Dear Doctors: I am in my early 50s, and I am experiencing a problem that can cause social embarrassment. When I stand up, I pass small amounts of gas. This can happen immediately as I stand up or as I start walking. What might be causing this? What can I do to stop the issue?
Dear Reader: Intestinal gas is a fact of life. It's a normal part of the process of digestion. Most of the time, it’s a sign of a healthy gut. And yet, whether due to the odor, comical sound or the region of the body, public flatulence can be embarrassing. That has led social mores to require that we handle intestinal gas quietly and discreetly. However, certain changes to the body -- and even everyday movements -- can make this difficult.
The intestines produce anywhere from 500 milliliters to 2 liters of gas per day. That may sound like a lot, but even at the high end, it would fill only about one-fifth of a party balloon. Peristalsis is the natural process of rhythmic contractions moving things through the intestines. Through this process, the gas is gently squeezed toward the anus. It is here that the distinction between voluntary and involuntary flatulence arises.
Passing gas on purpose involves relaxation of the anal sphincter. The anal sphincter is the pair of ring-shaped muscles that control the opening of the anus. This action is often aided by contraction of the abdominals. If the anal sphincter is weakened, intestinal gas can escape. This can occur passively or as the result of an action that engages the core and pelvic floor muscles. This includes the acts of standing up and walking.
Based on the details you have shared, it’s possible that your episodes of involuntary flatulence are tied to mechanics, such as a weakening of the anal sphincter. This weakening can occur as part of the aging process. Chronic constipation, straining during bowel movements, traumatic injury, nerve damage and the effects of rectal surgery can all cause this weakening. Excess weight, being sedentary, childbirth and certain medications can also play a role.
If muscle weakness is the cause of your involuntary flatulence, exercises to strengthen the external anal sphincter can help. The exercises involve voluntary tightening and release of the sphincter muscles. Tighten, hold for about five seconds, then release for five seconds. Do a series of five, rest, repeat. A variation of this exercise involves a partial tightening at first then a stronger contraction, a partial release and then full relaxation. This can also be done in sets of five. Improvement requires multiple daily practice sessions and can take a month or more.
It is also important to consider whether a digestive disorder, such as irritable bowel syndrome, or another physical problem may be involved. Be aware if more episodes of involuntary flatulence begin to occur. If you also experience bloating, abdominal discomfort or pain, or notice a change in bowel habits, you should check in with your doctor. They will review your symptoms and determine whether you need follow-up testing.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
