Hysterectomy and Urinary Incontinence in Postmenopausal Women: A Cross-Sectional Analysis from the Ardakan Cohort Study on Aging.

INTRODUCTION AND HYPOTHESIS: Hysterectomy is common, yet its long-term impact on urinary incontinence (UI) in low- and middle-income countries is unclear. Limited data exist from Iran. This study examined the association between hysterectomy and UI and its subtypes among postmenopausal women in Ardakan, Iran.

METHODS

In this cross-sectional analysis of the Ardakan Cohort Study on Aging, 2835 postmenopausal women aged 50 years and older were interviewed. UI was assessed using the validated five-item Revised Urinary Incontinence Scale; scores ≥ 1 indicated incontinence. Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were defined by positive responses to specific scale items. Baseline characteristics, hysterectomy status, and related factors were recorded. The data were analyzed using logistic regression models. A p value less than 0.05 was considered statistically significant.

RESULTS

Overall, 58% of women reported UI. Women with a history of hysterectomy showed a similar overall UI prevalence to those without. In fully adjusted models, hysterectomy was independently associated with SUI (OR ≈ 1.28; 95% CI 1.04-1.58). No significant associations were observed for UUI (adjusted OR ≈ 1.10; 95% CI 0.88-1.37) or for overall UI (adjusted OR ≈ 1.15; 95% CI 0.93-1.42). These findings suggest that, among Iranian postmenopausal women, hysterectomy might confer a modest increase in the odds of stress-type leakage but not urgency or overall incontinence.

CONCLUSIONS

In this large cohort of postmenopausal Iranian women, hysterectomy was associated with SUI but not with UUI or overall UI. Clinicians should discuss potential long-term pelvic floor consequences when counseling women about hysterectomy and consider strategies to prevent or manage SUI after surgery.