Menopausal Hormone Therapy Is Associated With Increased Risk of Fecal Incontinence in Women After Menopause

Staller, Kyle; Townsend, Mary K.; Khalili, Hamed; Mehta, Raaj S.; Grodstein, Francine; Matthews, Catherine A.; Kuo, Braden; Chan, Andrew T.

doi:10.1053/j.gastro.2017.02.005

Cited by 28 publications

(20 citation statements)

References 32 publications

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“…Staller et al studied the association between HRT and risk of FI among 55.828 postmenopausal women (participating in the WHI, Nurses' Health Study as well as HERS), and current or past use of HRT was associated with a modestly increased risk of FI among postmenopausal women. These results support a potential role for exogenous estrogens in the impairment of the fecal continence mechanism [4,5,33].…”

Section: Influence Of Hrt On Fisupporting

confidence: 76%

Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion

et al. 2019

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Introduction and hypothesis There is clear evidence of the presence of estradiol receptors (ERs) in the female lower urinary and genital tract. Furthermore, it is a fact that estrogen deficiency after menopause may cause atrophic changes of the urogenital tract as well as various urinary symptoms. Moreover, the effect of hormone replacement therapy (HRT) on urinary incontinence (UI) symptoms as well as pelvic organ prolapse (POP), anal incontinence (AI) and vulvovaginal symptoms (VVS) is still a matter of debate. This committee opinion paper summarizes the best evidence on influence of sex steroids as well as hormonal treatment (local and systemic) in postmenopausal women with pelvic floor disorders. Methods A working subcommittee from the International Urogynecology Association (IUGA) Research and Development Committee was formed. A thorough literature search was conducted and an opinion statement expressed. The literature regarding hormones and pelvic floor disorders was reviewed independently and summarized by the individual members of the subcommittee. Results The majority of studies reported that vaginal estrogen treatment when compared with placebo has more beneficial effects on symptoms and signs of vaginal atrophy including sensation of burning, dyspareunia and UI symptoms. Definitive evidence on local estrogen application and prolapse treatment or prevention is lacking. A statistically significant increase in risk of worsening of UI as well as development of de novo incontinence was observed with estrogen-only or combination systemic HRT. Conclusions In summary, local estrogen seems to be safe and effective in the treatment of VVS and can also improve urinary symptoms in postmenopausal patients with UI, but most of these recommendations correspond to evidence level 2C. The evidence in POP is still scarce but not in favor of benefit. Finally, the duration of local estrogen treatment (LET), optimal dosage, long-term effects and cost-effectiveness compared with current practice are still unknown.

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Section: Influence Of Hrt On Fisupporting

confidence: 76%

Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion

et al. 2019

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“…Since bowel disturbances may impact the relationship between physical activity and FI, we conducted separate analyses examining the association of physical activity with risk of liquid or solid stool FI alone. Covariates were selected a priori based on previously reported risk factors for FI 1 , 2 , 4 , 17 . BMI, MHT use, smoking, and diagnoses of diabetes mellitus, hypertension, or neurologic disease were included as time-varying covariates to account for changes in these exposures over time.…”

Section: Methodsmentioning

confidence: 99%

Physical Activity, BMI, and Risk of Fecal Incontinence in the Nurses’ Health Study

Staller

Song

Grodstein

et al. 2018

Clinical and Translational Gastroenterology

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BackgroundHigher body mass index (BMI) and low physical activity have been associated with increased prevalence of fecal incontinence (FI) in cross-sectional studies, but prospective studies examining the role of these factors are lacking. We sought to determine whether BMI and/or physical activity are associated with risk of FI among older women.MethodsWe prospectively examined the association between BMI and physical activity and risk of FI in the Nurses’ Health Study among 51,708 women who were free of FI in 2008. We defined FI as at ≥1 liquid or solid FI episode/month during the past year reported in 2010 or 2012. We used Cox proportional hazards models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for FI according to physical activity and BMI, adjusting for potential confounding factors.ResultsDuring more than 175,000 person-years of follow-up, we documented 5954 cases of incident FI. Compared with women in the lowest activity category (<3 metabolic equivalent of task (MET)-hrs/week), multivariable-adjusted HRs for FI were 0.86 (95% CI 0.80–0.93) for women doing 3–8 MET-hrs/week, 0.78 (95% CI 0.72–0.84) for 9–17 MET-hrs/week, 0.76 (95% CI 0.69–0.83) for 18–26 MET-hrs/week, and 0.75 (95% CI 0.70–0.81) for 27 + MET-hrs/week (Ptrend = <0.0001). There was no association between BMI and risk of FI.ConclusionsHigher levels of physical activity were associated with a modest reduction (25%) in risk of incident FI among older women. These results support a potential role of ongoing physical activity in the neuromuscular health of the anorectal continence mechanism with aging.Translational impactThese results support a potential role of ongoing physical activity in the neuromuscular health of the anorectal continence mechanism with aging.

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“…In contrast, estrogen taken as part of menopausal replacement therapy (MRT) has been shown to be associated with increased FI symptoms in women. [4] In the Nurses’ Health Study, the authors reported that women who had used MRT in the past had an increased hazard ratio for FI of 1.32 (95% CI, 1.20-1.45) compared to women who had never used MRT. [4] Women who took oral combined estrogen and progestin MRT also had an increased risk of FI (hazard ratio, 1.37; 95% CI, 1.10-1.70) compared to women who used estrogen-only MRT.…”

Section: Discussionmentioning

confidence: 99%

“…[4] In the Nurses’ Health Study, the authors reported that women who had used MRT in the past had an increased hazard ratio for FI of 1.32 (95% CI, 1.20-1.45) compared to women who had never used MRT. [4] Women who took oral combined estrogen and progestin MRT also had an increased risk of FI (hazard ratio, 1.37; 95% CI, 1.10-1.70) compared to women who used estrogen-only MRT. [4] Of note, in the current study, women who reported FI symptoms reported higher rates of “ever” using hormones compared to women without FI symptoms.…”

Section: Discussionmentioning

confidence: 99%

Association of Urinary Phytoestrogens With Pelvic Organ Prolapse and Fecal Incontinence Symptoms in Postmenopausal Women

Cardenas-Trowers¹,

Meyer

Richter

et al. 2019

Female Pelvic Med Reconstr Surg

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OBJECTIVES: To investigate the association between urinary phytoestrogen levels with symptoms of pelvic organ prolapse (POP) and fecal incontinence (FI) in post-menopausal women. METHODS: Cross-sectional study utilizing the National Health and Nutrition Examination Survey (NHANES) database from 2005-2010 including post-menopausal women defined age ≥ 40 years who either had both ovaries removed and/or no period in the past year due to hysterectomy and/or menopause. Urinary concentrations of six phytoestrogens were measured. POP symptoms were defined as a positive response to the question, “Do you see or feel a bulge in the vaginal area?” FI defined as leakage of mucus, liquid, or solid stool occurring at least monthly. Using appropriate sample weights, prevalence estimates and 95% confidence intervals (CIs) were calculated. Logistic regression was performed assessing associations between pelvic floor symptoms and log-transformed phytoestrogen levels adjusting for appropriate covariates. RESULTS: Participants included 1,341 post-menopausal women with phytoestrogen data; 1,213 with or without POP symptoms and 1,221 with or without FI symptoms. Multivariable analysis revealed no association of urinary phytoestrogen levels with POP symptoms. Higher urinary O-Desmethylangolensin (O-DMA) level was associated with decreased odds of FI symptoms in post-menopausal women, adjusted OR (aOR) 0.92, 95% CI 0.86-0.99. CONCLUSIONS: Increased urinary O-DMA level was associated with lower odds of FI. Future research may be warranted to further investigate the potential of specific phytoestrogens as mediators of FI, as well as the role of phytoestrogens on POP symptoms.

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Menopausal Hormone Therapy Is Associated With Increased Risk of Fecal Incontinence in Women After Menopause

Cited by 28 publications

References 32 publications

Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion

Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion

Physical Activity, BMI, and Risk of Fecal Incontinence in the Nurses’ Health Study

Association of Urinary Phytoestrogens With Pelvic Organ Prolapse and Fecal Incontinence Symptoms in Postmenopausal Women

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