The primary aim of this study was to estimate the population-based prevalence of bowel symptoms in women across menopausal life stages. A secondary aim was to examine associations between bowel symptoms and lower urinary tract symptoms (LUTS).

This was a cross-sectional analysis of 2,494 women enrolled in the multi-center, prospective RISE FOR HEALTH cohort study.[1] Bowel function and symptoms were assessed using items created by the investigators and from common measures including, the PROMIS Gastrointestinal Symptoms Scales, the Bristol Stool Scale, International Consultation on Incontinence Questionnaire for anal incontinence (ICIQ-B) and the Fecal Incontinence and Constipation Questionnaire (FICQ). Bowel symptoms included stool consistency, time to defecate, constipation, straining, diarrhea, fecal incontinence, pain with defecation, incomplete evacuation, requiring manual disimpaction, no sensation with defecation, and fecal urgency. LUTS were measured with the Lower Urinary Tract Research Network Symptom Index (LURN SI-10, LURN SI-29) and grouped into five categories: urinary incontinence (UI) LUTS, voiding/emptying LUTS, pain LUTS, non-UI storage LUTS, and bothersome LUTS. Menopausal status was self-reported. Comparative statistics estimated differences in bowel symptoms prevalence by menopausal status. Logistic regression models adjusted for age, vaginal parity, and menopausal status were used to estimate associations between bowel and bladder symptoms.

Participants had a mean(SD) age of 52.6(18.5) and high educational attainment (70.5% had a college degree). Participants were geographically diverse, with the largest proportion residing in the US regions of the Midwest (52.1%), followed by the Northeast (24.5%), South (12.8%), and West (10.5%). Most were White (64.7%), but Black (11.6%) and Hispanic (13.2%) women were also represented. Over half had given birth and 43.6% had vaginal deliveries. More than half were postmenopausal (52.4%), while 39.6% were premenopausal and 8% were perimenopausal. 

Bowel symptoms were highly prevalent (Table 1). Over half of all participants reported constipation, diarrhea, straining, and/or incomplete evacuation. Significant differences emerged by life stage. Postmenopausal women reported higher rates of hard stool, fecal incontinence, fecal urgency, and no sensation to defecate, while premenopausal women more frequently reported prolonged toileting time, straining and pain with defecation. Perimenopausal women more frequently reported loose stool, constipation and incomplete evacuation. Women at all menopausal stages had similar rates of diarrhea and needing manual disimpaction. 

The prevalence of LUTS categories included 44.2% for UI, 61.4% for non-UI storage, 48.8% voiding/emptying symptoms, 38.5% for bothersome symptoms, and 10.8% for pain. Strong associations between bowel symptoms and LUTS were observed in 52 of 60 regression models (Figure 1). Notably, eight bowel symptoms were significantly associated with all five LUTS categories. Bowel symptoms demonstrated the strongest associations with pain-related LUTS.

The findings reveal that bowel symptoms are not merely isolated gastrointestinal issues but are deeply integrated with bladder health. The high prevalence of symptoms like straining and incomplete evacuation across all adult age women groups suggest that subclinical bowel dysfunction is widespread. The variation of symptoms by menopausal status suggests that age-related changes and hormonal fluctuations may act as shared biological drivers for dual-system dysfunction. The consistent association between most bowel symptoms and every category of LUTS reinforces the concept of a "broader pelvic floor functional disorder" rather than siloed organ conditions.

Bowel symptoms are highly prevalent and co-occur with LUTS in women across the lifespan, supporting the need for integrated pelvic health care. Clinicians should move away from siloed treatments and instead incorporate routine bowel assessments when evaluating LUTS, and vice versa. Addressing modifiable bowel dysfunction may serve as a low-risk, high-yield strategy to improve overall urinary outcomes and quality of life for women. Future longitudinal research is essential to clarify the causal pathways of these interactions and to develop integrated therapeutic targets.

Smith, A.L., et al., RISE FOR HEALTH: Rationale and protocol for a prospective cohort study of bladder health in women. Neurourol Urodyn, 2023. 42(5): p. 998-1010.