Bladder Problems and UTIs After Hysterectomy: What’s Normal, What Helps and When to Get Help

ByThe PartialHysterectomy.net Editor

Bladder changes are common in the first days and weeks after a hysterectomy. You may have trouble peeing once the catheter comes out, need to go more often, or pick up a urinary tract infection (UTI). Most of these problems are short-lived and easy to treat.[1][2][3] Serious bladder injuries are rare.[7][8] In the longer term, the research gives a mixed picture: many people find that bladder symptoms they had before surgery get better, but hysterectomy is also linked to a modestly higher chance of leaking urine years later.[9][10][11] This guide explains what is normal during recovery, what the evidence says about each problem, what helps, and which symptoms need a doctor.

Why a hysterectomy can affect your bladder

The bladder sits just in front of the uterus, separated from it by a thin layer of tissue. To remove the uterus, the surgeon gently pushes the bladder down and away. The ureters, the tubes that carry urine from the kidneys to the bladder, run very close to the uterine blood vessels. Nerves that control bladder emptying also pass through this area. Handling these tissues, swelling after surgery, the catheter, anesthesia and strong painkillers can all affect how your bladder works for a while.

How much this matters depends on the operation. A simple hysterectomy for fibroids, heavy bleeding or endometriosis disturbs the bladder far less than a radical hysterectomy for cancer, which removes more tissue around the cervix and can affect the bladder nerves. If you are not sure which type you had, our guides to partial hysterectomy and partial vs total hysterectomy explain the differences.

Common bladder problems in the first days and weeks

The catheter and your first pee

Many people have a thin tube (catheter) in the bladder during and after surgery. The Royal College of Obstetricians and Gynaecologists (RCOG) says it is usually removed within 24 hours, but may stay for a few days if you have problems passing urine.[2] Some hospitals now remove it in the operating room. Before you go home, staff usually check that you can empty your bladder, sometimes with a quick ultrasound scan to see how much urine is left afterward.

Trouble emptying your bladder (urinary retention)

Not being able to pee, or not emptying fully, is one of the most common bladder problems straight after a hysterectomy. In a study of 233 women whose catheter was removed right after a laparoscopic or vaginal hysterectomy, 21% had difficulty emptying their bladder at first and needed a catheter again. It was more common after vaginal surgery. In every case it had settled within 48 hours.[3] A Cochrane review found that urinary retention was less likely after a subtotal (partial) hysterectomy than after a total hysterectomy.[4]

If you go home with a catheter, or are taught to empty your bladder with a small tube yourself for a few days, it is usually a temporary step while the bladder recovers. After a radical hysterectomy for cancer, bladder emptying problems are more common and can last longer, because some of the nerves to the bladder may be affected. Your cancer team will give you a specific plan.[14]

Peeing more often, urgency and a weak stream

For the first few weeks it is common to need to pee more often, to feel a sudden urge, or to have a slower stream. Swelling around the bladder, drinking more than usual, some medicines and a lot of time lying down all play a part. These symptoms usually ease as you heal. If they come with burning or pain, think of an infection (see below).

Constipation makes bladder problems worse

Strong painkillers, less movement and fear of straining often cause constipation after surgery. A full bowel presses on the bladder and can make emptying harder, and straining weakens the pelvic floor. The RCOG advises keeping your stools soft, using laxatives if needed and avoiding straining.[2] Our guide to swelly belly after hysterectomy has more tips on bloating and bowel comfort.

Urinary tract infections (UTIs) after hysterectomy

UTIs are among the most common problems after any operation that uses a catheter. In a US national study of more than 445,000 women having a total hysterectomy, about 2% developed a UTI while in hospital.[5] More infections are diagnosed after people go home, so the real number is higher. Older age and other health conditions raised the risk.[5] Difficulty emptying the bladder after surgery is also linked to a higher chance of infection.[3]

Typical UTI symptoms include:[6]

  • pain or burning when you pee
  • needing to pee more often or more urgently than usual
  • cloudy urine, or blood in the urine
  • pain low in the tummy
  • a high temperature, or feeling shivery and unwell

NHS guidance says UTIs after a hysterectomy are not usually serious and are treated with antibiotics.[1] Contact your doctor promptly rather than waiting, especially soon after surgery: some symptoms of a UTI overlap with other complications, and a urine test helps sort them out. Take the full course of any antibiotics you are given, even once you feel better.[6] Back pain just under the ribs, fever or shivering can mean the infection has reached the kidneys and needs urgent care.[6]

If you have been through menopause, including surgical menopause after your ovaries were removed, and you keep getting UTIs, ask about low-dose vaginal estrogen. The Menopause Society’s position statement supports it for urinary symptoms linked to menopause, including recurrent UTIs.[13] If you get thrush rather than a UTI, our article on yeast infection after hysterectomy covers the difference.

Woman with short grey hair drinking a glass of water in a bright kitchen
Drinking enough water to keep your urine pale is one of the simplest ways to look after your bladder while you recover.

Bladder injury and fistula: rare, but worth knowing about

Because the bladder and ureters lie so close to the uterus, they can occasionally be damaged during surgery. The NHS describes this as rare, and most injuries are noticed and repaired during the same operation.[1] In a Finnish national study of more than 62,000 hysterectomies, bladder injuries were reported in about 1.3 per 1,000 operations.[7]

Very occasionally, an injury that was not seen at the time leads to a fistula: an abnormal opening between the bladder (or urethra) and the vagina. Urine then leaks into the vagina. In a study of 343,771 women who had a hysterectomy in English NHS hospitals, a fistula developed within a year in about 1 in 788. The risk was highest after radical hysterectomy for cervical cancer (about 1 in 87) and lowest after vaginal hysterectomy for prolapse (about 1 in 3,861).[8] A fistula usually shows up in the first weeks after surgery. The main sign is a constant, watery leak from the vagina, day and night, that you cannot stop or control. This is different from leaking when you cough or rush to the toilet. If you notice it, contact your surgeon. Fistulas can be repaired, sometimes simply by draining the bladder with a catheter for a few weeks, sometimes with an operation.

Long-term: does a hysterectomy cause incontinence?

This is one of the most common worries, and the honest answer is: it can raise the risk somewhat, but for many people bladder symptoms improve rather than worsen in the first years.

Many people’s symptoms get better

Large fibroids or a heavy, enlarged uterus can press on the bladder and cause frequency, urgency and night-time peeing. Removing the uterus takes that pressure away. A 2025 review of 10 studies that measured urinary symptoms before and after a simple (non-radical) hysterectomy found that frequency, stress incontinence, urge incontinence and night-time peeing were all less common after surgery than before.[9] If fibroids are your reason for surgery, our comparison of myomectomy vs hysterectomy covers the options.

But the risk of leaking rises over the years

Studies that compare people who had a hysterectomy with people who did not tell a different part of the story. A Swedish study followed more than 165,000 women who had a hysterectomy for benign reasons and about 480,000 who did not. Those who had a hysterectomy were about 2.4 times as likely to have surgery for stress incontinence later, with the highest risk in the first five years. The risk was greater in women who had had several vaginal births.[10]

A 2025 meta-analysis of 60 studies found that, in the first 10 years after surgery, hysterectomy was linked to a higher likelihood of urinary incontinence of all types, including stress incontinence and overactive bladder. The increase was modest, roughly 30% to 60% depending on the type. Beyond 10 years, the link with stress incontinence was stronger.[11]

These are associations, not proof that the surgery itself caused the leaking. Age, childbirth, weight and menopause all affect the bladder too. But they are a good reason to look after your pelvic floor for the long term. A related long-term risk is prolapse after hysterectomy, which can also cause bladder symptoms.

Does keeping the cervix protect the bladder?

Some people choose a partial (subtotal) hysterectomy hoping it will protect bladder function. The Cochrane review of randomised trials found no difference in urinary function between total and subtotal hysterectomy, either in the first two years or about nine years later.[4] The only bladder difference was less urinary retention straight after a subtotal operation.

What helps your bladder recover

  • Drink enough, but not too much. Aim to keep your urine pale yellow through the day. Drinking too little concentrates the urine and can irritate the bladder; drinking much more than you need makes frequency worse.[6][12]
  • Cut back on caffeine and fizzy drinks if you have urgency. The NHS suggests reducing tea, coffee and cola.[12]
  • Empty your bladder fully. Sit down properly on the toilet, lean slightly forward with your feet flat (or on a small step) and take your time. Do not hover or push.
  • Do not stop the flow mid-stream as an exercise. The RCOG says this is no longer recommended because it may affect bladder function.[2]
  • Keep your bowels moving with fluids, fiber and gentle walking, and laxatives if your team suggests them.[2]
  • Move gently every day. Short walks help your bowel and bladder and lower the risk of blood clots. Our week-by-week recovery guide shows how activity usually builds up.

Pelvic floor exercises

Pelvic floor muscle training is the first treatment for stress incontinence. The RCOG says you can start gently once your catheter is out and you can pass urine on your own.[2] For incontinence, the NHS recommends a program of at least 8 squeezes, at least 3 times a day, for at least 3 months.[12] A pelvic health physiotherapist can check that you are using the right muscles, which many people find hard to do alone. Our article on how to sit after a hysterectomy includes a simple way to start.

Bladder training for urgency

If you have urgency or need to pee very often once you have healed, bladder training can help. You gradually lengthen the time between toilet visits, using the pelvic floor and distraction to hold on when the urge comes. The NHS says a course usually lasts at least 6 weeks.[12] If it does not help, medicines and other treatments are available.

Night-time trips to the toilet

Waking at night to pee breaks up sleep that is already harder during recovery. Drinking most of your fluids earlier in the day and emptying your bladder just before bed can help. For more ideas, see how to sleep after a hysterectomy.

When to get medical help

Get urgent help (call your surgeon, emergency services or go to the emergency department) if you:

  • cannot pee at all for several hours, or have a painful, swollen lower tummy and only pass small amounts
  • have a fever, shivering, or pain in your back or side just under the ribs[6]
  • have increasing tummy pain after surgery, which can be a sign of bladder or bowel damage[2]
  • feel confused, very drowsy or very unwell

Contact your doctor or surgical team soon if you:

  • have burning or stinging when you pee, or need to go much more often[2]
  • see blood in your urine
  • notice a constant watery leak from the vagina that you cannot control
  • still have trouble emptying your bladder after you go home
  • have leaking or urgency that has not improved a few months after surgery
  • feel a bulge or a heavy, dragging feeling in the vagina

Bladder problems can be embarrassing to talk about, but they are common, and most have effective treatments. Ask for a referral to a pelvic health physiotherapist, urogynecologist or urologist if things are not improving.

Sources

  1. NHS. Hysterectomy: risks. nhs.uk
  2. Royal College of Obstetricians and Gynaecologists. Abdominal hysterectomy: recovering well (patient information). rcog.org.uk
  3. Ghezzi F, Cromi A, Uccella S, et al. Immediate Foley removal after laparoscopic and vaginal hysterectomy: determinants of postoperative urinary retention. Journal of Minimally Invasive Gynecology. 2007;14(6):706–711. pubmed.ncbi.nlm.nih.gov
  4. Lethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database of Systematic Reviews. 2012;(4):CD004993. pubmed.ncbi.nlm.nih.gov
  5. Cao X, Tu Y, Zheng X, et al. A retrospective analysis of the incidence and risk factors of perioperative urinary tract infections after total hysterectomy. BMC Women’s Health. 2024;24(1):311. pubmed.ncbi.nlm.nih.gov
  6. NHS. Urinary tract infections (UTIs). nhs.uk
  7. Härkki-Sirén P, Sjöberg J, Tiitinen A. Urinary tract injuries after hysterectomy. Obstetrics & Gynecology. 1998;92(1):113–118. pubmed.ncbi.nlm.nih.gov
  8. Hilton P, Cromwell DA. The risk of vesicovaginal and urethrovaginal fistula after hysterectomy performed in the English National Health Service: a retrospective cohort study examining patterns of care between 2000 and 2008. BJOG. 2012;119(12):1447–1454. pubmed.ncbi.nlm.nih.gov
  9. Arseni RM, De Angelis E, Cuccu I, et al. The impact of non-radical hysterectomy on urinary functions: evaluation of symptoms. A systematic review and meta-analysis. BJOG. 2026;133(3):391–400. pubmed.ncbi.nlm.nih.gov
  10. Altman D, Granath F, Cnattingius S, Falconer C. Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet. 2007;370(9597):1494–1499. pubmed.ncbi.nlm.nih.gov
  11. Chang OH, Saldanha IJ, Encalada-Soto D, et al. Associations between hysterectomy and pelvic floor disorders: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2025;233(3):141–151.e6. pubmed.ncbi.nlm.nih.gov
  12. NHS. Urinary incontinence: treatment. nhs.uk
  13. The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976–992. pubmed.ncbi.nlm.nih.gov
  14. Aue-Aungkul A, Kietpeerakool C, Rattanakanokchai S, et al. Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer. Cochrane Database of Systematic Reviews. 2021;1(1):CD012863. pubmed.ncbi.nlm.nih.gov

This article is for general information and is not a substitute for medical advice. Always discuss your own situation with your gynecologist or doctor, and contact them or emergency services if you are worried about any symptom.

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