{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:09:35Z","timestamp":1790946575647,"version":"4.1.0"},"reference-count":30,"publisher":"FapUNIFESP (SciELO)","issue":"suppl 1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Gastroenterol."],"abstract":"<jats:p>ABSTRACT  BACKGROUND:  Scleroderma or progressive systemic sclerosis is characterized by a chronic inflammatory process with proliferation of fibrous connective tissue and excessive deposition of collagen and extracellular matrix in the skin, smooth muscle, and viscera. The smooth muscle most involved in scleroderma is that of the esophagus, and dysphagia is the most commonly reported symptom. However, the internal anal sphincter may also be impaired by degeneration and fibrosis, leading to concomitant anal incontinence in scleroderma patients. These patients may neglect to complain about it, except when actively questioned.  OBJECTIVE:  To assess anorectal function and anatomy of female scleroderma patients with symptoms of anal incontinence through Cleveland Clinic Florida Fecal Incontinence Score (CCFIS), anorectal manometry and endoanal ultrasound at the outpatient clinic of colorectal and anal physiology, Clinics Hospital, University of S\u00e3o Paulo Medical School (HC-FMUSP).  METHODS:  Female scleroderma patients were prospectively assessed and questioned as to symptoms of anal incontinence. The anorectal manometry and endoanal ultrasound results were correlated with clinical data and symptoms.  RESULTS:  In total, 13 women were evaluated. Their mean age was 55.77 years (\u00b116.14; 27-72 years) and their mean disease duration was 10.23 years (\u00b16.23; 2-23 years). All had symptoms of fecal incontinence ranging from 1 to 15. Seven (53.8%) patients had fecal incontinence score no higher than 7; three (23.1%) between 8 and 13; and three (23.1%) 14 or higher, corresponding to mild, moderate, and severe incontinence, respectively. Ten (76.92%) patients had hypotonia of the internal anal sphincter. Three-dimensional endoanal ultrasound showed tapering associated with muscle atrophy of the internal sphincter in six cases and previous muscle defects in three cases.  CONCLUSION:  A functional and anatomical impairment of the sphincter is an important factor to assess in patients with progressive systemic sclerosis and it should not be underestimated.<\/jats:p>","DOI":"10.1590\/s0004-2803.201800000-49","type":"journal-article","created":{"date-parts":[[2018,10,3]],"date-time":"2018-10-03T20:00:47Z","timestamp":1538596847000},"page":"47-51","source":"Crossref","is-referenced-by-count":14,"title":["FUNCTIONAL AND ANATOMICAL ANALYSIS OF THE ANORECTUM OF FEMALE SCLERODERMA PATIENTS AT A CENTER FOR PELVIC FLOOR DISORDERS"],"prefix":"10.1590","volume":"55","author":[{"given":"Rodrigo Ambar","family":"PINTO","sequence":"first","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac Jos\u00e9 Felippe","family":"CORR\u00caA NETO","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9rgio Carlos","family":"NAHAS","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Alfonso","family":"BUSTAMANTE LOPES","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Walter","family":"SOBRADO J\u00daNIOR","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"CECCONELLO","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2018,10,4]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1053\/j.gastro.2005.04.006","article-title":"Prevalence and burden of fecal incontinence: a population-based study in women","volume":"129","author":"Bharucha AE","year":"2005","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"636","DOI":"10.4321\/S1130-01082007001100003","article-title":"Sacral root neuromodulation as treatment for fecal incontinence. Preliminary results","volume":"99","author":"Navarro JM","year":"2007","journal-title":"Rev. Esp Enferm Dig"},{"key":"ref3","first-page":"167","article-title":"New treatment modality of anal incontinence: trans-sphincteric silicone injection improved quality of life in 35 incontinent patients","volume":"27","author":"Oliveira L","year":"2007","journal-title":"Rev. Bras. Coloproct"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/BF02237236","article-title":"Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence","volume":"3","author":"Rockwood TH","year":"2000","journal-title":"Dis Colon Rectum"},{"key":"ref5","series-title":"Avalia\u00e7\u00e3o da qualidade de vida na incontin\u00eancia anal: valida\u00e7\u00e3o do question\u00e1rio \u201cfecal incontinence quality of life\u201d","author":"Yusuf SAI","year":"2001"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s00384-007-0357-0","article-title":"The artificial bowel sphincter for faecal incontinence: a single centre study","volume":"23","author":"Melenhorst J","year":"2008","journal-title":"Int J Colorectal Dis"},{"key":"ref7","series-title":"Principles and Practice of Surgery for the Colon, Rectum and Anus","first-page":"293","author":"Gordon PH","year":"2007","edition":"3th ed"},{"key":"ref8","first-page":"895","article-title":"Evaluation and treatment of incontinence","volume":"102","author":"Lahr C","year":"1998","journal-title":"Pract Gastroenterol"},{"key":"ref9","first-page":"722","article-title":"Gu\u00eda pr\u00e1ctica sobre incontinencia anal","volume":"95","author":"Aspiroz F","year":"2003","journal-title":"Rev Esp Enferm Dig"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S2173-5077(10)70056-9","article-title":"Current indications, surgical technique and results of anterior sphincter repair as a treatment of faecal incontinence","volume":"87","author":"Dorcaratto D","year":"2010","journal-title":"Cirug\u00eda Espa\u00f1ola"},{"key":"ref11","first-page":"33","article-title":"Epidemiology of fecal incontinence: the silent affliction","volume":"91","author":"Johanson JF","year":"1996","journal-title":"Am J Gastroenterol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s00423-008-0332-4","article-title":"Anal incontinence-sphincter ani repair: indications, techniques, outcome","volume":"394","author":"Galandiuk S","year":"2009","journal-title":"Langenbecks Arch Surg"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s00423-008-0332-4","article-title":"Anal Incontinence-sphincter ani repair: indications, techniques, outcome","volume":"394","author":"Galandiuk S","year":"2009","journal-title":"Langenbecks Arch Surg"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1007\/BF02050818","article-title":"Anorectal function in Systemic Sclerosis-correlation with esophageal dysfunction?","volume":"40","author":"Lock G","year":"1997","journal-title":"Dis Colon Rectum"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1148\/radiology.208.2.9680588","article-title":"Fecal incontinence in Scieroderma: assessment of the anal sphincter with Thin-Section Endoanal MR imaging","volume":"208","author":"Souza NM","year":"1998","journal-title":"Radiology"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"95","DOI":"10.3109\/00365528909092245","article-title":"Oesophageal motility and lower oesophageal sphincter competence in progressive systemic sclerosis and localized scleroderma","volume":"24","author":"Zaninotto G","year":"1989","journal-title":"Scand J Gastroenterol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1023\/B:DDAS.0000034569.85066.69","article-title":"Impaired rectoanal inhibitory response in scleroderma (systemic sclerosis):an association with fecal incontinence","volume":"49","author":"Heyt GJ","year":"2004","journal-title":"Dig Dis Sci"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S0889-8553(05)70021-2","article-title":"Gastrointestinal manifestations of scleroderma","volume":"27","author":"Rose S","year":"1998","journal-title":"Gastroenterol Clin North Am"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1080\/003655299750026434","article-title":"Bowel problems in patients with systemic sclerosis","volume":"34","author":"Trezza M","year":"1999","journal-title":"Scand J Gastroenterol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/BF02050307","article-title":"Etiology and management of anal incontinence","volume":"36","author":"Jorge JMN","year":"1993","journal-title":"Dis colon rectum"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1159\/000258662","article-title":"Influence of Gender and Age on Anorectal Function: Normal Values from Anorectal Manometry in a Large Caucasian Population","volume":"81","author":"Gundling F","year":"2010","journal-title":"Digestion"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1055\/s-2008-1075860","article-title":"Anorectal physiologic evaluation of constipation","volume":"21","author":"Denoya P","year":"2008","journal-title":"Clin Colon Rectal Surg"},{"key":"ref23","first-page":"683","article-title":"Differences in the pressures of canal anal and rectal sensitivity in patients with fecal incontinence, chronic constipation and healthy subjects","volume":"102","author":"Rios CC","year":"2010","journal-title":"Rev Esp Enfer Dig"},{"key":"ref24","first-page":"230","article-title":"Limita\u00e7\u00f5es e Detalhes T\u00e9cnicos do Ultra-Som Endo-Anal no Diagn\u00f3stico de Afec\u00e7\u00f5es Benignas e Malignas no Canal Anal","volume":"24","author":"Regadas SMM","year":"2004","journal-title":"Rev bras Coloproct"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"462","DOI":"10.3109\/03009742.2011.579575","article-title":"Faecal incontinence in patients with systemic sclerosis: is an impaired internal anal sphincter the only cause?","volume":"40","author":"Fynne L","year":"2011","journal-title":"Scand J Rheumatol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1136\/ard.55.6.370","article-title":"Investigation of anal function in patients with systemic sclerosis","volume":"55","author":"Herrick AL","year":"1996","journal-title":"Annals of the Rheumatic Diseases"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1093\/rheumatology\/ker153","article-title":"Internal anal sphincter atrophy in patients with systemic sclerosis","volume":"50","author":"Thoua NM","year":"2011","journal-title":"Rheumatology"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1093\/rheumatology\/kel337","article-title":"Patient perception of UK scleroderma services-results of an anonymous questionnaire","volume":"45","author":"Mawdsley AH","year":"2006","journal-title":"Rheumatology"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/MEG.0b013e32831dac75","article-title":"Lower gastrointestinal symptoms and quality of life in patients with systemic sclerosis: a population-based study","volume":"21","author":"Franck-Larsson K","year":"2009","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref30","first-page":"581","article-title":"Clinical correlates of faecal incontinence in systemic sclerosis: identifying therapeutic avenues","volume":"56","author":"Richard N","year":"2017","journal-title":"Rheumatology"}],"container-title":["Arquivos de Gastroenterologia"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/ag\/v55s1\/1678-4219-ag-s0004280320180000049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,12,21]],"date-time":"2018-12-21T20:55:04Z","timestamp":1545425704000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0004-28032018000500047&lng=en&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,4]]},"references-count":30,"journal-issue":{"issue":"suppl 1","published-online":{"date-parts":[[2018,11]]}},"alternative-id":["S0004-28032018000500047"],"URL":"https:\/\/doi.org\/10.1590\/s0004-2803.201800000-49","relation":{},"ISSN":["1678-4219","0004-2803"],"issn-type":[{"value":"1678-4219","type":"electronic"},{"value":"0004-2803","type":"print"}],"subject":[],"published":{"date-parts":[[2018,10,4]]}}}