The second most frequent surgical operation in the world, around 540,000 hysterectomies a year in the US and 90,000 in the UK are performed to manage problems like period pain and heavy menstrual flow.

Chronic back pain has many causes, including sprains, injury and trauma, age, weight gain, disc degeneration or rupture, spinal compression, infection, pregnancy, kidney stones, poor posture, poor core strength, arthritis, osteoporosis, endometriosis and fibromyalgia and many others.

Considering the prevalence of back pain in women, it seems odd that no formal studies have ever looked at the links between hysterectomy and chronic back pain.

Hysterectomies are known to have, over time, a direct, negative impact on pelvic floor muscle strength and stability, contributing to pelvic organ prolapse. This can cause urinary stress incontinence, bowel dysfunction and lower back pain, according to the Harvard Medical School Family Health Guide.

The Hysterectomy Association of the UK states that “the pelvic organs and tissues are linked by connective supportive tissues that attach them to the pelvic bone structure. When a hysterectomy is performed and the uterus is removed, this structure becomes vulnerable, as weakening support tissues pull away and other pelvic organs, such as the bladder and cervix of the rectum, start to collapse into the vagina”.

The trunk and pelvic floor muscles in women work together to help maintain an upright posture, by helping to keep the trunk and spine stable, and also contribute to stability of the pelvic ring made up of the two hip bones and the sacrum (tail bone), which are all connected by the sacroiliac joints (Clin. Biomech., 2004).

This means that they also control the lumbar spine and help keep a normal blood pressure within the abdominal cavity, which helps with proper breathing. “It’s not unusual for women to have back pain after hysterectomy, or stress incontinence, because the uterus is not there,” says Simon Ross, one of the founding osteopaths at Kane & Ross Clinics in London.

Hysterectomies are known to have, over time, a direct, negative impact on pelvic floor muscle strength and stability

“The uterus is normally something like four to seven centimetres, and if you are going to have a hysterectomy, it is probably a lot larger than that because there are fibroids or a problem with endometriosis. That empty space has to be filled. The structural dynamics change along the spine and the pelvic floor.”

Infection can also contribute to back pain. Up to 25 per cent of women who have a hysterectomy will go on to develop some sort of pelvic infection, and up to a third will develop an infection with fever (US Pharm., 2008).

The hysterectomy procedure is very common. If you are a woman aged 60, living in the UK, there is a one in five chance that you have had a hysterectomy. If you live in the US, the chances jump to one in three. The second most frequent surgical operation in the world, about 90 per cent of hysterectomies are for non-life-threatening, benign reasons, such as fibroids and endometriosis. This means that around 540,000 hysterectomies a year in the US and 90,000 in the UK are performed for ‘quality of life’ reasons – to manage problems like period pain, heavy menstrual flow, constipation and even chronic back pain (MMWR, 1997).

An ongoing study conducted by the Hysterectomy Educational Resources and Services (HERS) Foundation in the US reports that of the 1,000 women who responded to the HERS questionnaire, within one to 33 years after their hysterectomy, 79 per cent reported both a personality change and irritability, 77 per cent reported loss of energy and profound fatigue, 66.4 per cent a diminished or lack of sexual pleasure with intercourse, 59.9 per cent had pain in joints and bones and 52.6 per cent reported back pain.

Post-hysterectomy complaints and conversations about chronic back pain as a major symptom are common on women’s internet health sites, dedicated to hysterectomy topics. If chronic back pain really does affect almost half of the women who undergo hysterectomies, why hasn’t there been a global conversation about it? Mainly because it is not known, also because it hasn’t been proved and finally because of the length of post-operative care.

Most of the studies of chronic pain after hysterectomy cover an average follow-up of one to five years. Yet, many symptoms and complications of hysterectomy often appear outside of this time scale, sometimes even decades later.

The follow-up care, or otherwise, is not always related to the hysterectomy and the link is not made. However, what could be done? I can only relate an experience and leave it up to the woman who has the choice of whether to have a hysterectomy or not to make that decision.

Many years ago I had a hysterectomy for severe period pains. My life was a miserable existence for two days each month, which came round very quickly. I had a hysterectomy and left the hospital in less than seven days. I felt fine. I even started exercising soon after, as I felt my body could cope. I went on to run half marathons, play squash and have a very active life.

Never at any time have I suffered back pain related to my hysterectomy, nor any other symptoms mentioned. I did, however, lead a very active life with a healthy diet. Could this be a post-operative answer? Change your lifestyle and your body.

kathryn@maltanet.net