Can you get a UTI after a hysterectomy?

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The short answer is yes, it is possible to get a UTI after a hysterectomy procedure. The long answer is that a UTI after a hysterectomy may not be directly related to the procedure and here’s why.

A hysterectomy is a surgical procedure that removes the uterus and is most common in females ages 40-50 years old. Depending on the reason for the hysterectomy, other surrounding organs may be removed as well, including the cervix, fallopian tubes, and ovaries. Due to the location of the procedure, hysterectomies can increase the risk of urinary incontinence and UTIs.

The procedure requires an incision either externally in the lower abdomen, or internally at the top of the vagina. There are also a few different types of hysterectomy procedures:

• Partial hysterectomy = removal of the uterus

• Total hysterectomy = removal of the uterus and cervix

• Total hysterectomy with bilateral salpingo-oophorectomy = removal of uterus, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy); regardless of age, if someone has not gone through menopause yet, removing the ovaries will begin menopause symptoms.

For all of these types of hysterectomy procedures, the patient will no longer have the ability to become pregnant so monthly periods will also stop.

Here are some of the many conditions that may require a hysterectomy procedure.

• Gynecologic cancer such as uterine, cervical or fallopian tube cancer. Hysterectomies may be the best treatment option to help lower the risk and potentially be life saving (1). Note: treatment options depend on type and how far advanced the cancer is.

• Abnormalities of the cervix or uterus that may lead to cancer. A hysterectomy could be performed for cancer prevention.

• Fibroids (benign uterine tumors). A hysterectomy is the only permanent solution for fibroids.

• Endometriosis happens when the tissue lining of the uterus (endometrium) grows outside of the uterus on the ovaries, fallopian tubes, or other pelvic or abdominal organs. A hysterectomy may be needed when medication or conservative surgery doesn’t improve endometriosis.

• Uterine prolapse occurs when the supporting tissues and ligaments around your uterus weaken and the uterus could descend into the vagina. Symptoms of uterine prolapse include: urinary incontinence, pelvic pressure, and difficulty with bowel movements. In order to treat these conditions a hysterectomy may be needed.

• Abnormal vaginal bleeding. When heavy, prolonged and irregular periods cannot be controlled by other methods – hysterectomies may be a preventive measure.

• Chronic pelvic pain. A hysterectomy could be a last resort for women who have chronic pelvic pain that clearly arises in the uterus.

• Adenomyosis. This is a condition where the tissue that lines the uterus grows inside the uterine walls where it does not belong. This causes the uterine wall to thicken and can result in severe pain and heavy bleeding.

For any type of hysterectomy, there is an increased risk for urinary incontinence (2). Urinary health can be impacted in different ways since there are different types of hysterectomies and different surgical procedure methods used to perform hysterectomies. Some surgical methods may require a catheter during the procedure which can increase the risk of a UTI.

Women having a vaginal hysterectomy with a sling/pelvic organ prolapse repair surgeries were more likely to have a UTI versus women who had a vaginal hysterectomy alone. Those who had a vaginal hysterectomy with a sling/pelvic organ prolapse repair were also more likely to have UTI versus women who had an abdominal or laparoscopic hysterectomy with a sling/pelvic organ repair (3).

For females that are premenopausal and receive a hysterectomy where the ovaries are also removed, will cause them to enter menopause and can increase the risk of a UTI (1). The risk of a UTI can increase during menopause due to the changes in the vaginal microbiome that occur when there is a decline in estrogen. Estrogen decline as a result of menopause leads to decreased levels of lactobacilli bacteria in the vagina and can increase the risk of UTI (4).

In some rare cases, the bladder can be damaged during surgery and cause problems such as infection, incontinence, and an increased need to urinate. It is possible that a temporary catheter would be needed to drain urine (5). Depending on the length of time of postoperative catheterization, UTI risk can increase. A study conducted by National Institutes of Health found that UTI risk increases the longer the catheter is left in place (3).

Since there are different types of hysterectomy procedures, there are different risk factors for developing a UTI.

If the procedure requires a catheter:

• A catheter-associated UTI occurs when bacteria enter the urinary tract via the catheter and cause infection. The longer duration that a catheter is inserted, the more time bacteria has to travel to the urinary tract and cause an infection. This is why it’s important that catheters only be used for appropriate indications and should be removed when they are no longer needed (3).

If someone is premenopausal prior to the procedure and if you have a hysterectomy that removes the ovaries:

• Removing the ovaries will induce surgical menopause. As mentioned above, the risk of a UTI can increase during menopause due to the changes in the vaginal microbiome that occur when there is a decline in estrogen. One study found that oral probiotics designed to restore vaginal lactobacillus and increase populations of healthy vaginal bacteria could decrease the presence of pathogenic bacteria in postmenopausal women.

For any hysterectomy procedure:

• If you are concerned about UTI risk after a hysterectomy procedure, it's imperative to seek medical treatment from your doctor. It’s important to remember that every body and situation is different. We recommend talking to your doctor or a healthcare professional to ensure that you are taking the proper precautions to help prevent an infection.

1. Abdominal hysterectomy, Mayo Clinic, https://www.mayoclinic.org/tests-procedures/abdominal-hysterectomy/about/pac-20384559 
2. Skorupska, K., Wawrysiuk, S., Bogusiewicz, M., Miotła, P., Winkler, I., Kwiatkowska, A., & Rechberger, T. (2021). Impact of Hysterectomy on Quality of Life, Urinary Incontinence, Sexual Functions and Urethral Length. Journal of clinical medicine, 10(16), 3608. https://doi.org/10.3390/jcm10163608
3. Karp, N. E., Kobernik, E. K., Kamdar, N. S., Fore, A. M., & Morgan, D. M. (2018). Length of Catheter Use After Hysterectomy as a Risk Factor for Urinary Tract Infection. Female pelvic medicine & reconstructive surgery, 24(6), 430–434. https://doi.org/10.1097/SPV.0000000000000486

4. Storme O, Tirán Saucedo J, Garcia-Mora A, Dehesa-Dávila M, Naber KG. Risk factors and predisposing conditions for urinary tract infection. Ther Adv Urol. 2019 May

5. Hysterectomy | Office on Women's Health, https://www.womenshealth.gov/a-z-topics/hysterectomy

6. Duncan, J. M., Jean-Felix, S. A., Arimoro, F., & Harvie, H. S. (2020). Urinary tract infections after minimally invasive hysterectomy. Journal of Minimally Invasive Gynecology, 27(7). https://doi.org/https://doi.org/10.1016/j.jmig.2020.08.327

7. Cleavland Clinic, Hysterectomy, https://my.clevelandclinic.org/health/treatments/4852-hysterectomy

8. NHS Choices, NHS, https://www.nhs.uk/conditions/hysterectomy/