Medically reviewed by Amanda Savage 20/07/2023
Flatus incontinence (flatal incontinence) is a symptom of bowel (anorectal) dysfunction. It is defined by it being more noticeable when you pass wind, and being unable to restrain it, leaving you embarrassed. Flatulence is part of a normal, healthy digestive system and cannot be completely prevented, usually being odourless and inoffensive. The gas you release is a mix of air swallowed as you eat, drink or smoke. Alongside gas produced by the colonic microbiota (live microbes) within your digestive system as they break down your food.
If your internal sphincter has nerve damage, you may not be stimulated by the gas as it passes through. Therefore you can pass wind without realising it was coming. If you do feel the urge to pass wind, you contract your external sphincter to keep it in until an appropriate time. If this sphincter is damaged or weak, you may have no control over stopping the gas.
60% of people suffering with faecal incontinence also experience flatus incontinence. But it can often occur in isolation. Unfortunately, the number of people suffering from flatus incontinence cannot be accurately reported on, as many sufferers do not seek diagnosis or treatment for fear of embarrassment. It is thought that the largest group of sufferers are women over 65, however, men and women of any age can suffer. Although not life-threatening, flatus incontinence can lead to social isolation, depression and anxiety.
Flatus incontinence can be treated with conservative, non-medical treatments. Therefore there is no reason to not get your condition diagnosed and begin a programme of treatment now. Often a lifestyle amend as simple as reviewing your diet can see a great improvement in your flatus incontinence.
Symptoms of Flatus Incontinence
You may be suffering from flatus incontinence if you:
- are unable to prevent wind from escaping
- pass wind more than 25 times a day
- try and avoid flatulence causing foods
- are often constipated
- visit the toilet just to pass wind, to reduce the risk of passing wind in front of colleagues and friends.
Flatus incontinence can be a symptom of another, more serious, bowel dysfunction or associated condition; such as Irritable Bowel Syndrome, coeliac disease or food intolerance. Therefore it is important to get a formal diagnosis from your GP before seeking treatment.
Causes of Flatus Incontinence
You can suffer from flatus incontinence after experiencing damage to your internal and/or external sphincter muscles. This can occur as a result of:
- Childbirth - In otherwise healthy women, childbirth is the leading cause of flatus incontinence. You are at a greater risk if you have a complicated childbirth where forceps or a vacuum are used, if the weight of the baby was over 4000 g, and/or if you experienced a tear. These factors leave your pelvic muscles weak and your sphincters damaged. Multiple births further enhance this risk.
- Constipation - When matter sits in the colon for an extended period of time it will produce gas as it spends longer fermenting.
- Disease and injury - If you suffer from Parkinson’s disease, Multiple Sclerosis, Stroke, a spinal cord injury, Alzheimer’s, spina bifida or diabetes, you are at a greater risk of developing flatus incontinence due to the nerve damage that you may have. You can lose the sensation of needing to pass wind, and as a result, the awareness of it occurring.
- Surgery - During a lower abdominal or urological surgery, accidental nerve damage can occur. This can prevent your muscles from functioning correctly to retain wind until an appropriate time.
- Carrying excess body weight - Excess body weight puts unnecessary pressure on your pelvic floor, causing it to weaken.
- Age - Your risk of suffering from flatus incontinence increases over the age of 35.
- Smoking - Its no secret that smoking can lead to a huge list of health problems. There are many diseases and dysfunctions that it can cause in your digestive system, including; cancers, peptic ulcers, liver disease, increased symptoms of Chrohn's disease, colon polyps and pancreatitis. The chronic cough that often accompanies smoking will also strain and weaken your pelvic floor.
- Food intolerance - This can increase the production of wind.
To read more about these causes, and the events that can lead to you developing any form of incontinence, visit the Causes and Diagnosis page.
How To Stop Flatal Incontinence
Treatments look to strengthen your sphincter and pelvic floor muscles, enhancing your ability to hold in wind. As well as reducing the amount of wind being reduced:
Conservative therapy's - Conservative therapy's, such as lifestyle changes and non-surgical medical treatments, resolve 25% of incontinence cases, and are the first course of treatment.
- Pelvic floor (Kegel) exercises - Your pelvic floor is responsible for supporting your bowels, and the muscles of it are responsible for moving waste through the lower digestive system and out of the anus. Regularly exercising it will improve the strength of you sphincters and the coordination of their contraction to prevent wind escaping. Biofeedback therapy and electronic pelvic toners (using NMES) can make your pelvic floor exercises more effective.
- Review your diet - If you suffer from lactose intolerance, avoid dairy. Other foods that increase the production of wind include cabbage, cauliflower, onions and carbonated drinks. Peppermint tea can settle your stomach.
- Eat more slowly - Chew food more slowly and take your time as you eat. Avoid eating as you walk.
- Stop smoking and chewing gum - When you smoke and chew gum you can swallow air which then makes it through your digestive system.
- Review medications with your GP - Excessive wind can be the result of taking laxatives, statins, ibuprofen and antifungal medicines. Never stop prescribed medications without first consulting your GP.
- Supplement with enzymes - The digestive enzyme galactosidase breaks down complex carbohydrates in an earlier section of the digestive system - in the small bowel instead of the large bowel where the bacteria otherwise produce gas as they metabolise. Lactase can be taken to break down lactose.
- Treat and prevent constipation - Increase your intake of fibre and drink more water. Pelvic floor exercises can also improve the ease of your bowel movements, with 50% of constipation due to pelvic floor dysfunction. Your doctor can prescribe stool softeners or laxatives if you are unable to treat the constipation without. You may be offered a tap-water enema or rectal suppository as a quicker resolution.
- Exercise - Exercise can help keep all the functions in the body working to their best ability.
To read about the other treatments available for general bowel incontinence, visit our incontinence treatment page.
Sources
Altman, D. Falconer, C. Rossner, S. Melin, I. (2007). International Urogynecology Journal. The risk of anal incontinence in obese women. [online] 18(11), p1283-1289 [viewed 26/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17356799
Carter, D. (2014). Gastroenterology. Conservative treatment for anal incontinence. [online] 2(2), p85-91. [viewed 26/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020129/#__ffn_sectitle
Cho-Dorado, M. (2017).10 Tips to Help You Stop Farting. [online] Healthline, 2017. [viewed 27/04/18]. Available from: https://www.healthline.com/health/how-to-stop-farting
Di Stefano, M. Miceli, E. Gotti, S. Missanelli, A. Mazzocchi, S. Corazza, G. R. (2007). Digestive Diseases and Sciences. The Effect of Oral α-Galactosidase on Intestinal Gas Production and Gas-Related Symptoms. [online] 52(1), p78-83. [viewed 27/04/18]. Available from: https://link.springer.com/article/10.1007%2Fs10620-006-9296-9
Haylen, B. T. de Ridder, D. Freeman, R. M. Swift, S. E. Berghmans, B. Lee, J. Monga, A. Petri, E. Rizk, D. E. Sand P. L. Schaer, G. N. (2010) Neurourology and Urodynamics. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. [online] 29, p4-20. [viewed 26/04/18]. Available from: https://www.ics.org/documents/DocumentsDownload.aspx?DocumentID=2015
Højberg, K-E. Salvig, J. D. Winsløw, N. A. Bek, K. M. Laurberg, S. Secher, N. J. (2000). British Journal of Obstetrics and Gynaecology. Flatus and faecal incontinence: prevalence and risk factors at 16 weeks of gestation. [online] 107, p1097-1103. [viewed 26/04/18]. Available from: https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1471-0528.2000.tb11107.x
Hull, T. (2007). Clinics in Colon and Rectal Surgery. Fecal Incontinence. [online] 20(2), 118-124. [viewed 26/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780180/
Kellow, J. E. Azpiroz, F. Delvaux, M. Gebhart, G. F. Mertz, H. R. Quigley, E. M. M. Smout, A. J. P. M. (2006). Gastroenterology. Applied Principles of Neurogastroenterology: Physiology/Motility Sensation. [online] 130, p1412-1420. [viewed 27/04/18]. Available from: https://www.gastrojournal.org/article/S0016-5085(06)00511-7/pdf
Manichanh, C. Eck, A. Varela, E. Roca, J. Clemente, J. C. González, A. Knights, D. Knight, R. Estrella, S. Hernandez, C. Guyonnet, D. Accarino, A. Santos, J. Malagelada, J-R. Guarner, F. Azpiroz, F. (2014). Gut. Anal gas evacuation and colonic microbiota in patients with flatulence: effect of diet. [online] 63(3), p 401-408. [viewed 27/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933177/#!po=73.0769
NHS Trust. (2017). Flatulence [online] NHS Trust, 2017. [viewed 27/04/18]. Available from: https://www.nhs.uk/conditions/flatulence/