A hysterectomy involves the removal of the uterus. A urinary tract infection (UTI) occurs when bacteria enter and multiply within the urinary system. Given the close proximity of the reproductive and urinary organs, a UTI is a frequent complication after a hysterectomy. This risk exists both in the immediate recovery phase and years after the procedure is complete.
Increased Risk During Initial Recovery
The highest risk for a UTI occurs in the first few weeks following the operation, primarily due to foreign objects and the trauma of the surgery itself. Most patients require a temporary urinary catheter during the procedure and sometimes afterward to manage urine output. The presence of this catheter provides a direct pathway for bacteria to enter the bladder, leading to a Catheter-Associated Urinary Tract Infection (CAUTI).
The risk of developing an infection increases the longer the catheter remains in place. Medical teams prioritize removing the catheter as soon as it is safe to do so. Furthermore, the extensive manipulation of tissues near the urethra and bladder during the hysterectomy can cause temporary inflammation or trauma. This surgical disturbance can make the area more vulnerable to bacterial colonization during the initial healing process.
Long-Term Anatomical and Hormonal Factors
Even after the initial recovery, a hysterectomy can introduce long-term factors that increase the risk of developing future UTIs. The removal of the uterus may alter the structural support of the surrounding pelvic organs, including the bladder and urethra. Changes in pelvic floor support can sometimes lead to incomplete bladder emptying, leaving a volume of urine known as post-void residual. This stagnant urine becomes a breeding ground for bacteria, increasing the likelihood of an infection.
If the ovaries are removed along with the uterus, the patient experiences immediate surgical menopause, resulting in a rapid decline in estrogen levels. Estrogen is necessary to maintain the health and thickness of the tissues lining the urethra and vagina. Lower estrogen levels cause these tissues to become thinner and drier, a condition called genitourinary syndrome of menopause, making them more susceptible to bacterial invasion.
The hormonal shift also affects the vaginal microbiome, reducing the population of protective Lactobacilli bacteria. This allows potentially harmful bacteria to thrive and ascend into the urinary tract more easily. In some cases, the surgical process may also cause minor injury to the nerves that control bladder function, which can impair the bladder’s ability to signal fullness or contract fully to empty itself.
Recognizing Symptoms and When to Seek Care
Identifying a UTI post-hysterectomy can be challenging because typical symptoms might be masked by post-operative pain or discomfort. The signs of a bladder infection include a frequent and urgent need to urinate, often resulting in only small amounts of urine, and a burning or painful sensation during urination.
Other common indicators are urine that appears cloudy, has a strong or foul odor, or contains traces of blood. It is important to monitor for signs that the infection may have traveled up the urinary tract to the kidneys, a more serious condition called pyelonephritis. Symptoms of a kidney infection include a fever of 100.4°F (38°C) or higher, chills, pain in the side or back below the ribs, and nausea or vomiting.
If any of these symptoms appear, especially during the recovery period, contact the surgeon or primary care physician immediately. Diagnosis typically involves providing a urine sample, which is tested to confirm the presence of bacteria and determine the appropriate antibiotic treatment. Prompt medical care is necessary to prevent the infection from worsening or spreading.
Strategies for Urinary Tract Health
Measures can be taken both during recovery and long-term to support urinary tract health and minimize the risk of infection. Maintaining adequate hydration helps to flush bacteria from the bladder and urinary tract. Consistent and complete voiding is also beneficial; patients should try to empty the bladder fully when urinating and avoid holding urine for extended periods.
Proper hygiene practices, such as always wiping from front to back after using the toilet, help prevent the transfer of bacteria to the urethra. Additionally, some individuals find it helpful to avoid known bladder irritants in their diet:
- Caffeine
- Alcohol
- Highly acidic foods
- Spicy foods
Incorporating pelvic floor exercises or considering the use of vaginal estrogen therapy, when appropriate, can also help strengthen pelvic support and improve tissue health long-term.