THE INFLUENCE OF ESTROGEN REPLACEMENT ON FECAL INCONTINENCE IN POSTMENOPAUSAL WOMEN

Objective To assess the value of hormone replacement therapy (HRT) in postmenopausal women with faecal incontinence. Design Prospective obse rvational study using a bowel function questionnaire and anorectal phy siological testing before and after six months of standard oestrogen h ormone replacement therapy. Setting Menopause and colorectal clinics o f two university teaching hospitals.Participants Twenty postmenopausal women (mean age 61 years) with demonstrable faecal incontinence (mean duration 6.1 years) previously untreated with HRT. Main outcome measu res Improvement in symptoms and objective alteration in anorectal phys iology tests. Results All women had significant symptoms of anorectal dysfunction before treatment, whereas 5/20 (25%) were asymptomatic aft er six months of HRT, and a further 13/20 (65%) were symptomatically i mproved in terms of flatus control, urgency, and faecal staining. Ther e was no change in bowel frequency or stool consistency following HRT, but social activity was considerably improved. Anal resting pressures and voluntary squeeze increments were significantly increased followi ng oestrogen therapy, although no differences in anal canal vector sym metry index were observed Insignificant changes occurred in threshold volume of rectal sensation and volume of defaecatory urge, but there w as a significant change in maximum tolerated rectal volume after six m onths. Neither anal canal electrosensitivity nor pudendal nerve termin al motor latency was altered following HRT. Seven of the 20 women (35% ) had an identifiable anal sphincter defect on anal endosonography. St atistical analysis, however, showed no significant difference in outco me in this group compared with those with an intact anal sphincter. A larger population sample may demonstrate this. Conclusion This observa tional study has shown a possible benefit of oestrogen replacement in postmenopausal women with symptoms of impaired faecal continence. A pr ospective randomised controlled trial is now advisable to test this hy pothesis.