of hysterectomy on bowel function: a three-year, prospective cohort study.
abstract: OBJECTIVE
  This study was a prospective evaluation of the long-term effects of hysterectomy on bowel function using self-reported outcome measures on symptoms of constipation, rectal emptying difficulties, and anal incontinence.
  
  
  METHODS
  In this prospective cohort study, 120 consecutive patients undergoing hysterectomy for benign conditions answered a questionnaire on bowel habits and anorectal symptoms preoperatively. Forty-four patients underwent vaginal and 76 abdominal hysterectomy. Follow-up was performed one and three years postoperatively. Data were analyzed by using multivariate regression and nonparametric statistics.
  
  
  RESULTS
  The bowel and anorectal survey was answered by 115 of 120 patients (96 percent) after one year and 107 of 120 patients (89 percent) after three years. Abdominal hysterectomy was associated with increased anal incontinence symptoms at one-year (P < 0.01) and three-year follow-up (P < 0.01). Vaginal hysterectomy was not associated with increased anal incontinence symptoms at one year follow-up, although there was a significant increase in incontinence symptoms at the three-year follow-up (P < 0.05). Risk factor analysis indicated that a reported history of obstetric sphincter injury was correlated to an increased risk of developing posthysterectomy anal incontinence (odds ratio, 2.07; 95 percent confidence interval, 1.05-2.87; P < 0.05). There was no significant rise in constipation symptoms or rectal emptying difficulties in either cohort through the follow-up.
  
  
  CONCLUSIONS
  Neither abdominal nor vaginal hysterectomy was associated with constipation, aggravation of constipation, or rectal emptying difficulties three years after surgery. Abdominal and vaginal hysterectomy was, however, associated with an increased risk of mild anal incontinence symptoms, and patients with a reported history of obstetric sphincter injury were at particular risk for posthysterectomy fecal incontinence.
authors.affiliation: Pelvic Floor Center, Department of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden. catharina.forsgren@ds.se
authors.forename: Catharina
authors.initials: C
authors.lastname: Forsgren
authors.forename: Jan
authors.initials: J
authors.lastname: Zetterström
authors.forename: Annika
authors.initials: A
authors.lastname: Lopez
authors.forename: Johan
authors.initials: J
authors.lastname: Nordenstam
authors.forename: Bo
authors.initials: B
authors.lastname: Anzen
authors.forename: Daniel
authors.initials: D
authors.lastname: Altman
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000209:etiology*; D003672:Defecation / Q000502:physiology*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000503:physiopathology* / Q000601:surgery