One of the aggravations we may face in the first few weeks of our surgical recovery is a crampy bladder. This may feel like having an infection, it may seem like cramps after we urinate, we may have trouble telling when we need to go or we may feel as though we need to go very frequently. All of these are fairly normal things and are results of the trauma to our bladders during surgery.
They've been discussing this recently over at the Survivor's Guide to Surgical Menopause, a website and message list that focus on hormone and other longterm health needs of women who have had a hyst. Here's some of what Framboise, the moderator, had to say about bladders and what they undergo in surgery:
The bladder is basically a muscular organ held in place by a number of ligaments that tie it to other structures (but not the intestines) to keep it up in the abdominal cavity instead of pressing onto the vagina and rectum (or even hanging into their space, as happens in a prolapse). Even when the surgical approach is from beneath, as with a vaginal or laparoscopic procedure, because the two organs--bladder and uterus--are directly adjacent and share some blood vessels and nerves, to remove one does physically impact the other.
Even in those procedures, some of the supports for the top end of the vagina and bladder are shifted away from the uterine area and onto other anchor points. This process is involved and really is the important part of a hyst: it takes only moments to sever the uterus (assuming it isn't fused in place by scar tissue or its fibroids haven't caused it to engulf other organs) but the rest of the time to tidy up bleeding and supports. And this is what takes so long in the healing, by the way--all those tidying up things have to heal securely and fully for your abdominal contents to have proper ongoing support.
So in the most uncomplicated of hysts, the bladder's circulation and nerves are affected and it's had a lot of handling go on in the vicinity. In a more complicated hyst, such as for endo, the entire bladder may need to be cut free from enveloping scars or it may need to be peeled away from being squashed by massive fibroids or any number of even more exciting things (from the bladder's perspective).
As though that weren't enough to induce a months-long fit of the crabbies, surgery also means we have a catheter inserted into our bladders for, usually, about 24 hours (it's needed to keep the bladder fully emptied, except when it may be pumped full of sterile fluid to make it more visible during the surgery--needs differ according to the surgery, but a catheter is standard for several very good reasons). In addition to the risk of introducing infection, a catheter is a mechanical irritant to an organ that normally only has to deal with liquid content.
It's generally believed that the catheter is left in during the first postop day so save us from having to get out of bed to go to the bathroom. Unfortunately, that's a misconception. Instead, it's left in because it's typical that our bladders are in such a foul snit over the uproar of surgery that they flat go on strike and aren't likely to work properly until they get over it. In fact, one of the earliest postop recovery challenges is: can you pee on your own once the catheter is out? For most women, the answer is yes and they give the matter no more thought. For others, typically those who had more complicated procedures with more bladder trauma, that answer may be no for a few days. For those who had actual bladder procedures associated with their hyst (typically more intensive support repairs), it may be routine to keep a catheter even once they go home and need to use it for several weeks.
So, you can begin to see why a bladder is not a big fan of a hyst, even when things go well. And it's not an on/off function, where it suddenly decides to go back to working and that's the end of it. In fact, as healing progresses, nerves and blood vessels go through their own stairstep healing process and you can expect to see bladder crankiness come and go with these stages. This is all normal healing, but it can be immensely aggravating and even outright discomforting while its going on.
Making sure you don't let yourself get dehydrated for fear of cramps is important--you need to retrain your bladder to be tolerant of being full, especially now that there's room for it to do so without having to muscle an enlarged uterus aside. You may want to limit your caffeine during this time, since caffeine is a known bladder cramp stimulant. Many doctors will throw in a list of other foods that may be irritants, just on spec, but most women really don't see that spicy foods, for example, constitute that much of an irritant to their bladders. I rather think that these are sort of verbal filler, not that the doctors really feel that all our ills will be averted if we subsist on a diet of cream of wheat and skim milk (not to mention that five minutes later when you're discussing postop constipation they'll tell you to eat plenty of fruits, vegies and fiber *rolls eyes*).
One "old wive's tale" you may encounter is that it's normal for the bladder to "fall" or for women to become incontinent after a hyst. This is a dated outlook. Surgical procedures have gotten more sophisticated in dealing with the need for bladder support, and this is no longer a normal outcome. Often the helpful women who are sharing these stories have actually had their hysts, or heard about their friends' hysts, decades ago. While some bladder discomfort is normal, then, we're no longer looking at trading serious bladder impairment for removal of our diseased uterus.
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