Can hysterectomy or other abdominal surgery cause irritable bowel syndrome?

Tagged Hysterectomy; Posted 9 months ago by Andreas Obermair

Abdominal surgery, including a hysterectomy (removal of the uterus), has been associated with changes in bowel function in some individuals. However, it is essential to distinguish between general postoperative changes and the specific diagnosis of irritable bowel syndrome (IBS).

Postoperative changes in bowel function can include alterations in bowel habits, abdominal discomfort, and changes in stool consistency. These changes may be temporary and related to:

• Altered Pelvic Anatomy: A hysterectomy involves the removal of the uterus, and depending on the type of hysterectomy (total or subtotal), other structures like the cervix and part of the vagina may also be affected. These changes in pelvic anatomy can potentially impact the surrounding structures, including the bowel.
• Disruption of Nerve Pathways: Radical surgery for cervical or ovarian cancer or for severe endometriosis can disrupt the normal functioning of nerve pathways in the pelvic region that regulate bowel movements.
• Inflammation and Scarring: Surgical procedures will always lead to temporary inflammation and scarring. Adhesions or scar tissue formation in the pelvic area may affect the movement and function of the intestines, leading to bowel dysfunction.
• Changes in Microbiota: Surgery and antibiotic use associated with surgery can alter the balance of gut microbiota, influencing bowel function.
• Stress and Anaesthesia: The stress of surgery and the effects of anaesthesia can contribute to changes in bowel habits.
• Medications: Postoperative medications, particularly pain medications, anti-nausea medication and anaesthesia, may affect bowel function.
• Hormonal Changes: While a hysterectomy itself does not cause hormonal changes (unless the ovaries are also removed), hormonal fluctuations associated with the surgery or other related factors may influence bowel function.
• Postoperative Complications: Complications such as adhesions or strictures can develop post-surgery, leading to changes in bowel function.
• Psychological Factors: The psychological stress associated with surgery and recovery can influence bowel habits.
• Complications: Every surgical procedure carries the risk of complications that can show in bowel disturbances. However, in such cases, many other parameters (blood tests, medical imaging) would also be altered and visible to your surgical team.

While abdominal surgery can contribute to gastrointestinal symptoms, IBS is a distinct functional gastrointestinal disorder with its own set of criteria for diagnosis. IBS is characterised by chronic abdominal pain, bloating, and changes in bowel habits without any identifiable structural or biochemical abnormalities.

Not everyone who undergoes a hysterectomy will develop bowel dysfunction, and for those that do, it is often temporary. However, some individuals may experience persistent gastrointestinal symptoms after surgery, and in some cases, these symptoms may resemble those of IBS.

If you are experiencing gastrointestinal symptoms after abdominal surgery, communicate with your surgeon. They can assess your symptoms, conduct relevant tests, and provide guidance on the most appropriate course of action for your specific situation. Management may involve addressing specific postoperative issues, such as adhesions or changes in anatomy, or it may focus on managing symptoms through dietary changes, medications, or other interventions.

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