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PubMed This is a summary of 29 peer-reviewed journal articles Updated
Gastroenterology

Why Does Scleroderma Cause Bloating & Bowel Issues?

At a Glance

Scleroderma can cause scarring that damages muscles and nerves throughout the digestive tract, leading to delayed stomach emptying, severe bloating from bacterial overgrowth (SIBO), and bowel issues. Managing these symptoms often requires specialized dietary changes, medications, and physical therapy.

In this answer

5 sections

01

Gastroparesis (Delayed Stomach Emptying)

02

Small Intestinal Bacterial Overgrowth (SIBO)

03

Chronic Constipation and Pseudo-obstruction

04

Fecal Incontinence (Bathroom Accidents)

05

Tracking Your Symptoms

If you are experiencing severe bloating, stomach pain, diarrhea, or bathroom accidents, these symptoms may be connected to your scleroderma. While many people associate scleroderma’s digestive issues with heartburn or swallowing difficulties, the disease can actually affect the entire length of your gastrointestinal (GI) tract, from the mouth to the rectum [1][2]. Note: If you experience sudden, unusually severe symptoms like intractable vomiting, an inability to pass gas, or agonizing pain, seek immediate emergency care to rule out unrelated acute issues.

Scleroderma causes changes in blood vessels and an overproduction of collagen, leading to fibrosis (scarring) [3]. In the digestive system, this scarring can damage the muscles and nerves responsible for moving food and waste through your body [1][4]. Because GI symptoms can feel “invisible” compared to skin changes, many people suffer in silence or mistakenly believe they have a separate issue, like irritable bowel syndrome (IBS) [5][6].

Here is how scleroderma commonly impacts the stomach and lower digestive tract:

Gastroparesis (Delayed Stomach Emptying)

When the stomach muscles weaken, they cannot empty food into the intestines at a normal rate. This condition is called gastroparesis [7][8]. Instead of moving smoothly, food sits in your stomach for too long, which can cause profound nausea, vomiting, feeling full after only a few bites, and upper abdominal pain [9][10].

  • What you can do: Eating smaller, more frequent meals throughout the day rather than three large ones can often make digestion easier and reduce nausea.

Small Intestinal Bacterial Overgrowth (SIBO)

Because scleroderma slows down the movement of the intestines (dysmotility), bacteria that normally live in the large intestine have time to travel up and multiply in the small intestine. This is known as Small Intestinal Bacterial Overgrowth (SIBO), and it affects up to 60% of people with systemic sclerosis [11][12]. SIBO is a major cause of the severe, painful bloating and diarrhea many patients experience [9][10]. Over time, SIBO can interfere with your body’s ability to absorb essential vitamins, leading to unintentional weight loss and malnutrition [11][13]. SIBO is often treated with targeted, sometimes rotating courses of antibiotics, such as rifaximin [14][11].

  • What you can do: Working with a dietitian to explore temporary dietary adjustments, such as a Low FODMAP diet, can also help manage your symptoms at home.

Chronic Constipation and Pseudo-obstruction

The slowed movement in the large intestine frequently leads to chronic, stubborn constipation [15][16]. In severe cases, the bowel muscles can become so weakened that waste stops moving entirely, mimicking a physical blockage. This dangerous complication is called chronic intestinal pseudo-obstruction [17][18].

When to Seek Emergency Care
Pseudo-obstruction requires immediate medical attention. Go to the emergency room if your normal constipation suddenly changes into:

  • Intractable (unstoppable) vomiting
  • Complete inability to pass gas or stool
  • Sudden, agonizing abdominal pain and extreme swelling

Fecal Incontinence (Bathroom Accidents)

Fecal incontinence—the inability to control bowel movements—is a highly distressing but common complication of scleroderma [19][20]. The disease can cause atrophy (wasting away) of the internal anal sphincter, the muscle that automatically keeps stool inside [21]. When this muscle loses its resting pressure, it can result in passive leakage or sudden bathroom accidents [21][22]. While this is a difficult topic to discuss, telling your doctor is critical. Management focuses heavily on symptom control and pelvic floor therapy—a specialized type of physical therapy that uses exercises and biofeedback to help strengthen the muscles that control bowel movements [23]. Surgical options often do not yield good results for scleroderma patients, making symptom management the primary goal [23].

Tracking Your Symptoms

To help your medical team understand the severity of your GI issues, they may use a tool called the UCLA SCTC GIT 2.0 [24][25]. This is a specialized questionnaire designed specifically to track gastrointestinal symptoms in scleroderma patients [26]. By keeping a daily log of the frequency of your bloating, diarrhea, constipation, and emotional distress, you and your doctor can better monitor whether treatments are working [27][28].

Because scleroderma GI symptoms are complex and interconnected, it is highly recommended to seek care from a gastroenterologist who has specific experience treating systemic sclerosis. Proper management usually requires a combination of dietary adjustments, motility medications, targeted antibiotics, and nutritional monitoring [11][29].

Common questions in this guide

Why does scleroderma cause severe bloating and diarrhea?
Scleroderma can slow down the movement of your intestines, allowing bacteria from the large intestine to travel up into the small intestine. This condition, called Small Intestinal Bacterial Overgrowth (SIBO), is a major cause of painful bloating and diarrhea.
What should I do if my scleroderma constipation becomes severe?
Severe constipation can sometimes lead to chronic intestinal pseudo-obstruction, a dangerous condition where waste stops moving entirely. If you experience unstoppable vomiting, extreme swelling, or a sudden inability to pass gas or stool, seek immediate emergency medical care.
Can scleroderma cause bathroom accidents?
Yes, fecal incontinence is a common complication because the disease can cause the internal anal sphincter muscle to weaken. This leads to passive leakage or sudden accidents. Pelvic floor physical therapy is often used to help strengthen these muscles and improve control.
How is gastroparesis managed in people with scleroderma?
Gastroparesis, or delayed stomach emptying, causes food to sit in the stomach for too long, leading to profound nausea and early fullness. Eating smaller, more frequent meals throughout the day instead of three large ones can make digestion easier and reduce discomfort.
How can I track my scleroderma digestive symptoms for my doctor?
Your doctor may use a specialized questionnaire called the UCLA SCTC GIT 2.0 to track your gastrointestinal health. Keeping a daily log of your bloating, diarrhea, constipation, and overall distress can help your medical team determine if your treatments are effective.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Could my severe bloating and diarrhea be caused by Small Intestinal Bacterial Overgrowth (SIBO), and should I be evaluated for it?
  2. 2.Can we use the UCLA SCTC GIT 2.0 questionnaire to establish a baseline for my digestive symptoms and track if treatments are working?
  3. 3.I have been experiencing bathroom accidents and it is affecting my quality of life; can you refer me to a physical therapist who specializes in pelvic floor therapy?
  4. 4.Given my risk for malabsorption and weight loss from bowel involvement, what specific blood tests should we run to check my nutritional status?
  5. 5.Would you recommend I work with a specialized dietitian to help adjust my meals, such as trying a Low FODMAP diet or eating smaller, more frequent meals?

Questions For You

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Related questions

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This page provides educational information about scleroderma gastrointestinal symptoms. Always consult your gastroenterologist or rheumatologist for a proper diagnosis and personalized treatment plan for your digestive issues.

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