Faecal incontinence in systemic sclerosis: A narrative review

Area of Science:

• Gastroenterology
• Rheumatology
• Neurology

Background:

• Faecal incontinence (FI) significantly impairs quality of life but is frequently overlooked in systemic sclerosis (SSc).
• FI pathophysiology in SSc is complex, involving vasculopathy, fibrosis, and potential autoimmune neuropathy.
• Prevalence of FI in SSc is 5-6 times higher than in the general population, with severe cases in 15%.

Purpose of the Study:

• To highlight the underdiagnosis of faecal incontinence in systemic sclerosis patients.
• To review the complex pathophysiology and associated factors of FI in SSc.
• To recommend screening, diagnostic approaches, and management strategies for FI in SSc.

Main Methods:

• Review of existing literature on faecal incontinence in systemic sclerosis.
• Discussion of diagnostic tools including questionnaires, digital rectal examination, neurological assessment, endoscopic explorations, and anorectal manometry.
• Outline of multidisciplinary management strategies.

Main Results:

• FI is significantly more prevalent and often severe in SSc patients compared to the general population.
• Associated conditions include diarrhoea, small intestinal bacterial overgrowth, constipation, urinary incontinence, and specific autoantibodies.
• Current management aligns with general population guidelines, emphasizing lifestyle modifications and biofeedback therapy.

Conclusions:

• Regular screening for faecal incontinence is crucial in all systemic sclerosis patients.
• A multidisciplinary approach integrating diet, lifestyle changes, biofeedback, and targeted therapies is essential for effective management.
• Further research is needed for novel treatments like nerve stimulation and fecal microbiota transplantation.