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Rheumatology (Oxford). 2017 Apr 1;56(4):581-588. doi: 10.1093/rheumatology/kew441.

Clinical correlates of faecal incontinence in systemic sclerosis: identifying therapeutic avenues.

Author information

Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec.
Division of Rheumatology, Nova Scotia Rehabilitation Centre, Dalhousie University, Halifax, Nova Scotia.
Division of Rheumatology, St Joseph's Healthcare, McMaster University, Hamilton.
Division of Rheumatology, St Joseph Health Care, University of Western Ontario, London, Ontario.
Department of Biostatistics, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke.
Division of Rheumatology, CHU de Québec, Université Laval, Quebec City, Quebec.
Division of Rheumatology, Southlake Regional Health Centre, Newmarket, Ontario.
Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada.



The aim was to establish the prevalence and severity of faecal incontinence (FI) in SSc, its association with other intestinal manifestations and potential predictors of FI, and its impact on quality of life.


A multicentre, cross-sectional study of 298 SSc subjects followed in the Canadian Scleroderma Research Group cohort was performed using validated questionnaires: Jorge-Wexner score (an FI severity scale), Bristol stool scale (a visual scale of stool consistency) and FI Quality-of-Life scale. Constipation was defined by the Rome III criteria. Associations between the Jorge-Wexner score and other clinical variables were determined using multivariate regression analyses.


Eighty-one (27.2%) subjects had FI, which was mild in 37 (12.4%) and moderate to severe in 44 (14.8%). Most patients had well-formed stools, 111 (38.8%) reported constipation and 38 (13.4%) had been previously treated for small intestinal bacterial overgrowth (SIBO). Variables independently associated with FI were: loose vs well-formed stools [odds ratio (OR) = 7.01, 95% CI: 2.09, 23.51)], constipation (OR = 3.64, 95% CI: 1.61, 8.27, P = 0.002), history of SIBO (OR = 2.97, 95% CI: 1.06, 8.27) and urinary incontinence (OR = 2.45, 95% CI: 1.14, 5.27). Quality of life measured with the FI Quality-of-Life scale was inversely correlated with FI severity (correlation coefficients between -0.602 and -0.702, P < 0.001).


FI was common and often severe in SSc. Loose stools, SIBO, constipation and urinary incontinence were strongly associated with FI. Other than targeting anorectal dysfunction, concomitant treatment of clinical correlates could lead to improvement in FI and quality of life in SSc.


faecal incontinence; gastrointestinal manifestations; systemic sclerosis

[Indexed for MEDLINE]

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