Years After a Hysterectomy, Now Constipated and Urinating Often: Is It the Surgery? Pelvic Organ Prolapse, Falling Hormones, What to Get Checked, and Evidence-Based Care

A reader’s question: the hysterectomy was long ago, so why constipation and frequent urination now?

A member of a support group for women who have had a hysterectomy shared that her surgery was a long time ago, but she has only recently become constipated and is urinating more often, and she wonders whether it is related to the operation.

Short answer: it can be, but it is not always the surgery. Hysterectomy raises the chance of pelvic organ prolapse and brings menopause earlier for some women,
and both can cause constipation and frequent urination. Other common causes are easy to test and treat, so rule them out first.
If the surgery was recent and you are worried about earlier menopause, read
Hysterectomy and salpingectomy with ovaries kept: does menopause come earlier?

1. The surgery was long ago and symptoms started now: can they be related?

Direct answer: yes. Hysterectomy is linked to a higher risk of pelvic organ prolapse, but most women who have a hysterectomy never develop it,
and the risk builds over time, so symptoms can begin many years after surgery.

Data from national registries

Following 165,260 women who had a hysterectomy and 479,506 who did not in Sweden for 30 years found 179 vs 76 operations for stress urinary leakage per 100,000 person-years,
a 2.4-fold higher risk regardless of surgical method
(Altman 2007)
Another study of 118,601 vs 579,200 women found the highest risk after vaginal hysterectomy done for uterine prolapse
(4.9 times the risk of later prolapse surgery)
(Forsgren 2012)

The risk grows over time but stays a minority

Following 17,032 women in England found prolapse needing surgery after hysterectomy at 3.6 per 1,000 person-years.
The cumulative risk rose from 1% at 3 years to 5% at 15 years, and was 5.5 times higher if the hysterectomy had been done for uterine prolapse.
Number of births, age, and weight were the clearest risk factors
(Mant 1997)
Pelvic exams in 10,727 older women who had had a hysterectomy found a cystocele in 32.9% and a rectocele in 18.3%, mostly mild and without symptoms
(Hendrix 2002)

Constipation after hysterectomy

Following 327 patients for 4 years after hysterectomy found constipation in 7.8%, 8.2%, 8.6%, and 5.3% across the years, along with more obstructed defecation and leakage than before surgery,
but the study had no comparison group without surgery
(Kocaay 2017)

2. How prolapse causes constipation and frequent urination

Direct answer: when the front vaginal wall sags, the bladder drops and does not empty fully, so you need to go more often.
When the back wall bulges, stool collects in the pocket, so emptying feels incomplete and you strain.

What holds the vagina up after a hysterectomy

The vagina is supported by connective tissue around the pelvic organs, the ligaments that once held the uterus, and the pelvic floor muscles that act like a hammock.
Age, several births, excess weight, chronic cough, or long-term straining weaken these supports.

Cystocele (front vaginal wall prolapse)

A sagging bladder kinks the bladder neck, so urine flows slowly and incompletely and some is left behind, causing frequent urges and infections.
In 1,912 women, needing to press on the vagina to start urinating was 97% specific for front-wall prolapse
(Tan 2005)

Rectocele (back vaginal wall prolapse)

A rectal pocket means straining pushes on the vaginal wall instead of pushing stool out. Large rectoceles (over 4 cm) are more likely to cause difficult defecation,
but symptoms often also come from pelvic floor muscles that do not coordinate, so treatment starts with stool softening and biofeedback before surgery
(Bharucha 2022)

Signs that point to prolapse

A feeling of a lump or dragging in the vagina is a useful screening symptom. In the same study, 77% of women with stage 2 prolapse reported it,
and reporting a bulge had an 81% positive predictive value
(Tan 2005)
Symptoms are often worse in the evening, after standing, lifting, or straining, and better when lying down.

3. How falling hormones after a hysterectomy play a part

Direct answer: even with the ovaries kept, they may stop working several years earlier. As estrogen falls, the lining of the urethra and vagina thins,
causing frequent urges, trouble holding urine, and repeat infections, which can be treated with vaginal estrogen.

Earlier ovarian failure

Following 406 women aged 30–47 who had a hysterectomy with ovaries kept and 465 who did not found a 1.92-fold higher risk of ovarian failure,
reaching 14.8% vs 8.0% within 4 years
(Moorman 2011)
Another study of 257 vs 259 women found menopause arrived 3.7 years earlier
(Farquhar 2005)

Genitourinary syndrome of menopause (GSM)

The North American Menopause Society and the International Society for the Study of Women’s Sexual Health define GSM as symptoms from falling estrogen in the vagina, urethra, and bladder,
including dryness, burning, pain with sex, urgency, painful urination, and repeat infections
(Portman 2014)
A systematic review of 44 studies found that vaginal estrogen reduces urinary frequency and repeat infections, as well as urgency and leakage,
while blood hormone levels stay within the postmenopausal range
(Rahn 2014)

About tying off the uterine arteries

There is no evidence that tying off the uterine arteries cuts blood flow to the ovaries by 50–70%. Why the ovaries stop earlier is still unclear,
and the researchers themselves say they cannot tell whether it is the surgery or the condition that led to it
(Moorman 2011)

4. Other causes to rule out before blaming the surgery

Direct answer: for new frequent urination, check the urine for infection and sugar first. Constipation itself also causes frequent urination, because a full bowel presses on the bladder.

Infection and diabetes

A bladder infection causes frequent urges, burning, and cloudy urine. Diabetes causes large amounts of urine each time with thirst. Both are easy to check with a urine test and blood sugar.

Constipation causes frequent urination

In 52 older adults with chronic constipation and urinary symptoms, treating constipation cut the number with frequent urination from 47 to 25
and lowered leftover urine from 85 to 30 mL
(Charach 2001)
Both problems should be treated together.

Medicines that cause constipation or frequent urination

Medicines that can constipate include opioid pain relievers, iron, calcium, some calcium channel blockers for blood pressure, and anticholinergic drugs.
Diuretics, coffee, tea, and alcohol increase urination. Bring a list of all medicines and supplements to your doctor.

Scar tissue in the abdomen

Scar tissue after surgery is not a common cause of frequent urination. What matters about scar tissue is that it can block the bowel, which comes with cramping, swelling, vomiting, and no gas, not slowly building constipation.

5. How much to drink when you urinate often but are also constipated

Direct answer: drinking 2.5–3 liters a day can make frequent urination worse. Drink enough to keep urine pale yellow, spread through the day, cut back on coffee and tea,
and treat constipation with fiber and the right medicines instead of large volumes of water.

Evidence on fluid volume

In a crossover trial of 24 people with overactive bladder, drinking 25% less reduced frequency, urgency, and night-time urination,
while drinking 25% and 50% more made daytime frequency worse
(Hashim 2008)

Do not cut fluids too far

Cutting fluids too much makes urine concentrated, irritates the bladder, and hardens stool. The goal is the right amount for you, not one number for everyone.
People with heart or kidney disease should ask their doctor directly about fluid amounts.

• Record drinks in your bladder diary: to see whether you drink too much or too little
• Drink a glass at a time through the day: instead of large amounts at once
• Cut back on coffee, tea, fizzy drinks, and alcohol: all increase urination
• Drink less in the 2–3 hours before bed: if you wake at night to urinate

6. Managing constipation without straining

Direct answer: start with soluble fiber such as psyllium, a knees-up toilet posture, and an osmotic laxative if that is not enough.
Repeated long straining adds pressure to a pelvic floor that is already weak.

Medicines recommended in the 2023 guideline

The joint American gastroenterology guideline strongly recommends polyethylene glycol and sodium picosulfate,
and conditionally recommends fiber, magnesium oxide, lactulose, and senna
(Chang 2023)
People with kidney disease should ask a doctor before using magnesium oxide, because magnesium can build up in the blood.

Toilet posture

Rest your feet on a low stool so your knees are above your hips, lean forward, breathe out slowly instead of holding your breath to push, and do not sit for more than 5–10 minutes.
If you need a finger to press on the vagina or perineum to pass stool, tell your doctor, because this points to a rectocele or uncoordinated straining.

Uncoordinated straining: treated with training

In a randomized trial of 77 people with constipation from uncoordinated straining, biofeedback corrected the problem better than sham training or standard care
and increased complete spontaneous bowel movements
(Rao 2007)

When rectocele surgery is considered

Surgery is considered when stool softeners and biofeedback have not worked. Past data show difficult defecation improved in about 30–50%, with the bulge returning in 17% at 2 years
(Bharucha 2022)

• Psyllium or other soluble fiber: start low and increase over 1–2 weeks to reduce bloating
• High-fiber foods: oats, vegetables, beans, kiwi, and prunes
• Walk or move every day: helps the bowel move
• Try the toilet after breakfast: use the natural bowel contraction after eating

7. Pelvic floor training and pessaries

Direct answer: pelvic floor training reduces prolapse symptoms and leakage in randomized trials,
but pelvic floor exercises work best when a physiotherapist teaches the correct technique, because half of women do them wrong after verbal instructions alone.

Evidence from trials

The POPPY trial in 447 women with stage 1–3 prolapse found individualized training with a physiotherapist lowered prolapse symptom scores by 3.77 vs 2.09 with a leaflet alone at 12 months
(Hagen 2014)
A Cochrane review of 31 trials and 1,817 women found stress urinary leakage resolved in 56% of women who trained vs 6% of those who did not
(Dumoulin 2018)

From Dumoulin 2018 (Cochrane) and Bump 1991

Correct technique matters more than repetitions

Of 47 women given brief verbal instructions, only 49% squeezed correctly, and 25% bore down in a way that could make leakage worse
(Bump 1991)
Programs used in trials typically hold each squeeze for 6–10 seconds, 8–12 squeezes per set, 3 sets a day, for at least 12 weeks, with a physiotherapist checking technique.

Vaginal pessary

A pessary can be used even after a hysterectomy. In a trial of 276 women, those using a pessary plus pelvic floor training saw prolapse bother scores fall by 29.7 vs 4.7 with training alone at 12 months,
with similarly low complication rates
(Cheung 2016)

• Ask for a pelvic floor physiotherapist: to check that you squeeze the right muscles
• Squeeze before you cough, sneeze, or lift: reduces downward pressure on the pelvic floor
• Lose excess weight and treat chronic cough: lowers pressure in the abdomen
• Lift heavy things with bent knees while breathing out: instead of holding your breath and pushing

8. Managing frequent urination: diary, training, and medicines

Direct answer: the 2024 guideline starts with a bladder diary, bladder training, and adjusting drinks before medicines,
so do not buy bladder-relaxing medicines and use them on your own.

A 3-day bladder and bowel diary

For 3 days, record urination times, volumes (measured with a cup), what you drink, urgency, leakage, and bowel movements. This helps separate frequent urination from drinking a lot,
an overactive bladder, or incomplete emptying
(Cameron 2024)

Gradual bladder training

When urgency hits, stand still, do 5–6 quick squeezes, breathe slowly, wait for the urge to fade, then walk to the toilet, and gradually stretch the time between visits by 15 minutes.

Medicines for overactive bladder

There are 2 main groups: beta-3 agonists (mirabegron, vibegron) and antimuscarinics (oxybutynin, solifenacin).
A study of 58,769 people with dementia and 225,574 controls found high cumulative use of bladder antimuscarinics was linked with 1.65 times the odds of dementia
(Coupland 2019)
Antimuscarinics also worsen constipation, so a doctor should choose the medicine.

Vaginal estrogen tablets or cream

If an exam shows thin vaginal lining with frequent urges or repeat infections, a doctor may prescribe estradiol as a vaginal tablet or cream, which is absorbed into the blood very little
(Rahn 2014)
Women with a history of breast cancer should talk to their oncologist first.

• Empty fully: sit all the way down, lean forward, and try again after standing for 30 seconds
• Avoid frequent “just in case” trips: they train the bladder to hold less
• Treat constipation at the same time: reduces pressure on the bladder

9. Preparing for a doctor visit: what to get checked

Direct answer: start with a gynecologist or urogynecologist. The key checks are a pelvic exam while straining, a urine test,
an ultrasound of leftover urine after voiding, and blood sugar.

Pelvic exam while straining

The doctor looks at the front wall, the top of the vagina, and the back wall while you strain or cough, and grades prolapse with the POP-Q system,
along with pelvic floor strength and the vaginal lining.

Common tests

A urine test for infection, blood, and sugar; a urine culture if infection is suspected; leftover urine after voiding; and blood sugar and kidney function.
Urodynamic testing is not needed at the first assessment and is usually used when planning surgery or when first-line treatment has not worked
(Cameron 2024)

When a colonoscopy is needed

New constipation after age 50 with bleeding or weight loss needs a colonoscopy, as does anemia, persistently narrow stools,
a close relative with colorectal cancer, or never having had age-appropriate screening.

• Year, method, and reason for the surgery: for example fibroids, prolapse, or bleeding, and whether the ovaries were kept
• 3-day bladder and bowel diary: urine, drinks, and stool
• List of all medicines and supplements: including blood pressure medicines, iron, calcium, and pain relievers
• Related symptoms: a vaginal lump, pressing to pass stool, leakage, hot flashes, or vaginal dryness

Table: which symptoms point to which cause

Summarized from the research in this article, to prepare for a doctor visit, not for diagnosis

Table: comparing care options

Drug classes and generic names only. The right choice depends on test results, other conditions, and your doctor’s assessment

Common beliefs vs the evidence

After a hysterectomy, prolapse will happen eventually

No. The risk is higher, but the cumulative risk of needing prolapse surgery is about 5% at 15 years, and it also depends on births, age, weight, and chronic straining.

Tying off the uterine arteries cuts ovarian blood flow by 50–70%

No evidence supports this figure. What the evidence shows is earlier ovarian failure in some women, for reasons that are still unclear.

Drinking 2.5–3 liters helps both constipation and urination

In people who already urinate often, drinking more worsens daytime frequency. Drink the right amount and treat constipation with fiber and suitable medicines.

The more squeezes, the better

Correct technique matters more than numbers. Many women bear down without realizing it, so have a physiotherapist check first.

The bowel gets lazy because estrogen falls

The evidence is unclear. Constipation at this age more often comes from diet, low activity, medicines, and uncoordinated straining, which can be treated more directly.

Prolapse always needs surgery

Many women improve with pelvic floor training, a pessary, and bowel care. Surgery is an option when symptoms still bother you after non-surgical care.

Frequently Asked Questions (FAQ)

My hysterectomy was years ago. Why am I only now constipated and urinating more often?

Because the risk of prolapse builds over time. Following 17,032 women found the risk of needing prolapse surgery rose from 1% at 3 years to 5% at 15 years after hysterectomy, and earlier menopause thins the urinary lining. Still, always rule out infection, diabetes, and medicine side effects first.

How do a cystocele and a rectocele develop after a hysterectomy?

When the connective tissue and pelvic floor muscles that support the vagina weaken with age, births, weight, or chronic straining, the front wall can sag and take the bladder with it, causing incomplete and frequent urination, while the back wall can bulge into a pocket where stool collects and needs straining.

I kept my ovaries. Will my hormones fall sooner?

Possibly. A follow-up study found a 1.92-fold higher risk of earlier ovarian failure, and another found menopause arrived 3.7 years earlier. As estrogen falls, genitourinary syndrome of menopause can develop, causing urgency, frequent urination, and repeat infections.

How much should I drink if I am both constipated and urinating often?

There is no single number for everyone. Drinking 2.5–3 liters a day can make frequent urination worse; in a trial, drinking 25% less reduced frequency and urgency. Drink enough to keep urine pale yellow, spread through the day, cut back on coffee and tea, and treat constipation with fiber and suitable laxatives.

Do pelvic floor exercises really help, and how should I do them?

Yes. The POPPY trial found training with a physiotherapist reduced prolapse symptoms more than a leaflet, and Cochrane found stress leakage resolved in 56% vs 6%. But after verbal instructions alone only 49% squeeze correctly, so have a physiotherapist check your technique and train for at least 12 weeks.

Which doctor should I see, and what will they check?

Start with a gynecologist or urogynecologist. The key checks are a pelvic exam while straining to grade prolapse, a urine test, leftover urine after voiding, and blood sugar. If constipation started after age 50 with bleeding or weight loss, you need a colonoscopy.

Can I take medicine for frequent urination on my own?

It is better not to. Antimuscarinics worsen constipation, and high cumulative use was linked with 1.65 times the odds of dementia in a large study. The 2024 guideline starts with a bladder diary and bladder training, and a doctor may choose another drug class or local estrogen instead.

Which symptoms mean I should go to hospital now?

Being unable to urinate or a tight swollen lower belly, fever with chills and back pain, clearly bloody urine, cramping pain with a swollen belly, vomiting, and no gas, large amounts of blood in the stool, or a vaginal bulge that cannot be pushed back: go to the emergency room or call emergency services.

Scientific mechanism

Three levels of pelvic support: the top of the vagina is held by ligaments and connective tissue around the organs, the vaginal walls are attached at the sides,
and the levator ani muscle forms the floor. At hysterectomy, surgeons attach the top of the vagina to the remaining ligaments, but over time past births, age, weight, and repeated abdominal pressure
weaken this system, so the risk builds over years
(Mant 1997,
Altman 2007)

Estrogen and the urinary lining: the vagina, urethra, and bladder base develop from the same embryonic tissue and carry many estrogen receptors.
As estrogen falls, the lining thins, blood vessels beneath it decrease, and vaginal lactobacilli decline, causing urgency and easier infection
(Portman 2014)

Bowel and bladder affect each other: stool held in the rectum presses on the bladder and bladder neck, so urine does not fully empty,
and both organs share sacral spinal nerves. Treating constipation can therefore reduce leftover urine
(Charach 2001)

Compiled and reviewed by Asst. Prof. Dr. Norawit Raatpiboon

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