Fecal incontinence in systemic sclerosis: prevalence, clinical correlates, and impact on quality of life.

INTRODUCTION

Fecal incontinence is a frequent underrecognized complication of systemic sclerosis. It has been associated with reduced quality of life and increased psychosocial burden, but its clinical determinants remain poorly characterized.

METHODS

We performed a post-hoc case-control analysis within a cohort of patients with SSc at a tertiary care center with prospectively collected clinical data. Fecal incontinence was defined by the fecal soilage subscale of the University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0. Patient-reported outcomes included the Short Form-36 and Hospital Anxiety and Depression Scale. We compared patients with and without fecal incontinence and used logistic regression to identify associated factors.

RESULTS

Fecal incontinence was reported by 30.1% of patients. Patients with fecal incontinence had significantly lower physical and mental component scores (Physical:35.4±23.2 vs. 52.6±26.2; Mental: 48.0±21.0 vs. 62.1±19.8; p<0.001). HrQoL impairment extended across almost all subdomains except for vitality (p<0.05 for all). Fecal incontinence was independently associated with the diffuse cutaneous subset (OR 2.61, 95% CI 1.12-6.07) ,telangiectasias (OR 2.45, 95% CI 1.31-12.0) and Late pattern-capillaroscopy (OR 2.63, 95% CI 1.12-6.14 p= 0.02). Liquid stools and obstructive defecation symptoms were more frequent in patients with fecal incontinence (p<0.05). Despite its clinical relevance, only half of patients with fecal incontinence had been evaluated by a gastroenterologist.

CONCLUSIONS

Fecal incontinence is a common and clinically relevant complication that significantly impairs HrQoL. Our findings highlight the need for systematic screening of fecal incontinence in routine care of patients with systemic sclerosis.