Anorectal manometry before, during and after estrogen replacement therapy

Effects of ovarian failure on submucosal collagen and blood vessels of the anal canal in postmenopausal women

BACKGROUND

Estrogen and progesterone receptors are expressed in the anal canal. Fecal control deteriorates after menopause. This phenomenon is related to decreased circulating levels of estrogen and progesterone due to ovarian failure at menopause.

AIM OF WORK

To study the effects of estrogen and progesterone on inflammatory cells, submucosal collagen fibers, and vascular plexus of the anal canal of postmenopausal women.

SUBJECTS AND METHODS

Experiments were performed on samples of anorectal tissue obtained from 40 women, 19 menstruating (group I), and 21 postmenopausal women (group II). Investigations included immunohistochemistry of estrogen and progesterone receptors and CD34.

RESULTS

In negative estrogen receptors (ER) and progesterone receptors (PR), inflammatory cells, submucosal blood vessels, collagen type I were nonsignificantly changed in postmenopausal women relative to menstruating women (P > 0.05) whereas, in positive ER and PR, inflammatory cells and collagen I were significantly increased and submucosal blood vessels were significantly decreased in postmenopausal women relative to menstruating women (P < 0.05).

CONCLUSION

Estrogen and progesterone, in menstruating women, produce beneficial effects by decreasing incidence of inflammation and increasing anal canal submucosal blood vessels number and collagen types I, thus both hormones have a positive effect on anal compliance and pressure.

Anal incontinence after vaginal delivery: a prospective study in primiparous women

OBJECTIVE

To investigate the incidence and degree of anal incontinence after vaginal delivery among primiparous women and to define associated risk factors.

DESIGN

Prospective observational study.

SETTING

Karolinska Institutet, Danderyd Hospital, Sweden, a university hospital.

PARTICIPANTS

Three hundred and forty-nine primiparous women.

METHODS

Questionnaires distributed within the first days after delivery and re-distributed five and nine months postpartum. Analysis of delivery records.

RESULTS

Eighty percent of the women answered all questionnaires. At five months postpartum, 2% of the women had symptoms of faecal incontinence and 25% had symptoms of involuntary flatus. At nine months postpartum, 1% of the women had symptoms of faecal incontinence and 26% had symptoms of involuntary flatus. The majority of the women had infrequent symptoms and a decrease in severity was noted at nine months. Symptoms of incontinence were more common in women who sustained a sphincter tear at delivery. Risk factors for incontinence at five months included maternal age, duration of the second stage of labour, instrumental vaginal delivery, and clinically diagnosed sphincter tear at delivery. Development of incontinence at nine months was associated with maternal age and clinically diagnosed sphincter tear at delivery.

CONCLUSIONS

The present study demonstrates that infrequent involuntary flatus is a common symptom after vaginal delivery in primiparous women. These symptoms of involuntary flatus frequently improved and only a few women suffered from frank faecal incontinence. Factors associated with an increased risk of anal incontinence and sphincter tears should be considered during delivery.

Mapping of androgen, estrogen and progesterone receptors in the anal continence organ

OBJECTIVE

To investigate the expression of androgen, estrogen and progesterone receptors (ARs, ERs, PRs) in the tissues of the anal continence organ using immunohistochemical techniques.

STUDY DESIGN

Thirty-nine samples of anorectal tissue were obtained from 23 patients (seven men, seven premenopausal women and nine postmenopausal women). Immunostaining for ARs, ERs and PRs was performed by the ABC technique using 3,3'-diaminobenzidine tetrahydrochloride as the chromogen.

RESULTS

Specific immunostaining for ARs, ERs and PRs was found exclusively over cell nuclei. ARs were found in the smooth muscle cells of the internal anal sphincter in all but one of the females (10/11) and all males (7/7), ERs were found in 12/12 females and 4/7 males, and PRs were found in 4/10 females and 1/7 males. The squamous epithelium exhibited a similar pattern of immunostaining. The nuclei of the striated muscle fibers expressed none of the sex steroid receptors investigated.

CONCLUSION

The intense expression of ARs, ERs and, in some cases, PRs in the tissues of the anal continence organ at all ages and in both sexes indicates that this organ is a target for sex steroid hormones.