Dr. Cornella, a gynecologic surgeon at Mayo Clinic in Phoenix, Arizona, describes how he diagnoses urinary incontinence and shares when a woman would be at risk for this condition after having a hysterectomy.
Urinary incontinence is primarily diagnosed by the patient in the sense that, they complain of urinary leakage and they experience it during the day. So we may see patients in the office and we may do physical examination, but in the end, it’s really what they experience at home that makes the difference.
In other words, our endpoint is to give the patient satisfaction to the degree possible in terms of urinary loss. In order to do that however, we need to have objective findings and objective examinations.
So our opportunities in that regard would be something as simple as filling the bladder and having the patient cough and looking for immediate and non-sustained urinary leakage, which would indicate stress urinary leakage and again, that relates to weakness of that tube that drains the bladder, or if we see a sustained contraction of the bladder with persistent leakage not associated with cough then that would suggest bladder overactivity, which is the other common cause of urinary leakage.
Urodynamics is a test where we place pressure catheters in the bladder and surrounding areas, in terms of looking at the pressure, to see if we can determine why the patient is losing urine.
Hysterectomy has not been found to increase the incidents or prevalence of urinary incontinence in women under the age of 60. There are not a lot of well-done studies on this issue, but studies, which have been done and reviewed suggest that there may be a small association in patients over the age of 60 who have hysterectomy.
But even in those patients, the risk is only an absolutely risk of 11%. So it’s very limited, it’s complicated, and I don’t think patients should be concerned that hysterectomy predisposes them to urinary incontinence because there are so many co-founding factors surrounding the issue.