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Flatus incontinence (flatal incontinence) is a medical condition characterized by the inability to control the passage of gas from the rectum. The condition is often experienced with anal incontinence, a condition that usually involves accidental bowel leakage and the inability to control the escape of both gas and fecal matter from the anus.
Those who experience flatus incontinence often find the condition distressing, including experiencing feelings of shame, embarrassment and reluctance to engage in social activities, sexual activity and events outside of the home. Because of these factors, flatus incontinence — while not usually dangerous to a person’s health — can severely impact patients’ quality of life.
Flatulence (passing gas, breaking wind or farting), is the release of gas from the digestive system through the rectum. This gas is primarily composed of nitrogen, oxygen, carbon dioxide, hydrogen and methane. The unpleasant odor associated with flatulence is usually due to small amounts of sulfur-containing gasses produced by bacteria in the GI tract.
Though many people consider flatulence embarrassing — especially if there’s an audible release of gas while in the company of others — it is a normal part of digestion and a healthy digestive system. Most adults pass gas between a dozen and two dozen times a day. However, if trapped gas builds up in the gastrointestinal tract without being released, it can lead to painful episodes that feel like cramping in the abdomen.
While flatulence is generally not dangerous to a person’s health, excessive or painful gas can sometimes be a symptom of certain digestive conditions, such as lactose intolerance, irritable bowel syndrome (IBS) or food intolerance.
The gas released during an episode of flatulence is produced by several factors. These may include:
Swallowed Air: While eating or drinking, people swallow small amounts of air, which can accumulate in the digestive system. Most of this air is expelled through the mouth by belching/burping. In some cases, swallowed air can travel through the digestive tract and be released as flatulence.
Digestion: As food breaks down in the stomach and intestines, gasses are produced. Some foods are more likely to create gas, especially those that are high in certain types of carbohydrates that are not easily digested in the small intestine.
Bacterial Fermentation: The large intestine houses a variety of bacteria that aid in the digestion of food (AKA the colonic microbiota). These bacteria produce gas as they break down food particles that were not fully digested in the small intestine.
The primary symptom of flatus incontinence is the involuntary release of gas from the bowels. This can occur during daily activities, causing social embarrassment and psychological distress.
In many cases, flatus incontinence is accompanied by other symptoms related to anal incontinence, including:
Loss of bowel control
Involuntary leakage of solid stool or liquid stool
Chronic constipation
Flatal incontinence — the inability to hold in bowel gas — is often experienced by those who suffer from anal incontinence, which is the inability to contain both feces and gas inside the rectum until a person is ready for a voluntary bowel movement. There are several factors which can cause or contribute to anal incontinence, including:
Damage to the anal sphincter: At the end of the rectum, there are rings of muscle called the internal sphincter and the external sphincter. These muscles close off the end of the digestive system, holding in stool until a person is ready to have a voluntary bowel movement or release of gas. If these muscles are damaged, the result can be flatus and fecal incontinence. Difficult or prolonged childbirth is a common cause of damage to the anal sphincter muscles.
Nerve damage: In some cases, the nerves that control the rectum and anal sphincter can be damaged, which may result in an inability to fully close the internal sphincter or external sphincter. That can cause accidental bowel leakage, fecal incontinence and flatal incontinence. Several factors can cause damage to these nerves, including carrying excess body weight, a spinal cord injury, constipation straining and other issues impacting the nerves that deliver impulses to the muscles of the pelvic floor.
Hemorrhoids: In severe cases, hemorrhoids can keep the anal sphincter from completely closing. This can result in flatal or fecal incontinence.
Rectal Prolapse: Rectal prolapse is a condition in which the lining of the rectum may begin to protrude through the anal sphincter. This can damage the nerves and muscles involved in healthy bowel movements, resulting in flatus and fecal incontinence.
Rectal surgery: In some cases, surgery to the rectum can damage the muscles or nerves of the anus or rectum, reducing a person’s ability to hold in gas and feces.
If you visit the doctor’s office with symptoms that might seem to suggest you have flatus incontinence, your healthcare provider will likely ask you questions about the symptoms you are experiencing followed by a physical exam, which may include a rectal exam. Your doctor will also likely ask you about any conditions you may have that might be contributing the the issue, including inflammatory bowel disease, chronic cough, constipation, prior history of rectal surgery, etc.
During the examination, the doctor will likely attempt to assess the muscle tone of the anal sphincter and look for any signs of nerve damage, swelling, hemorrhoids and other issues that might be allowing gas to escape from the bowel.
Depending on the results of this exam, your doctor may order certain tests to further diagnose or rule out conditions that may be causing or contributing to flatus incontinence or anal incontinence while providing a more detailed view of the anal muscles and anal canal.
There are a variety of tests used to diagnose flatus incontinence and fecal incontinence, as the two conditions are often related and experienced together. These tests can suggest options for medical treatment.
Tests used to diagnose flatus incontinence may include:
Anal manometry, which measures the coordination of the muscles and nerves involved in bowel movements, along with the pressure exerted by the anal sphincter and the muscles of the anal canal
Anal ultrasound, which uses sound waves to create images of the rectum, anus and anal sphincter muscles.
Nerve function tests, which can assess any nerve damage that may be making pelvic muscles weak or inhibiting the proper function of the anal sphincter muscles.
Flatus incontinence is often related to other medical conditions that can impact the lower bowel, nerves involved in control of pelvic muscles, the anal sphincter muscles and/or overall bowel function.
Medical conditions that might be related to or contribute to developing flatus incontinence include:
Spinal Cord Injury
Diabetes Mellitus
Nerve Damage to the anus or rectum
Issues with Colonic Microbiota, the bacteria that live inside the colon and assist with the function of the digestive system
Pelvic Floor Disorders or Weak Pelvic Dloor Muscles
Rectal Prolapse, a condition in which the lining of the rectum drops down and can actually protrude from the anus in some cases
Multiple Sclerosis
Chronic Constipation
The treatment options for flatus incontinence depend on the severity and underlying cause of the condition. Conservative treatment may include bowel training and pelvic floor exercises (also known as Kegel exercises), which can help strengthen the pelvic floor muscles, improve bowel control and decrease the severity of anal incontinence symptoms and improve quality of life for patients.
Other strategies for managing or treating flatus incontinence include:
Dietary changes: a change in diet is often part of treating flatus incontinence, helping patients avoid flatulence-causing foods and spicy foods that may increase the amount of gas in the GI tract.
Medications: Your healthcare provider may prescribe certain mediations to treat the conditions that contribute to flatus incontinence, including chronic cough (which can result in weakened pelvic floor muscles). Certain over the counter medications like stool softeners and fiber supplements that can help prevent constipation may also be recommended, but check with your doctor before beginning any medication.
Bowel training: Bowel training is a process by which patients establish a set schedule for their bowel movements, often in conjunction with biofeedback therapy, pelvic floor exercises and other measures to strengthen and coordinate the muscles and nerves associated with bowel movements.
Biofeedback therapy: Biofeedback therapy is about using the mind to get better control of bowel function. Techniques may include breathing exercises, full-body relaxation, exercises to improve muscle response and tone in the pelvic floor or anal sphincters, etc.
Hemorrhoid removal surgery: If hemorrhoids are contributing to the inability to fully close the anus, they can be removed, potentially restoring the ability to hold in gas and solid stool.
Surgery to install an artificial bowel sphincter: In serious cases where a patient has no control over their anal muscles due to nerve damage, a spinal cord injury, or other issues, physicians may install an artificial bowel sphincter to close off the end of the rectum and restore the ability to hold in feces until the patient is ready for bowel movements.
Bowel incontinence — which often includes flatal incontinence — is more common in women and the elderly. Other risk factors for bowel incontinence include:
Difficult or prolonged childbirth that results in nerve or muscle damage
A history of rectal surgery
Inflammatory bowel disease
Irritable bowel syndrome
Long-term constipation
Spinal cord injury
Neurological issues like multiple sclerosis, Parkinson’s disease, etc.
While it might not be possible to prevent flatal and fecal incontinence there are measures you can take to reduce the risk. These may include:
Maintaining a healthy weight
Keeping your pelvic floor healthy, as the risk of flatus incontinence increases if you have weak pelvic floor muscles. Doing pelvic floor exercises can help improve or maintain muscle tone and function.
Eating a healthy diet, including plenty of fiber and whole grains, to reduce the risk of issues like constipation
Seeking prompt medical treatment for medical issues involving the anus, rectum and muscles of the pelvic floor