Dis Colon Rectum. 2023 Apr 1;66(4):591-597. doi: 10.1097/DCR.0000000000002422.Epub 2022 Mar 24.

Rose Q Trieu ^1 2, Yoav Mazor ³, Gillian Prott ¹, Michael P Jones ⁴, John E Kellow ¹, Margaret Schnitzler ^2 5, Allison Malcolm ¹

Author information

¹Neurogastroenterology Unit, Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.

²The University of Sydney, New South Wales, Australia.

³Neurogastroenterology Unit, Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.

⁴Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.

⁵Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.

Abstract

Background: Incontinence to gas can be a troublesome symptom impacting quality of life for patients even in the absence of fecal incontinence. Whether isolated flatus incontinence represents part of the spectrum of true fecal incontinence or a separate condition with a different pathophysiology remains unclear.

Objective: This study aimed to evaluate the clinical features and anorectal physiology in women presenting with severe isolated flatus incontinence compared to women with fecal incontinence and healthy asymptomatic women.

Design: This was a retrospective case-control study of prospectively collected data.

Settings: Data from participants were obtained from a single tertiary Neurogastroenterology Unit in Sydney, Australia.

Patients: Data from 34 patients with severe isolated flatus incontinence, 127 women with fecal incontinence' and 44 healthy women were analyzed.

Main outcome measures: The primary outcomes were clinical (including demographic, obstetric, and symptom variables) and physiological differences across the 3 groups.

Results: Patients with flatus incontinence were significantly younger (mean 39 versus 63 years; p = 0.0001), had a shorter history of experiencing their symptoms ( p = 0.0001), and had harder stool form than patients with fecal incontinence ( p = 0.02). Those with flatus incontinence had an adverse obstetric history and impaired anorectal physiology (motor and sensory, specifically rectal hypersensitivity) but to a lesser extent than patients with fecal incontinence.

Limitations: This study was limited by its retrospective design and modest sample size.

Conclusions: Anorectal physiology was impaired in patients with flatus incontinence compared to healthy controls, but to a lesser extent than in those with fecal incontinence, raising the possibility that flatus incontinence could be a precursor to fecal incontinence. As clinical and physiological findings are different from healthy controls (including the presence of visceral hypersensitivity), isolated flatus incontinence should be considered a distinct clinical entity (like other functional GI disorders), or possibly part of an incontinence spectrum rather than purely a normal phenomenon. See Video Abstract at http://links.lww.com/DCR/B946 .