Question from Reader:
How do I cope? I’ve been using self cath for two weeks now. I had hysterectomy on 6-14-18. I went into retention and they sent me home with a catheter. I had also gone into retention previously for a different surgery 2 years ago. I’m afraid I have bladder damage from those 2 incidents. I am so afraid of this. How can I cope? I feel like my life is over. My doctors have given me no answers yet.
I wonder if people ever recover. My doctors keep telling me it’s temporary but it’s been 7wks and my bladder worked at first but then after 6wks stopped again. Just wondering what that could be? Because if I was to have an issue wouldn’t it be right after surgery?
Trudy’s Answer
My answer has two parts.
The first part is the possibility of an underactive bladder after a hysterectomy and the second is dealing with grief and depression.
From the book, “Beyond Embarrassment“ by JoAnne Lake with Julia Parker
Surgical Trauma, Vaginal Hysterectomy
At the age of forty-three, I had a vaginal hysterectomy, and, at the time, I was glad I did. My periods were lasting longer than three weeks a time, and the nearly constant loss of blood was making me weak. It was hard keeping my clothes clean and my spirits up. To say I was desperate is an understatement. Now that I look back, I might have acted rashly; I definitely acted without informing myself of the possible consequences.
Here are some facts for you from the book.
Knowledge Nugget:
Both hard physical work and past gynecological surgeries are risk factors for urinary incontinence (UI)4. Major pelvic surgery, including radical hysterectomy, is known to cause bladder dysfunction. In his article “Neurogenic Bladder,” Dr. Raymond R. Rackley states that “as many as 80 percent of affected patients will experience spontaneous recovery of function within six months after surgery.”5 That leaves 20 percent or more who will continue to have problems. Feelings of extreme shame and embarrassment that accompany disclosure of UI often lead to inaction or significant delay in seeking help, which could ultimately contribute to additional damage to organs of the urinary tract.
There are so many causes of neurogenic bladder and a hysterectomy is certainly one of them. Sometimes bladder function comes back, sometimes it does not.
Also in “Beyond Embarrassment: Reclaiming your life with neurogenic bladder and bowel”, I have a whole chapter on depression.
Situations arise that seem so much bigger than we can handle.
Sometimes I can get into a funk. Physical loss is hard, sometimes I grieve the body of my youth. So many losses. I did not even think to appreciate the whole body I enjoyed at one time. Perhaps before my bladder and bowel broke, I thought that basic functions were my right.I took what I had before, for granted. Life was so easy and I did not thank God once for my easy life.
Even now my life is easy in many ways. I have a new normal to get used to.Thankfulness is the key I have found to get through the hard times.
Give yourself time to grieve and only then you will be better able to move on.
Profound loss can be powerful in a good sense too, because we are reminded from where our power comes. My faith in God helps me.
HE roars like a lion.
HE gives me strength.
Our Father has broad shoulders.
Enjoy this song. Please allow me to share it with you that just lifts my mood and helps understand that I love a powerful God. “You make me Brave” and “Oceans” sung together remind us that that as our trials come we have a choice to look up or look down.
Julia was kind enough to find other resources for you regarding surgical procedures and hysterectomy. Be informed and enjoy.
New therapeutic directions to treat underactive bladder
This article will give you some topics to discuss with your doctor.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740036/
Articles about hysterectomy and the underactive bladder.
1: Wallis CJD, Peltz S, Byrne J, Kroft J, Karanicolas P, Coburn N, Nathens AB,
Nam RK, Hallet J, Satkunasivam R. Peripheral Nerve Injury during Abdominal-Pelvic
Surgery: Analysis of the National Surgical Quality Improvement Program Database.
Am Surg. 2017 Nov 1;83(11):1214-1219. PubMed PMID: 29183522.
2: Ramdhan RC, Loukas M, Tubbs RS. Anatomical complications of hysterectomy: A
review. Clin Anat. 2017 Oct;30(7):946-952. doi: 10.1002/ca.22962. Epub 2017 Aug
22. Review. PubMed PMID: 28762535.
3: Kyo S, Kato T, Nakayama K. Current concepts and practical techniques of
nerve-sparing laparoscopic radical hysterectomy. Eur J Obstet Gynecol Reprod
Biol. 2016 Dec;207:80-88. doi: 10.1016/j.ejogrb.2016.10.033. Epub 2016 Oct 28.
Review. PubMed PMID: 27825032.
4: Castiglione F, Bergamini A, Albersen M, Hannan JL, Bivalacqua TJ, Bettiga A,
Benigni F, Salonia A, Montorsi F, Hedlund P. Pelvic nerve injury negatively
impacts female genital blood flow and induces vaginal fibrosis-implications for
human nerve-sparing radical hysterectomy. BJOG. 2015 Oct;122(11):1457-65. doi:
10.1111/1471-0528.13506. Epub 2015 Jul 14. PubMed PMID: 26179559.
5: Chen L, Liu M, Huang X, Zheng Y, Qiu J, Liu H. A Modified Nerve-Sparing
Panhysterectomy for Benign Uterine Diseases: Techniques and Evaluation of
Postoperative Pelvic Dysfunctions. Gynecol Obstet Invest. 2015;80(1):38-45. doi:
10.1159/000370149. Epub 2015 Mar 21. PubMed PMID: 25823505.
6: Chen L, Zhang WN, Zhang SM, Yang ZH, Zhang P. Effect of laparoscopic
nerve-sparing radical hysterectomy on bladder function, intestinal function
recovery and quality of sexual life in patients with cervical carcinoma. Asian
Pac J Cancer Prev. 2014;15(24):10971-5. PubMed PMID: 25605211.
7: Kanao H, Fujiwara K, Ebisawa K, Hada T, Ota Y, Andou M. Various types of total
laparoscopic nerve-sparing radical hysterectomies and their effects on bladder
function. J Gynecol Oncol. 2014 Jul;25(3):198-205. doi:
10.3802/jgo.2014.25.3.198. Epub 2014 Jul 3. PubMed PMID: 25045432; PubMed Central
PMCID: PMC4102738.
8: Laterza RM, Sievert KD, de Ridder D, Vierhout ME, Haab F, Cardozo L, van
Kerrebroeck P, Cruz F, Kelleher C, Chapple C, Espuña-Pons M, Koelbl H. Bladder
function after radical hysterectomy for cervical cancer. Neurourol Urodyn. 2015
Apr;34(4):309-15. doi: 10.1002/nau.22570. Epub 2014 Feb 12. Review. PubMed PMID:
24519734.
9: Hodges KR, Davis BR, Swaim LS. Prevention and management of hysterectomy
complications. Clin Obstet Gynecol. 2014 Mar;57(1):43-57. doi:
10.1097/GRF.0000000000000004. Review. PubMed PMID: 24488052.
10: Zhang XM, Huang XF, Xu H, Quinn M. Endometriosis: a consequence of varying
injuries to pelvic autonomic nerves. Fertil Steril. 2012 Dec;98(6):e29. doi:
10.1016/j.fertnstert.2012.10.002. Epub 2012 Oct 18. PubMed PMID: 23084268.
11: Tseng CJ, Shen HP, Lin YH, Lee CY, Wei-Cheng Chiu W. A prospective study of
nerve-sparing radical hysterectomy for uterine cervical carcinoma in Taiwan.
Taiwan J Obstet Gynecol. 2012 Mar;51(1):55-9. doi: 10.1016/j.tjog.2012.01.011.
PubMed PMID: 22482969.
12: Vrzackova P, Weiss P, Cibula D. Sexual morbidity following radical
hysterectomy for cervical cancer. Expert Rev Anticancer Ther. 2010
Jul;10(7):1037-42. doi: 10.1586/era.10.89. Review. PubMed PMID: 20645693.
13: Hohenfellner R. Nerve injuries in urological surgery. Georgian Med News. 2007
Feb;(143):7-11. PubMed PMID: 17404430.
14: Kafy S, Huang JY, Al-Sunaidi M, Wiener D, Tulandi T. Audit of morbidity and
mortality rates of 1792 hysterectomies. J Minim Invasive Gynecol. 2006
Jan-Feb;13(1):55-9. PubMed PMID: 16431324.
15: Kirby RS, Fowler CJ, Gilpin SA, Gosling JA, Milroy EJ, Turner-Warwick RT.
Bladder muscle biopsy and urethral sphincter EMG in patients with bladder
dysfunction after pelvic surgery. J R Soc Med. 1986 May;79(5):270-3. PubMed PMID:
3723519; PubMed Central PMCID: PMC1290310.
Julia Parker
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