Hormones Linked to Fecal Incontinence in Postmenopausal Women
There are few things that are as embarrassing as fecal incontinence. Going out of the house to work, go to the store, or even church seems so daunting that many decide not to. Women over 40 are already known to be at a higher risk, and now research shows that menopausal hormones therapies may increase the chance of fecal incontinence.
In adults, the rectum is about 15cm in length with the distal end called the anal canal being an inch wide. The colonic nerve supply controls contractions, mucus secretion, and the rectal sphincter.
The involuntary striated muscles and levator ani muscles surround the rectum and keep defecation voluntary. Fecal incontinence is caused when the anal sphincter becomes incompetent to voluntarily hold stool.
When the ring of smooth muscles and nerves at the end of the rectum are damaged it makes it difficult to hold stool. Below is a list of causes:
Childbirth (especially if forceps are used or patient gets an episiotomy)
Spinal cord injuries
Scarring from IBS
Fecal incontinence has such a stigma attached to it that many people suffer from depression, work attendance issues, and social isolation.
Women Over 40 Are More At Risk
According to the article, “Fecal Incontinence in Females Older Than Aged 40 Years: Who is at Risk?” by Madhulika G. Varma M.D. et. al., out of the 2,106 racially diverse group of women, almost one quarter reported fecal incontinence, making it as common as any chronic illness. The average age of women in the study was 55 plus or minus.
Some risk factors for fecal incontinence are; obesity, IBS, urinary incontinence, COPD, and a history of having a colectomy. There is new research to add another risk factor to the list - hormones.
Role of Menopausal Hormones
56,000 postmenopausal women were part of a study published in February by Kyle Staller, MD. part of the American Gastroenterological Association titled, “Menopausal Hormone Therapy is Associated With Increased Risk of Fecal Incontinence in Women After Menopause”. The research began in 2008 with women who reported no history of fecal incontinence.
Current users of hormones - 32% had fecal incontinence
Former users of hormones - 26% had fecal incontinence
Dr. Staller is quoted as saying, “It’s enough that it could significantly worsen the problem among women who already have mild leakage due to factors such as diabetes, prior multiple vaginal births with anal sphincter trauma, or neurological conditions such as multiple sclerosis or Parkinson’s”. The ratio is relatively small between current hormone users and those who are former users, but with these other factors added in, fecal incontinence can be exacerbated.
If these women are already on the cusp of suffering from fecal incontinence, then hormone therapy may just be that one factor to push them to be a candidate. However, Stellar states that if a woman is healthy other than menopausal symptoms, “hormone therapy may outweigh the risks”.
Research also reinforces the recommendation that hormones be used for the shortest duration possible. The study shows that the longer you are on hormones, the more prevalence of fecal incontinence, and the longer one is off hormones the risk decreases.
Mirium E. Tucker’s article, “Menopausal Hormone Therapy Tied to Fecal Incontinence”, talks about the mechanism of hormones and anorectal estrogen receptors. She compares it to the link between hormones and urinary incontinence.
“The idea is that the tissues are all potentially estrogen-sensitive. Certainly in the case of urinary incontinence we know the tissues around the urethra and vagina are estrogen-sensitive, which is why many complaints about vaginal dryness come up when estrogen is depleted naturally”.
Tucker’s article suggest there may be estrogen receptors in the anus and rectum, but at this time not enough is known to give a clear explanation. There is another theory that estrogen might affect the breakdown of connective tissue. Connective tissue holds everything in place, therefore if it can’t do it’s job than incontinence could be a result.
Starting the Conversation
The takeaway from this information is that women need to know that as they enter into postmenopause, that there are many changes that will happen to their body, and incontinence can be one of those things. If they know it could happen, and become comfortable with discussing it, then treatments and options can then be brought into the conversation.
As we have learned, there is a small chance that fecal incontinence can occur in relation to taking hormones during the postmenopausal period. Fecal incontinence is a difficult thing to talk about, so many women avoid the subject. Being aware of what can happen as our bodies age is important for us nurses, not just for ourselves but our patients as well. Do you suffer from fecal incontinence due to hormones or do you treat patients that do? Tell us your story and what treatments or alternatives were incorporated for treatment.
Staller, Kyle M.D. et. al.“Menopausal Hormone Therapy is Associated With Increased Risk of Fecal Incontinence in Women After Menopause”. 13 Feb, 2017. American Gastroenterological Association. 24 Feb. 2017. Web.
Tucker, Miriam. “Menopausal Hormone Therapy Tied to Fecal Incontinence”. 24 Feb. 2107. Medscape. 24 Feb. 2017. Web.
Varma, Madhulika G. M.D., “Fecal Incontinence in Females Older Than Aged 40 Years: Who is at Risk?”. June 2006. HHS Public Access Author manuscript, Peer Reviewed and accepted for publication. 24 Feb. 2017. Web.Last edit by Joe V on Oct 20, '17
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RN at Gi Lab
23+ year(s) of experience in Gastrointestinal Nursing