Anal incontinence and menopause

Anal incontinence is a multifactorial condition arising from complex anatomical, neurological, and physiological interactions. Although its true prevalence is likely underestimated due to social stigma, anal incontinence affects approximately 2-21% of women, with prevalence increasing after menopause and further rising with advancing age. Menopause plays a key role through hypoestrogenism-related changes in pelvic floor musculature, connective tissue integrity, and sphincter function. Additional contributors include aging, lifestyle factors, and comorbid gastrointestinal or neurological disorders, while surgical and other iatrogenic factors may precipitate or worsen symptoms. Despite its clinical relevance, anal incontinence remains underreported, and many physicians caring for menopausal women may be unfamiliar with its evaluation and management. This review synthesizes current evidence on the pathophysiology, risk factors, diagnostic approach, assessment tools and management strategies for anal incontinence, aiming to support menopause physicians in early identification, comprehensive assessment, and optimal management of this underrecognized yet highly impactful condition.