A hysterectomy is a surgical procedure involving the removal of the uterus, sometimes including the cervix, ovaries, or fallopian tubes. A urinary tract infection (UTI) is a bacterial infection most commonly affecting the lower urinary tract, including the bladder and urethra. Given the close proximity of the reproductive and urinary organs in the pelvis, surgical alteration of one system raises questions about the health of the other. Understanding the connection between this procedure and UTI incidence requires examining the risk during both the immediate recovery period and the long term.
Understanding UTI Risk in the Short Term and Long Term
The risk of developing a UTI after a hysterectomy changes significantly depending on the time elapsed since the operation. The immediate, short-term risk is primarily tied to the surgical event itself and the standard procedures used during and after the operation. Studies have shown that catheter-associated UTIs are a common complication immediately following a hysterectomy.
A urinary catheter is often temporarily placed to drain the bladder during or after surgery, particularly in complex cases. The presence of this foreign object provides a pathway for bacteria to travel into the bladder. The risk of developing a catheter-associated UTI increases the longer the catheter remains in place; one study identified catheterization for more than seven days as a significant risk factor.
The long-term risk of UTIs, observed months or years later, shifts away from surgical factors toward functional and structural changes in the urinary tract. This later risk is an indirect result of how the surgery affects the surrounding pelvic environment. Structural changes and nerve function issues can lead to incomplete bladder emptying, creating a stagnant environment where bacteria multiply and increase the chance of chronic infections. The long-term profile is also influenced by hormonal changes if the ovaries are removed, which affects the health of the urinary tract lining.
Physical and Hormonal Factors Influencing Urinary Tract Health
The primary reason a hysterectomy can influence urinary tract health stems from the close anatomical relationship between the uterus and the bladder. The bladder sits directly in front of the uterus, and the extensive network of nerves, blood vessels, and connective tissues supporting both organs are intertwined in the pelvis. The surgical removal of the uterus necessarily involves navigating and cutting through some of this shared support structure.
A deeper cause of long-term urinary issues is the potential disruption of the autonomic nerves that control bladder function. These parasympathetic nerves regulate the detrusor muscle, which is responsible for bladder contraction and emptying. Trauma to these nerves during surgery can impair communication between the bladder and the brain. This nerve damage can result in bladder dysfunction, such as urinary retention, or the inability to fully empty the bladder.
Incomplete bladder emptying leaves residual urine, which is an environment conducive to bacterial growth and a predictor of post-operative UTIs. Beyond physical disruption, the removal of the ovaries (oophorectomy) causes a sudden decline in estrogen levels, which plays a major role in long-term urinary health. Estrogen helps maintain the elasticity and health of the tissues lining the urethra and bladder.
The loss of estrogen can lead to the tissues of the genitourinary tract becoming thinner and more fragile, often called genitourinary syndrome of menopause. This loss of integrity makes the urinary tract more susceptible to colonization by bacteria, increasing the likelihood of infection. Furthermore, the decline in estrogen can negatively alter the vaginal microbiome, reducing protective bacteria and elevating the risk of ascending infections.
Reducing the Likelihood of Post-Hysterectomy UTIs
Managing the risk of UTIs after a hysterectomy involves focusing on both immediate post-operative care and adopting long-term habits that support urinary function. In the initial recovery phase, the most direct intervention is the timely removal of the urinary catheter. Surgical teams prioritize removing the catheter as soon as safely possible, ideally within seven days, to minimize the risk of catheter-associated infection.
Maintaining adequate hydration is a preventive measure that should be a focus during and after recovery. Drinking sufficient fluids helps to flush bacteria from the urinary tract, preventing them from establishing an infection. This mechanical action is a primary defense against infection.
For individuals who experience long-term issues like incomplete bladder emptying, specific techniques like double voiding may be recommended by a healthcare provider. Strengthening the pelvic floor muscles through exercises is also a beneficial strategy, as these muscles support the bladder and can improve control and function.
If the hysterectomy included the removal of the ovaries, individuals should discuss the possible use of hormone replacement therapy (HRT) with their physician. Topical estrogen therapy, in particular, may help restore the health and resilience of urinary and vaginal tissues affected by estrogen loss, potentially reducing vulnerability to recurrent UTIs. Any new or persistent urinary symptoms, such as burning, urgency, or difficulty emptying the bladder, warrant prompt medical attention for early diagnosis and treatment.