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If I had Scleroderma, I Would S**t my Pants!

February 18 2016 8:16 PM ET via RheumReports RheumReports

All puns aside, systemic sclerosis (SSc, scleroderma) is a devastating autoimmune connective tissue disease that involves many organs and vasculature. Gastrointestinal involvement is very common in SSc especially GERD and retrosternal dysphagia. But the entire bowel can be involved including but not limited to: malnutrition, stomach (gastroparesis, GAVE), small bowel (bacterial overgrowth), large bowel (obstipation, constipation, diarrhea and rarely, pneumatosis intestinalis) and rectal/anal including fecal incontinence. 

The Canadian Scleroderma Research Group database (CSRG) contains more than 1000 patients with SSc, and a substudy of this database was presented by Nicholas Richard, a trainee from Sherbrooke, QC. The substudy evaluated 270 patients and is likely the largest SSc study investigating fecal incontinence conducted to date. Most patients had long standing disease (the median duration was a decade). I think this complication may increase with longer standing disease but this study in prevalent patients could not answer that question.

Facts about Fecal Incontinence:

  • 1 in 4 patients with SSc have complaints of fecal incontinence

  • It is often perceived by the patient as severe

  • Other bowel involvement is associated with fecal incontinence, e.g., loose stools, small bowel overgrowth and constipation

  • It impairs the quality of life (QoL)

The causes of constipation and diarrhea may be pathologically similar in SSc (fibrosis of the bowel and nerves at the bowel such as myenteric plexus). So, sometimes our treatment approach overlaps.

The take home message is that we should ask our SSc patients if they have fecal incontinence as it is something that is common and often not discussed.

We also need ways of treating fecal incontinence which may include the following, although we often have NO data (so these are some of the treatments I have heard of):

  • Kegel exercises

  • Bulking of stools

  • Laxatives if constipation is part of the problem, or other bowel stimulants

  • Prokinetic drugs but they may not affect the large bowel

  • Treatment of gastric dumping and small bowel overgrowth to decrease diarrhea

  • Keeping a regular bowel routine (trying to defecate at the same time daily)

  • Nerve stimulation to improve tone

  • Sacral massage

  • Rarely surgery (implantable nerve stimulator, colostomy, etc)


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About the Author

Dr. Janet Pope
Dr. Janet Pope

Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.

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