title: Clinical correlates of faecal incontinence in systemic sclerosis: identifying therapeutic avenues.
abstract: 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.
authors.affiliation: Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Richard
authors.affiliation: Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.affiliation: Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Gyger
authors.affiliation: Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Murray
authors.initials: M
authors.lastname: Baron
authors.affiliation: Division of Rheumatology, Nova Scotia Rehabilitation Centre, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Sutton
authors.affiliation: Division of Rheumatology, St Joseph's Healthcare, McMaster University, Hamilton.
authors.forename: Nader
authors.initials: N
authors.lastname: Khalidi
authors.affiliation: Division of Rheumatology, St Joseph Health Care, University of Western Ontario, London, Ontario.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: Department of Biostatistics, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Carrier
authors.affiliation: Division of Rheumatology, St Joseph's Healthcare, McMaster University, Hamilton.
authors.forename: Maggie
authors.initials: M
authors.lastname: Larché
authors.affiliation: Division of Rheumatology, CHU de Québec, Université Laval, Quebec City, Quebec.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Albert
authors.affiliation: Division of Rheumatology, CHU de Québec, Université Laval, Quebec City, Quebec.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Fortin
authors.affiliation: Division of Rheumatology, Southlake Regional Health Centre, Newmarket, Ontario.
authors.forename: Carter
authors.initials: C
authors.lastname: Thorne
authors.affiliation: Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Ariel
authors.initials: A
authors.lastname: Masetto
mesh_terms: D000223:Adaptation, Psychological; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D002170:Canada; D003248:Constipation / Q000188:drug therapy / Q000209:etiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D004644:Emotions; D005242:Fecal Incontinence / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007410:Intestinal Diseases / Q000188:drug therapy; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012595:Scleroderma, Systemic / Q000150:complications*; D012649:Self Concept; D014549:Urinary Incontinence / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents
keywords: faecal incontinence; gastrointestinal manifestations; systemic sclerosis