Pelvic Pain after Hysterectomy: Understanding the Causes and Consequences

The female reproductive system is a very complex and multi-faceted structure where each component serves an essential role for the system to function optimally. For many years, the uterus was thought to serve mainly as the site for supporting pregnancy. However, research has shown that it also has wider hormonal and structural functions that may affect long-term health. Based on this assumption, it was also assumed that the uterus of a woman was no longer needed onceshe decidesto not have any more children.

In the UK alone, more than 55,000 cases of hysterectomy are routinely carried out each year as treatment for benign conditions of the uterus – such as cysts, fibroids and adenomyosis. Over the last several decades, various types of medical research studies carried out in the area of women’s health have located numerous uterine health issues.

Hysterectomy can have long-term impacts that are often under-discussed during preoperative consultations. the risks of heart disease, urinary incontinence, hormonal changes, and sexual function disorders are among the potential consequences.

In this blog we are discussing another long-term, chronic issue stemming from the surgery that many women are unaware of or misunderstand. It has the potential to create pelvic pain years after a hysterectomy, along with menstrual-type cramps and a variety of other serious life-altering complications.

Why am I experiencing pain after a hysterectomy?

Pain after a hysterectomy will change depending on the individual and the circumstances; however, the typical recommendation from a physician is generally a timeframe of 3 months. If you still have pelvic pain 3 months after your hysterectomy, please book consultation with a private gynaecologist to evaluate the pain, as often the treatment of the pelvic nerves and muscles will allow for a resolution of the pain. Please remember prolonged pain following hysterectomy is not normal.

What are some causes for pelvic pain years after a hysterectomy?

There can be a few reasons for pelvic pain years after a hysterectomy, and the ones here have been identified:

Residual Ovarian Syndrome or ROS

This can happen when there is an ovary or both of them are left in place during the hysterectomy. Residual Ovarian Syndrome (ROS) produces symptoms of chronic pelvic pain and a massformation. This condition can cause sexual intercourse to be painful. Some women with ROS may eventually require additional surgery for symptom relief, and many report persistent pelvic pain or dyspareunia.

Ovarian Remnant Syndrome

Another less common reason for pelvic pain and cramping, years after a hysterectomy, is ovarian remnant syndrome. This syndrome arises after surgical removal of both ovaries and involves leaving a small amount of ovary behind that is still somewhat functional. These remnant ovaries can create cysts and produce ongoing pelvic or abdominal pain.

Scar Tissue

Scar tissue is also a potential source of ongoing menstrual-like cramping years after a hysterectomy or recurrent pelvic pain. Some women have even reported that they have more pain post-surgery than before they underwent their hysterectomy.

Fluctuations in Hormones

Abdominal cramps, which feel like PMS,occur years after hysterectomy and are caused by a fluctuation in hormones. If the ovaries remain intact, they still can produce and release these hormones and cause bloating, cramping and other PMS symptoms, even when the uterus is removed.

Some women are surprised to experience cramps after a hysterectomy, particularly if their ovaries were not removed, as hormonal activity can still trigger PMS-like symptoms. While ovaries are the primary hormone-producing organ that initiates PMS-type side effects like cramping, other organs (like the thyroid) produce hormones that may cause symptoms such as depression and irritability, multiple symptoms, including bloating.

Pre-Existing Conditions

Any pre-existing condition, such as pelvic inflammatory disease (PID) or endometriosis, present before the uterus was surgically removed from the body, can remain and contribute to discomfort and chronic pain in the lower abdomen or pelvic area. In addition, the underlying pain caused by these conditions can be worsened by the scar tissue from the surgery.

Where can the pain be after a hysterectomy?

After your hysterectomy, pain should be expected as you have had major surgery and some degree of pain is very normal. However, if you develop pain and dysfunction in your pelvic floor, you will want to consult with someone who specialises in pelvic pain.

That includes (but is not an exhaustive list):

• Back Pain
• pelvic or lower abdominal pain
• Stomach Pain
• Pain in the lower abdomen
• Leg Pain
• Bowel Pain
• Bladder Pain after Hysterectomy
• A painful, burning sensation while urinating with an increased urge and frequency
• Pain during sexual intercourse
• Constipation or pain during bowel movements (Opioids can also cause constipation – as a result, minimal bowel movement or painful bowel movements; but sometimes contribute to post-operative pain as well)

What other conditions can occur besides Chronic Pelvic Pain after a hysterectomy?

Pelvic Floor Dysfunction

It can be persistent pain in the pelvic area along with urinary incontinence, and could lead to pain or difficulty during sexual encounters.

Prolapse

When the uterus is removed, the pelvic organs or bladder can drop down from their regular place and become dislodged. They may protrude out of the vagina, or cause discomfort in the bowel and bladder.

Increased Risk Factor for other Conditions

Hysterectomy may reduce the risk of ovarian cancer if ovaries are removed, but it has also been associated in some studies with increased risks of cardiovascular disease, osteoporosis, and urinary problems.

Conclusion

Pelvic pain after a hysterectomy is more common than most people realise and can arise from conditions including, but not limited to, residual ovarian syndrome, ovarian remnant syndrome, scar tissue or adhesions, hormonal fluctuations and pre-existing health conditions. While pelvic discomfort after major surgery is somewhat expected, prolonged or worsening pain should never be ignored. Consulting with a pelvic pain specialist is crucial in determining the cause and exploring treatment options. Understanding the long-term effects of hysterectomy, allows women to seek help in a timely manner, improve their quality of life, and make better decisions regarding their reproductive health.

Experiencing ongoing pelvic pain after a hysterectomy?

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