Effect of oestrogen therapy on faecal incontinence in postmenopausal women: a systematic review

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Effect of oestrogen therapy on faecal incontinence in postmenopausal women : a systematic review. / Bach, Fiona L; Sairally, B Zeyah F; Latthe, Pallavi.

In: International Urogynecology Journal, 04.03.2020.

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@article{6a245c735cf0498d99a9f10205324a7e,
title = "Effect of oestrogen therapy on faecal incontinence in postmenopausal women: a systematic review",
abstract = "INTRODUCTION AND HYPOTHESIS: Faecal incontinence (FI) is prevalent in postmenopausal women. Oestrogen receptors have been identified in the anal sphincter and have been implicated in the pathogenesis and potential treatment. We sought to evaluate the literature regarding the impact of local and systemic oestrogen therapy on FI in postmenopausal women.METHODS: A systematic review of all studies in postmenopausal women was performed to establish how oestrogen therapy affects FI. Eight articles were deemed eligible for inclusion following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Their quality was assessed using the Cochrane risk-of-bias tool (RoB-2) and Newcastle-Ottawa quality assessment scale.RESULTS: One randomised controlled trial (RCT), two cohort studies, one observational and four cross-sectional studies were identified. The RCT showed an improvement in FI with anal oestrogen (p = 0.002), but this improvement was also observed in the placebo arm (p = 0.013) and no difference was seen between these groups. A prospective observational study demonstrated significant improvement with an oestrogen patch (p = 0.004), but had no control group. Conversely, a large prospective cohort study demonstrated an increased hazard ratio of FI with current (1.32; 95% CI, 1.20-1.45) and previous oestrogen use (1.26; 95% CI, 1.18-1.34) compared with non-users.CONCLUSION: All studies had a high risk of bias and had conflicting views on the effects of oestrogen on FI in postmenopausal women. This review has identified the need for further research in this area by highlighting the paucity of good research for evidence-based practice. We believe that a further RCT of local oestrogen is mandated to draw a valid conclusion.",
keywords = "Accidental bowel leakage, Faecal incontinence, Hormone replacement therapy, Oestrogen therapy, Postmenopausal, Systematic review",
author = "Bach, {Fiona L} and Sairally, {B Zeyah F} and Pallavi Latthe",
year = "2020",
month = mar,
day = "4",
doi = "10.1007/s00192-020-04252-1",
language = "English",
journal = "International Urogynecology Journal",
issn = "0937-3462",
publisher = "Springer",

}

RIS

TY - JOUR

T1 - Effect of oestrogen therapy on faecal incontinence in postmenopausal women

T2 - a systematic review

AU - Bach, Fiona L

AU - Sairally, B Zeyah F

AU - Latthe, Pallavi

PY - 2020/3/4

Y1 - 2020/3/4

N2 - INTRODUCTION AND HYPOTHESIS: Faecal incontinence (FI) is prevalent in postmenopausal women. Oestrogen receptors have been identified in the anal sphincter and have been implicated in the pathogenesis and potential treatment. We sought to evaluate the literature regarding the impact of local and systemic oestrogen therapy on FI in postmenopausal women.METHODS: A systematic review of all studies in postmenopausal women was performed to establish how oestrogen therapy affects FI. Eight articles were deemed eligible for inclusion following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Their quality was assessed using the Cochrane risk-of-bias tool (RoB-2) and Newcastle-Ottawa quality assessment scale.RESULTS: One randomised controlled trial (RCT), two cohort studies, one observational and four cross-sectional studies were identified. The RCT showed an improvement in FI with anal oestrogen (p = 0.002), but this improvement was also observed in the placebo arm (p = 0.013) and no difference was seen between these groups. A prospective observational study demonstrated significant improvement with an oestrogen patch (p = 0.004), but had no control group. Conversely, a large prospective cohort study demonstrated an increased hazard ratio of FI with current (1.32; 95% CI, 1.20-1.45) and previous oestrogen use (1.26; 95% CI, 1.18-1.34) compared with non-users.CONCLUSION: All studies had a high risk of bias and had conflicting views on the effects of oestrogen on FI in postmenopausal women. This review has identified the need for further research in this area by highlighting the paucity of good research for evidence-based practice. We believe that a further RCT of local oestrogen is mandated to draw a valid conclusion.

AB - INTRODUCTION AND HYPOTHESIS: Faecal incontinence (FI) is prevalent in postmenopausal women. Oestrogen receptors have been identified in the anal sphincter and have been implicated in the pathogenesis and potential treatment. We sought to evaluate the literature regarding the impact of local and systemic oestrogen therapy on FI in postmenopausal women.METHODS: A systematic review of all studies in postmenopausal women was performed to establish how oestrogen therapy affects FI. Eight articles were deemed eligible for inclusion following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Their quality was assessed using the Cochrane risk-of-bias tool (RoB-2) and Newcastle-Ottawa quality assessment scale.RESULTS: One randomised controlled trial (RCT), two cohort studies, one observational and four cross-sectional studies were identified. The RCT showed an improvement in FI with anal oestrogen (p = 0.002), but this improvement was also observed in the placebo arm (p = 0.013) and no difference was seen between these groups. A prospective observational study demonstrated significant improvement with an oestrogen patch (p = 0.004), but had no control group. Conversely, a large prospective cohort study demonstrated an increased hazard ratio of FI with current (1.32; 95% CI, 1.20-1.45) and previous oestrogen use (1.26; 95% CI, 1.18-1.34) compared with non-users.CONCLUSION: All studies had a high risk of bias and had conflicting views on the effects of oestrogen on FI in postmenopausal women. This review has identified the need for further research in this area by highlighting the paucity of good research for evidence-based practice. We believe that a further RCT of local oestrogen is mandated to draw a valid conclusion.

KW - Accidental bowel leakage

KW - Faecal incontinence

KW - Hormone replacement therapy

KW - Oestrogen therapy

KW - Postmenopausal

KW - Systematic review

U2 - 10.1007/s00192-020-04252-1

DO - 10.1007/s00192-020-04252-1

M3 - Review article

C2 - 32130466

JO - International Urogynecology Journal

JF - International Urogynecology Journal

SN - 0937-3462

ER -