Estrogen receptors in the external anal sphincter

Haadem, Knut; Ling, L; Fernö, Mårten; Graffner, Hans

doi:10.1016/s0002-9378(11)80032-3

Cited by 50 publications

(18 citation statements)

References 2 publications

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“…There is evidence to suggest that the proximal urethra is influenced by oestrogen, and that oestrogen replacement is beneficial to patients with sensory urge incontinence of urine 21 . In our view, a similar benefit may apply to the rectum and anus, a benefit which is not unexpected, since oestrogen receptors are preferentially present in external anal sphincter tissue in women 22 . A prospective randomised placebo‐controlled trial is now advisable to test the hypothesis that HRT will benefit women with faecal incontinence.…”

Section: Discussionmentioning

confidence: 93%

The influence of oestrogen replacement on faecal incontinence in postmenopausal women

Donnelly

O'Connell

O’Herlihy

1997

BJOG

116

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Objective To assess the value of hormone replacement therapy (HRT) in postmenopausal women with faecal incontinence.Design Prospective observational study using a bowel function questionnaire and anorectal physiological testing before and after six months of standard oestrogen hormone replacement therapy.Setting Menopause and colorectal clinics of 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 measures Improvement in symptoms and objective alteration in anorectal physiology tests.Results All women had significant symptoms of anorectal dysfunction before treatment, whereas 5/20 (25%) were asymptomatic after six months of HRT, and a further 13/20 (65%) were symptomatically improved in terms of flatus control, urgency, and faecal staining. There was no change in bowel fiequency or stool consistency following HRT, but social activity was considerably improved. Anal resting pressures and voluntary squeeze increments were significantly increased following oestrogen therapy, although no differences in anal canal vector symmetry index were observed. Insignificant changes occurred in threshold volume of rectal sensation and volume of defaecatory urge, but there was a significant change in maximum tolerated rectal volume after six months. Neither anal canal electrosensitivity nor pudendal nerve terminal motor latency was altered following HRT. Seven of the 20 women (35%) had an identifiable anal sphincter defect on anal endosonography. Statistical analysis, however, showed no significant difference in outcome in this group compared with those with an intact anal sphincter. A larger population sample may demonstrate this. ConclusionThis observational study has shown a possible benefit of oestrogen replacement in postmenopausal women with symptoms of impaired faecal continence. A prospective randomised controlled trial is now advisable to test this hypothesis.

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Section: Discussionmentioning

confidence: 93%

The influence of oestrogen replacement on faecal incontinence in postmenopausal women

Donnelly

O'Connell

O’Herlihy

1997

BJOG

116

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“…Conventional wisdom and earlier studies in tissue models presumed that exogenous replacement of diminishing estrogen levels could be beneficial to tissues with significant estrogenization, such as the pelvic floor; 4–6 indeed, physiologic levels of sex hormones have been proposed to be involved in the development and maintenance of the epithelial, muscular, and connective tissue components of the pelvic floor tissues where sex receptors have been localized. 5, 18 However, two large, randomized controlled trials demonstrated that MHT was associated with an increased risk of urinary incontinence, 19, 20 and we found similar results in a parallel cohort of younger women.…”

Section: Discussionmentioning

confidence: 99%

“…Steroid hormone receptors have been mapped in vitro to the external anal sphincter, 4 smooth muscle of internal anal sphincter, 5, 6 and connective tissue of the anal canal 5 with some data showing increased estrogen receptors in the anorectum of women with FI compared to controls. 7 There are conflicting data linking exogenous hormones in the form of menopausal hormone therapy (MHT) with FI.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Background & Aims Low estrogen levels could contribute to development of fecal incontinence (FI) in women after menopause by altering neuromuscular continence mechanisms. However, studies have produced conflicting results on the association between menopausal hormone therapy (MHT) and risk of FI. Methods We studied the association between MHT and risk of FI among 55,828 post-menopausal women (mean age 73 years) who participated in the Nurses’ Health Study, enrolled since 2008, with no report of FI. We defined incident FI as a report of at least 1 liquid or solid FI episode per month during 4 years of follow up from self-administered, biennial questionnaires, administered in 2010 and 2012. We used Cox proportional hazards models to calculate multivariate-adjusted hazard ratios (HRs) and 95% CIs for FI risk in women receiving MHT, adjusting for potential confounding factors. Results During more than 185,000 person-years of follow up, there were 6834 cases of incident FI. Compared with women who never used MHT, the multivariate HR for FI was 1.26 (95% CI, 1.18–1.34) for past users of MHT and 1.32 (95% CI, 1.20–1.45) for current users. The risk of FI increased with longer duration of MHT use (P trend ≤.0001) and decreased with time since discontinuation. There was an increased risk of FI among women receiving MHT that contained a combination of estrogen and progestin (HR, 1.37; 95% CI 1.10–1.70) compared to estrogen monotherapy. Conclusions Current or past use of MHT was associated with a modestly increased risk of FI among post-menopausal women in the Nurses’ Health Study. These results support a potential role for exogenous estrogens in the impairment of the fecal continence mechanism.

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“…Patients were predominately Caucasians from a homogenous socioeconomic population. Mean age was [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Mean parity was 1.65 (range, 0-4) children and six patients reported that they had undergone primary sphincter repair at the time of delivery.…”

Section: Patientsmentioning

confidence: 99%

“…28 The decline in anal pressures described after menopause29 implies that HRT could help maintain anal continence by affecting estrogen receptors of the anal sphincter muscle fibers. 30,31 Considering that 13 of 17 patients in the bilateral SOE group had initiated HRT within six months after surgery, estrogen deficiency should not influence the result. In the present study, the number of patients in the bilateral SOE group was few, allowing detection of significant complaints in only one of the variables analyzed.…”

Section: Abdominal Hysterectomymentioning

confidence: 99%

Effect of Hysterectomy on Bowel Function

Altman

Zetterström²,

López³

et al. 2004

Diseases of the Colon &Amp; Rectum

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Patients undergoing abdominal hysterectomy may run an increased risk for developing mild to moderate anal incontinence postoperatively and this risk is increased by simultaneous bilateral salpingo-oopherectomy. An increased risk of anal incontience symptoms could not be identified in patients undergoing vaginal hysterectomy. Our study does not support the assumption that hysterectomy is associated with de novo or deteriorating constipation.

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Estrogen receptors in the external anal sphincter

Cited by 50 publications

References 2 publications

The influence of oestrogen replacement on faecal incontinence in postmenopausal women

The influence of oestrogen replacement on faecal incontinence in postmenopausal women

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

Effect of Hysterectomy on Bowel Function

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