Anal incontinence in perimenopause

Anal Incontinence in Perimenopause: Understanding Causes and Management Strategies

Anal incontinence in perimenopause. Yikes! Perimenopause, can bring about several changes in your body. One of these changes can be anal incontinence, a condition characterized by the involuntary loss of bowel control. This condition is not just a normal part of aging; it stems from various factors that can affect the strength and function of the pelvic floor muscles.

If you’re experiencing symptoms of anal incontinence, know that you’re not alone, and options are available to help manage this condition. It’s vital to have open discussions with your healthcare provider about symptoms, as they can guide you towards effective management strategies tailored to your situation. Addressing anal incontinence promptly can help maintain your lifestyle and confidence during perimenopause.

What is Anal Incontinence?

Symptoms of Anal Incontinence

You may notice several indicators that suggest anal incontinence. These symptoms include:

  • Unintentional leakage of gas: The inability to control the passage of gas.
  • Stool leakage: Occasional or frequent leaking of stool, which may range from solid to liquid consistency.
  • Urgency: A sudden, intense urge to pass stool, potentially leading to an incontinence episode.

It is important to note if these symptoms occur sporadically or are part of a recurrent pattern, as this information is valuable during a professional diagnosis.

Pelvic Floor Disorders

According to The Menopause Society, ‘problems that affect the pelvic floor muscles, including urinary incontinence, pelvic organ prolapse, and anal incontinence, become more common during perimenopause and after menopause‘.

Role of Pelvic Floor Muscles

Your pelvic floor muscles are essential for maintaining continence. They work like a sling, supporting your bladder and bowel, and include the anal sphincter which helps to control the passage of stool. Weak or damaged pelvic floor muscles can contribute to symptoms of anal incontinence.

Influence of Estrogen on Pelvic Health

Estrogen is a hormone that helps maintain the strength and elasticity of the pelvic floor tissues. During perimenopause, fluctuating estrogen levels can lead to a weakening of these tissues and exacerbate issues with fecal incontinence.

Role of Childbirth and Age

Aging impacts muscle tone and strength, which may contribute to anal incontinence. Childbirth, particularly vaginal delivery, can lead to weakened pelvic floor muscles, which may increase the risk of anal incontinence as you age. Over time, these muscles can become less elastic and provide less support to your pelvic organs. The risk escalates as you transition through perimenopause due to hormone fluctuations that can further impact muscle strength and integrity.

Impact of Obesity and Lifestyle

Obesity is a significant risk factor for anal incontinence due to the increased pressure on the pelvic floor. Your lifestyle choices, including diet and exercise, also contribute to maintaining a healthy weight and overall pelvic health. Regular exercise can strengthen the pelvic floor muscles, reducing the likelihood of incontinence.

Chronic Health Problems and Nerve Damage

Chronic health issues, particularly type 2 diabetes, can lead to nerve damage that affects bladder and bowel control. This is because elevated blood sugar levels over time can damage nerves and impact their signaling ability. Maintaining control over your blood sugar levels and managing your diabetes effectively can help mitigate the risk of developing anal incontinence.

Professional Diagnosis Methods

When you consult a healthcare professional regarding symptoms of anal incontinence, they employ a variety of diagnostic methods. A standard approach is a medical history review and physical examination, which may include:

  • An assessment of sphincter muscle strength.
  • Evaluation of nerve function in the anal region.

For a more comprehensive diagnosis, additional tests may be recommended such as anal manometry, ultrasound, or MRI to visualize structures and assess the function of the anal sphincter. A stool diary tracking the frequency and type of incontinence episodes may also be used to determine the pattern and severity of symptoms.

Treatment Options

Lifestyle and Dietary Modifications

You may find that certain lifestyle and dietary changes can help manage symptoms of anal incontinence. Introducing more fiber into your diet can regulate bowel movements, while avoiding caffeine and spicy foods may reduce irritation and urgency. Prioritize adequate sleep and stress management, as these can also impact bowel function.

Exercise and Pelvic Floor Strengthening

Regular exercise, specifically pelvic floor exercises, can strengthen the muscles that support bladder and bowel control. Consistent practice of Kegel exercises—contracting and relaxing the pelvic floor muscles—may significantly improve anal incontinence. Additionally, you might benefit from supervised physical therapy.


In some cases, your healthcare provider may recommend medications to address underlying causes of anal incontinence. Specific supplements and medications will depend on individual health needs and should be discussed with a healthcare professional.

Surgical Treatments and Assistive Devices

Surgical treatments or assistive devices may be required for anal incontinence when conservative management, including lifestyle modifications and pelvic floor exercises, are ineffective. These approaches can offer significant improvements, though your specific situation will determine the most suitable options.

Managing Anal Incontinence

John Hopkins Medicine recommends the following steps for managing anal incontinence:

  • Work with your healthcare provider. Some treatment approaches may take time to become effective. Follow instructions for any medicines your healthcare provider gives you. Ask your medical team if you don’t understand how to use supplies. Contact your healthcare provider if you don’t see any improvement.
  • Try therapy. If fecal incontinence is damaging your relationships, work life, or your overall quality of life, talking to a psychologist may help.
  • Keep a food diary. Keep track of the foods you eat and the days or times when fecal incontinence strikes. This could help reveal a pattern in your diet that contributes to your problem.
  • Train your bowels. One way to reduce your risk of fecal incontinence is to use the toilet regularly and try to have a bowel movement.
  • Pack a change of clothing. Always be prepared. Carry fresh clothes and shoes, cleansing cloths, and a spare bag to store any dirty items.
  • Wear absorbent pads. While you’re learning to manage fecal incontinence, buy some incontinence products, such as pads, that absorb leaks and odors.
  • Take “fecal deodorant” medicine. Talk with your healthcare provider about medicine that can reduce odors associated with fecal incontinence.
  • Learn to care for delicate skin. Use cleansing and barrier products to prevent skin irritation and pain from fecal incontinence.

Approximately 1 in 1o adults has fecal incontinence. Although it is not a normal part of getting older, you are more likely to have it as you age and have experienced any of the contributing factors to pelvic floor disorders. Women are also more at risk for this condition than men. Don’t suffer in silence. Get help.