Although rare, anorectal involvement in rheumatic diseases (RD) can significantly impair quality of life. This chapter outlines normal anorectal anatomy and discusses how systemic sclerosis (SSc) causes sphincter dysfunction, neuropathy, and fecal incontinence through multiple mechanisms. Sarcoidosis, systemic lupus erythematosus (SLE), and antiphospholipid syndrome may present with anorectal plaques, ulcers, stenosis, or hemorrhoidal disease, often driven by granulomatous or vascular pathology. Treatment often focuses on sphincter muscle training in fecal incontinence form SSc and steroid therapy for SLE-related pathology, though further research is still needed. Recognizing anorectal symptoms may aid early diagnosis and facilitate coordinated care.