Bowel Dysfunction in Systemic Scleroderma

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Causes of Bowel Dysfunction
Constipation: Treatments
Diarrhea: Treatments
Bowel Incontinence
Bowel Management
Bowel Surgery
Habba Syndrome
Intestinal Pseudo-Obstruction
Intestinal Bacterial Overgrowth
Inflammatory Bowel Disease (IBD)
—Collagenous Colitis
—Crohn's Disease
—Ulcerative Colitis
Irritable Bowel Syndrome (IBS)


Abstract paintingSystemic sclerosis (scleroderma) can cause constipation, diarrhea, collagenous colitis, irritable bowel syndrome (IBS), malabsorption, diminished peristalsis, and bowel incontinence. It can also overlap with Crohn's disease and ulcerative colitis.

Typical in the initial stages of scleroderma is chronic constipation, sometimes alternating with diarrhea. Late stage scleroderma bowel involvement is often marked by diarrhea, malabsorption, and bowel incontinence. (Also see Scleroderma Gastrointestinal Involvement, What is Scleroderma?, Types of Scleroderma, and Systemic Sclerosis)

Causes of Bowel Dysfunction in Systemic Scleroderma

Intestinal microbiome in scleroderma (SSc): recent progress. Emerging evidence suggests that alterations in gut microbiota exist in the SSc disease state and more studies are needed to ascertain the mechanism by which these alterations perpetuate inflammation and fibrosis in SSc. PubMed, Curr Opin Rheumatol, 2017 Nov;29(6):553-560. (Also see Endocannabinoid System)

Lactose malabsorption in systemic sclerosis. Our findings highlight the fact that lactose breath test is a helpful, non–invasive method, by identifying the group of patients with systemic sclerosis with symptomatic lactose malabsorption that may benefit from a reduction in lactose intake. PubMed, Aliment Pharmacol Ther, 2016 Nov;44(10):1123-1133.

Endocannabinoids in the Gut This review highlights research that reveals an important role for the endocannabinoid system in the control of a variety of gastrointestinal functions. PMC, Cannabis Cannabinoid Res, 2016; 1(1): 67–77. (Also see Endocannabinoid System)

Systemic Sclerosis Patients Found To Have a Unique Colon Microbiota. The team concluded that patients with systemic sclerosis have an imbalance in their colon microbiota. They suggest that alterations in the gut may contribute to the disease symptoms, and could be potentially used in the diagnosis of systemic sclerosis as well as in the development of alternative therapeutic strategies. Scleroderma News, 06/12/2015.

Peristalsis: Scleroderma can cause diminished peristalsis. Peristalsis is the wavelike motion in the muscles of the GI tract.

Abdominal distention is a common condition, which usually results from over-eating, rather than from a serious illness. It can also be caused by lactose intolerance, air swallowing, irritable bowel syndrome, and partial bowel obstruction. Medline Plus.

Constipation: Treatments (1)

Warning for Scleroderma!

Constipation treatments include increasing fiber, water and activity; bulking agents, softening agents, and stimulants.

Scleroderma patients with constipation should consult their scleroderma expert for treatment, because reduced motility can make increased fiber or bulking agents hazardous or even fatal. (Also see: What is Scleroderma?)

Diarrhea: Treatments (Small Bowel Dysfunction)(1)

Broad Spectrum Antibiotics such as: Tetracycline, Ampicillan, Vancomycin; Metronidazole (Flagyl®), Clarithromycin (Biaxin®), Azithromycin (Zithromax®. Investigational for Scleroderma: Octreotide Acetate (Sandostatin®.

Bowel Incontinence

Clinical correlates of faecal incontinence (FI) in systemic sclerosis (SSc): identifying therapeutic avenues. Other than targeting anorectal dysfunction, concomitant treatment of clinical correlates could lead to improvement in FI and quality of life in SSc. PubMed, Rheumatology (Oxford), 12/24/2016.

Physiological and structural anorectal abnormalities in patients with systemic sclerosis (SSc) and fecal incontinence. The finding of increased fiber density in most patients further supports involvement of the external anal sphincter function in SSc and could indicate previous nerve injury with consequent incomplete reinnervation. PubMed, Scand J Gastroenterol. 2014 Sep;49(9):1076-83.

Vascular events are risk factors for anal incontinence (AI) in systemic sclerosis: a study of morphology and functional properties measured by anal endosonography and manometry. SSc patients with AI have a thin internal anal sphincter and a low resting pressure. Risk factors for AI among SSc patients are centromeric antibodies and vascular disease. PubMed, Scand J Rheumatol. 2014;43(5):391-7. (Also see Vascular Involvement in Systemic Scleroderma)

Bowel Management

Eating 1 to 2 tablespoons a day of live culture acidophilus yogurt may be helpful for combatting bowel involvement with systemic scleroderma, especially small bowel bacterial overgrowth. It may also be particularly helpful when taking antibiotics. It has the additional benefit of being nutritious and easy to swallow. Only a very few brands/types of yogurt (especially in the U.S.) have live cultures, so study product labels carefully.

Elimination Problems Use this chart when you or a family member has pain, itching or blood with a bowel movement.

Endocannabinoid system acts as a regulator of immune homeostasis in the gut. Our study unveils a role for the endocannabinoid system in maintaining immune homeostasis in the gut/pancreas and reveals a conversation between the nervous and immune systems using distinct receptors. PubMed, Proc Natl Acad Sci U S A, 2017 May 9;114(19):5005-5010. (Also see Endocannabinoid System)

Bowel Surgery: Ileostomy, Colostomy, and Ileoanal Reservoir

Ileostomy, Colostomy, and Ileoanal Reservoir Surgery. Sometimes treatment for Crohn's disease, ulcerative colitis, and familial adenomatous polyposis involves removing all or part of the intestines. NDDIC.

Sandy J: CREST Scleroderma I have had an ileostomy for two years and a feeding peg for just over one year, and would appreciate comments from any person who also has one or both of these problems…

Habba Syndrome

Habba Syndrome Symptoms, Diagnosis and Treatment. This is chronic diarrhea that predominately occurs after meals, for at least three months. Diarrhea is often urgent, explosive, and may result in incontinence. VeryWell.

Intestinal Pseudo-Obstruction

Intestinal Pseudo-Obstruction Intestinal pseudo-obstruction (false blockage) is a condition that causes symptoms like those of a bowel obstruction (blockage). Symptoms include cramps, stomach pain, nausea, vomiting, bloating, fewer bowel movements than usual, and loose stools. Diseases that affect muscles and nerves, such as lupus erythematosus, scleroderma, or Parkinson's disease, can cause symptoms. NIDDK

Mortality, Recurrence, and Hospital Course of Patients with Systemic Sclerosis (SSc)-related Acute Intestinal Pseudo-obstruction. Acute intestinal pseudo-obstruction is a rare gastrointestinal manifestation of SSc with few data existing as to its demographics, clinical course, outcomes, and mortality. PubMed, J Rheumatol, 2014 Aug 15.

A new method for evaluation of intestinal muscle contraction properties: studies in normal subjects and in patients with systemic sclerosis. Systemic sclerosis patients had increased stiffness and impaired muscle dynamics of the duodenum. Decreased muscle function and increased wall stiffness may explain the GI symptoms reported in this patient group. PubMed, Neurogastroenterol Motil. (Also see Gastrointestinal Involvement)

Intestinal Bacterial Overgrowth

Intestinal microbiome in scleroderma (SSC): recent progress. Therapeutic trials are needed to investigate whether dietary interventions or fecal transplantation can restore the gut microbial balance and improve health outcomes in SSc. PubMed, Curr Opin Rheumatol, 07/15/2017.

Systemic sclerosis (SSc) is associated with specific alterations in gastrointestinal microbiota in two independent cohorts. These findings suggest that gastrointestinal tract dysbiosis may be a pathological feature of the SSc disease state. BMJ Open Gastro, 2017; 4:e000134.

Intestinal dysbiosis is common in systemic sclerosis (SSc) and associated with gastrointestinal and extraintestinal features of disease. Intestinal dysbiosis was common in patients with SSc and was associated with gastrointestinal dysfunction, malnutrition and with some inflammatory, fibrotic and vascular extraintestinal features of SSc. PubMed, Arthritis Res Ther, 2016 Nov 29;18(1):278.

Systemic sclerosis (SSc) is associated with a unique colonic microbial consortium. This study demonstrates a distinct colonic microbial signature in SSc patients and this unique ecological change may perpetuate immunological aberrations and contribute to clinical manifestations of SSc. PubMed, Arthritis Rheumatol, 01/08/2016.

Systemic Sclerosis Patients’ Intestinal Microbiome Found To Be Enriched by Inflammatory Bacteria. Patients with systemic sclerosis harbor a unique microbiome in their gut when compared to healthy individuals, which may contribute to patients’ immune dysfunction. Scleroderma News, 06/17/2015.

Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD) should not be confused with Irritable Bowel Syndrome (IBS) which is less severe. In particular, collagenous colitis should be suspected in systemic scleroderma patients who develop watery diarrhea. ISN.

Correlation with Other Diseases
Collagenous Colitis
Crohn's Disease
Ulcerative Colitis
Support for IBD

Irritable Bowel Syndrome (IBS)

Overlap of symptoms of gastroesophageal reflux disease (GERD), dyspepsia (FD) and irritable bowel syndrome (IBS) in the general population. GERD, FD and IBS are common conditions in the general population and the overlap between these conditions is also quite common. PubMed, Scand J Gastroenterol, 2015 Feb;50(2):162-9. (Also see Reflux and Scleroderma Heart Involvement)

Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. Sympathetic dysfunction could be the common underlying pathogenesis that brings on these overlapping clinical features. PubMed, J Clin Rheumatol. (Also see Fibromyalgia, Chronic Fatigue Syndrome and Interstitial Cystitis)

Irritable Bowel Syndrome. Up to one in five American adults has irritable bowel syndrome (IBS). For most people, signs and symptoms of IBS are mild. In many cases, you can control irritable bowel syndrome by managing your diet, lifestyle and stress. MayoClinic.


Scleroderma can cause malabsorption, which is difficulty in the digestion or absorption of nutrients from food substances.

"Malabsorption caused by medical problems may be chronic and last for the remainder of a person's life. Some forms of malabsorption can be treated and corrected over time." University of Chicago


Systemic scleroderma can cause diminished peristalsis. Peristalsis is the wavelike motion in the muscles of the gastrointestinal tract.


Scleroderma Gastrointestinal Involvement. Almost every patient with scleroderma has symptoms or signs of gastrointestinal disease. Bloating, abdominal distention, diarrhea, bacterial overgrowth, weight loss, and constipation are common. Recurrent bouts of pseudo-obstruction are one of the most serious bowel problems in scleroderma. Medical Books Online.

Go to Dysmotility Syndrome in Scleroderma

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