Bowel incontinence is a rare complication that occurs during menopause, but because of its severity and serious implications it is important to be aware of it. It can be defined as the inability to control defecation (Shah, 2021). Moreover, as expected, it can affect sufferers in a variety of ways, such as (Bedard, 2017; Bharucha, 2015; Mundet, 2015):

• Decreases the overall quality or enjoyment of life.
• It is accompanied by bothersome symptoms.
• Increases medical and hygiene product costs.

Therefore, the impact of bowel incontinence goes beyond this disorder, thus affecting the overall wellbeing of an individual. If this is your case, or if you would like to know a little more about fecal incontinence and its relationship to menopause, read below.

How is bowel incontinence classified?

There is currently no single way of classifying fecal incontinence. Thus, it is divided according to its origin (Bharucha, 2015):

• Weakness of the anal sphincter: due to trauma, neurological diseases, and other non-traumatic causes.
• Pelvic floor alterations: the appearance of fistulas, pelvic organ prolapse, among others.
• Diseases that inflame the anus: Crohn's disease, infections, etc.
• Damage to the central nervous system: e.g. secondary to stroke.
• Intestinal disorders: infectious and non-infectious diarrheal diseases (such as irritable bowel syndrome).
• It is also classified according to the severity of symptoms or by the characteristics of incontinence (Bharucha, 2015).
• Urge: characterised by an overriding sensation of voiding, which cannot be avoided or controlled.
• Passive: there is a slow passing of feces throughout the day.
• Combined: cases occur in which there is passive incontinence alternating with an urgent need to void.

What is the relationship between menopause and bowel incontinence?

The menopausal period is responsible for several changes that may predispose to the development of bowel incontinence, as summarised in (Staller, 2017):

• With the end of menstruation, a decrease in the production of hormones such as oestrogen occurs.
• Such hormones support the growth and maintenance of the muscles and organs of the pelvic floor.
• Without this hormone, a weakening of the pelvic floor, including the anal sphincter, can occur.
• This weakening is promoted if there are injuries (including surgeries) or intestinal diseases.

Signs and symptoms

Signs and symptoms of fecal incontinence include (Mayo Clinic, 2020; NIH, 2017):

• Uncontrollable urge to go to the toilet.
• Diarrhea.
• Gas and flatulence.
• Constipation.
• Passive passage of stool.
• Emotional stress.
• Irritation or lesions of the skin around the anus.

How is it diagnosed?

To make the diagnosis, a doctor will usually need to perform a physical examination, but to determine the cause of the incontinence he or she may order some tests, such as (Mayo Clinic, 2020):

• Digital rectal examination.
• Anal manometry.
• Balloon expulsion test.
• Imaging tests (such as ultrasonography, colonoscopy or proctography).

Treatments

Treatment of bowel incontinence can be complex and requires a combination of the following measures (Shah, 2021):

• Medications to improve stool consistency or treat the underlying cause.
• In postmenopausal women, hormone replacement therapy may be necessary as a treatment for incontinence.
• Diets low in sugars or foods that may cause diarrhea.
• Biofeedback training, which consists of pelvic floor strengthening exercises.
• Reconstructive surgery is an option for people with anal sphincter damage or rectal abnormalities.

Complications of fecal incontinence

If incontinence is not treated in time, it can lead to complications such as (Shah, 2021; Bharucha, 2015):

• Perianal infections, including urinary tract infection.
• Pain during urination.
• Depression, anxiety, and other emotional changes.
• Damage to the skin and blood vessels around the anus.

How can you prevent fecal incontinence in menopause?

You can follow the tips below to help manage and, to some extent, prevent bowel incontinence (Continence Foundation of Australia, 2015):

• Maintain a balanced diet that includes fibre-rich foods.
• Do pelvic floor strengthening exercises, such as Kegel exercises.
• Get at least 30 minutes of physical activity a day, especially aerobic exercise such as walking.
• Adopt good toilet habits, go to the toilet only when you feel the need, try to empty, and don't rush.

Now that you know about fecal incontinence and its impact on quality of life, as well as its symptoms, diagnosis, and treatment, you will understand its impact and importance for women in menopause, so don't hesitate to see your doctor if you need to and follow the advice given.

References

• Bedard, K., Heymen, S., Palsson, O. S., Bharucha, A. E., & Whitehead, W. E. (2017). Relationship between symptoms and quality of life in fecal incontinence. Neurogastroenterology & Motility, 30(3), e13241. https://doi.org/10.1111/nmo.13241
• Bharucha, A. E., Dunivan, G., Goode, P. S., Lukacz, E. S., Markland, A. D., Matthews, C. A., Mott, L., Rogers, R. G., Zinsmeister, A. R., Whitehead, W. E., Rao, S. S., & Hamilton, F. A. (2015). Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. The American journal of gastroenterology, 110(1), 127–136. https://doi.org/10.1038/ajg.2014.396
• Continence Foundation of Australia. (2015). Menopause and bladder and bowel control. https://www.continence.org.nz/pages/Menopause-and-bladder-and-bowel-control/128/
• Mayo Clinic. (2020). Fecal incontinence. https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397
• Mundet, L., Ribas, Y., Arco, S., & Clavé, P. (2015). Quality of Life Differences in Female and Male Patients with Fecal Incontinence. Journal of Neurogastroenterology and Motility, 22(1), 94–101. https://doi.org/10.5056/jnm15088
• National Institute of Diabetes and Digestive and Kidney Diseases . (2017). Symptoms & causes of fecal incontinence. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/symptoms-causes
• Shah, R., & Villanueva Herrero, J. A. (2021). Fecal Incontinence. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459128/
• Staller, K., Townsend, M. K., Khalili, H., Mehta, R., Grodstein, F., Whitehead, W. E., Matthews, C. A., Kuo, B., & Chan, A. T. (2017). Menopausal Hormone Therapy Is Associated With Increased Risk of Fecal Incontinence in Women After Menopause. Gastroenterology, 152(8), 1915–1921.e1. https://doi.org/10.1053/j.gastro.2017.02.005