Every year, more than 600,000 hysterectomies are performed in the United States, making it one of the most common surgical procedures among women, according to the CDC. Yet despite how routine the operation has become, many women walk out of their surgeon's office without ever being told about one of its most common — and most manageable — side effects: urinary incontinence. For some, the first leak comes as a complete shock. For others, symptoms that were already present before surgery seem to worsen overnight. Either way, the experience can feel deeply isolating.
To get real answers, we sat down with a board-certified urogynecologist who has spent over fifteen years helping women navigate pelvic floor disorders. She asked to keep her name general for privacy reasons, but her clinical insights are grounded in the latest research from the American Urological Association (AUA), the National Association for Continence (NAFC), and peer-reviewed studies published through the National Institutes of Health (NIH). What follows is an edited, narrative account of that conversation — along with the practical guidance she wishes every woman received before going under the knife. If you've been struggling with incontinence after hysterectomy and feeling alone in it, this one's for you.
The Moment Nobody Warned Her About
Margaret, 54, had been living with uterine fibroids for years. By the time her gynecologist recommended a hysterectomy, she felt relieved. The heavy periods, the cramping, the constant fatigue — all of it was finally going to be over. She did her research, asked questions, prepared her home for recovery. What she didn't prepare for was standing in her kitchen six weeks post-op, laughing at a joke her husband made, and feeling a sudden, unmistakable rush of warmth.
"I thought something had gone wrong," Margaret said. "I called my doctor's office in a panic. The nurse told me it was probably just stress incontinence and that it might improve on its own. But nobody had ever mentioned it could happen."
She wasn't alone. Studies published through the NIH estimate that up to 30–40% of women experience new or worsened urinary incontinence following a hysterectomy. And yet, a significant number of those women report never being counseled about the risk beforehand. While she waited for her follow-up appointment, Margaret quietly ordered a pair of Orykas light leaks underwear — not because she had given up hope, but because she needed to feel like herself again while she figured out what came next.
Why Does Incontinence After Hysterectomy Happen? A Urogynecologist Explains
"The pelvis is an incredibly intricate neighborhood," the urogynecologist began, settling into her chair. "When we remove the uterus — whether vaginally, abdominally, or laparoscopically — we're working in very close proximity to the bladder, the urethra, and the nerves and connective tissue that support all of them. Even a technically perfect surgery changes the anatomy."
She explained that there are several distinct mechanisms at play:
1. Disruption of Pelvic Floor Support Structures
The uterus doesn't just sit there doing nothing between pregnancies. It's anchored by a web of ligaments — the uterosacral ligaments, the cardinal ligaments — that also provide indirect support to the bladder and urethra. When those ligaments are cut or altered during surgery, the supportive scaffolding of the entire pelvic floor can shift. "Think of it like removing a central tent pole," the doctor explained. "Everything around it adjusts."
2. Nerve Damage During Surgery
The autonomic nerves that control bladder function run very close to the cervix and the uterosacral ligaments. "Even when we're being extremely careful, some degree of nerve stretching or minor trauma can occur," she said. "For most women, nerve function recovers within weeks to months. But for some, especially after radical hysterectomy for cervical cancer, the disruption can be more lasting."
3. Pre-Existing Pelvic Floor Weakness
Many women who undergo hysterectomy already have some degree of pelvic floor dysfunction — they just haven't noticed it yet, or they've attributed symptoms to something else. "Surgery can unmask what was already there," the doctor noted. "A woman who had very mild stress incontinence before the operation may find it becomes impossible to ignore afterward."
4. The Type of Hysterectomy Matters
Research published in journals indexed by the NIH suggests that total hysterectomy (removal of the uterus and cervix) carries a somewhat higher risk of pelvic floor changes than subtotal hysterectomy (uterus only). Radical hysterectomy, typically performed for gynecologic cancers, carries the greatest risk due to the extent of tissue removal.
Two Types of Incontinence — and Why the Distinction Matters
"When a patient comes to me after a hysterectomy saying she's leaking, my first question is always: when are you leaking?" the urogynecologist said.
Stress urinary incontinence (SUI) occurs when physical movement — coughing, sneezing, laughing, lifting, or exercise — places pressure on the bladder and overwhelms the urethra's ability to stay closed. This is the most common type following hysterectomy, and it often responds well to pelvic floor physical therapy and behavioral changes.
Urgency urinary incontinence (UUI), sometimes called overactive bladder, involves a sudden, intense urge to urinate that's difficult to defer — and sometimes results in leakage before reaching the bathroom. Post-hysterectomy nerve disruption can trigger or worsen this pattern.
"Some women have both," she added. "That's called mixed incontinence, and it's more common than people realize." For women dealing with moderate to heavier leakage in that postoperative window, she often suggests practical protection like Orykas high-waist incontinence panties, which offer gentle abdominal support alongside meaningful absorbency — a combination that matters when your core is still healing from surgery.
What Actually Helps: Evidence-Based Solutions
"The most important thing I want women to know is that incontinence after hysterectomy is not a life sentence," the doctor said, leaning forward. "Most cases improve significantly with the right intervention."
Pelvic Floor Physical Therapy
This is, consistently, the first-line recommendation from both the AUA and the American College of Obstetricians and Gynecologists (ACOG). A trained pelvic floor physical therapist will assess muscle strength, coordination, and tension — and create a personalized program. "Kegels done incorrectly can actually make things worse," the doctor cautioned. "Please see a specialist, not just a YouTube video."
Bladder Training
For urgency incontinence in particular, behavioral techniques like scheduled voiding and urge suppression strategies have strong clinical support. The NAFC has excellent free resources for women starting this process.
Lifestyle Modifications
Caffeine, alcohol, acidic foods, and carbonated beverages can all irritate the bladder. Body weight is also a factor — Mayo Clinic notes that even a modest reduction in BMI can meaningfully reduce incontinence episodes. Staying well-hydrated (counterintuitively) helps too, since concentrated urine is more irritating to the bladder lining.
Medical and Surgical Options
If conservative measures don't provide sufficient relief, options include topical vaginal estrogen (particularly relevant for postmenopausal women), medications for overactive bladder, midurethral slings for stress incontinence, and neuromodulation therapies like Botox injections or tibial nerve stimulation. "There is a solution for almost everyone," the doctor said firmly. "The key is not giving up and not suffering in silence."
Nighttime Leakage
For women experiencing leakage at night — whether from urgency episodes or positional changes that increase abdominal pressure during sleep — adding a washable bed pad alongside protective underwear can make a significant difference in sleep quality and peace of mind.
Margaret's Turning Point
Six months after her hysterectomy, Margaret had completed eight weeks of pelvic floor PT and was seeing real improvement. The random leaks during laughter had become rare. She'd learned which foods were aggravating her bladder and cut back on her afternoon coffee. She'd also, she admitted, become something of an unofficial resource for friends who'd had hysterectomies of their own.
"I started talking about it, and I couldn't believe how many women said the same thing — 'I thought it was just me,'" she said. "That's the part that makes me angry. We shouldn't have to figure this out alone."
On days when she's heading out for a walk or a light workout and wants that extra layer of confidence, she still reaches for her Orykas light leaks underwear. "It doesn't feel like a medical product," she said. "It just feels like underwear. That matters more than people think."
For women who want a little more coverage for daily wear without sacrificing style, the Orykas lace incontinence underwear has become a go-to recommendation in online communities — proof that managing incontinence doesn't have to mean compromising on how you feel in your own skin.
The Doctor's Final Word
"If there's one message I want every woman to hear before — and after — a hysterectomy, it's this: ask about your pelvic floor. Ask your surgeon. Ask your OB. Ask for a referral to a urogynecologist or a pelvic floor PT. This is a conversation that should happen in the pre-op appointment, not six weeks later when you're panicking on the phone with a nurse."
She paused. "And if you're already on the other side of surgery and dealing with this right now — please know that you are not broken, you are not alone, and you absolutely deserve help."
Frequently Asked Questions
Is incontinence after hysterectomy permanent?
Not usually. Many women experience significant improvement — and often complete resolution — with pelvic floor physical therapy, behavioral strategies, and in some cases medical or surgical treatment. Early intervention tends to produce better outcomes, so it's important not to wait and assume symptoms will resolve on their own. If you're several months post-op and still struggling, see a urogynecologist for an individualized assessment.
How soon after a hysterectomy can incontinence start?
Some women notice leakage as soon as they return to normal activities in the first few weeks after surgery, while others don't experience symptoms until months later — particularly as they resume exercise or resume daily routines with greater physical demand. A small number of women find that pre-existing, previously unnoticed incontinence becomes apparent only after the surgery disrupts the surrounding structures.
Does the type of hysterectomy affect the risk of incontinence?
Yes. Research suggests that total hysterectomy (removal of the uterus and cervix) is associated with a somewhat higher risk of pelvic floor changes than subtotal hysterectomy. Radical hysterectomy, often performed for gynecologic cancers, carries the greatest risk due to the extent of tissue and nerve involvement. Laparoscopic and robotic approaches may involve less tissue trauma than open abdominal surgery, though research on long-term incontinence rates across approaches is ongoing.
Can I do Kegel exercises right after a hysterectomy?
Pelvic floor exercises are generally encouraged after hysterectomy, but timing and technique matter. Many surgeons recommend waiting until the initial healing period (typically four to six weeks) is complete before beginning any structured pelvic floor work. More importantly, Kegels performed incorrectly — or in the presence of pelvic floor tension rather than weakness — can worsen symptoms. A pelvic floor physical therapist can assess your specific situation and guide you safely.
What's the best underwear option for managing leaks after a hysterectomy?
It depends on the volume and type of leakage. For light stress incontinence — small leaks triggered by movement, coughing, or sneezing — Orykas light leaks underwear provides discreet, comfortable coverage. For women in the early post-surgical recovery phase who may need more absorbency and gentle abdominal support, Orykas high-waist incontinence panties are designed with recovery in mind. The best approach is to match the product to your current needs, knowing those needs may change as you heal and seek treatment.
Share:
8 Travel Essentials Every Woman With Incontinence Should Pack
How to Sleep Through the Night When You Have an Overactive Bladder