Transanal irrigation

Transanal irrigation (TAI, also termed retrograde irrigation)[nb 1] of the rectum and colon is designed to assist the evacuation of feces from the bowel by introducing water into these compartments via the anus.[1]

Transanal irrigation
Specialtygastroenterology

It is a treatment for persons with bowel dysfunction, including fecal incontinence and/or constipation (especially obstructed defecation). The impact of transanal irrigation varies considerably. Some individuals experience complete control of incontinence, and other report little or no benefit.[1] Evidence show this treatment can be considered for children as well.[2][3]

When diet and medication has proven ineffective, transanal irrigation is used.[1][4]

Advantages and disadvantages

Possible advantages:

  • Avoids surgery, medications, or other procedures[5]
  • By regularly emptying the bowel using transanal irrigation, controlled bowel function is often re-established to a high degree in patients with bowel dysfunction. This enables the users to develop a consistent bowel routine by choosing the time and place of evacuation.[1]
  • In patients with constipation, regular evacuation of the lower part of colon and rectum can accelerate transit through the entire colon.[6] There has, perhaps unsurprisingly, been a rapid uptake of transanal irrigation methods in highly symptomatic patient groups with anorectal symptoms.[7]
  • In individuals with fecal incontinence, efficient emptying of the lower part of colon and rectum means that new feces may not reach the rectum for up to 2 days, which may prevent leakage between irrigations.[8]
  • May decrease the incidence of urinary tract infections in patients with neurogenic bowel and bladder problems[9]

Possible disadvantages:

  • Requires training by a healthcare professional so individual understands how to use the equipment
  • A degree of dexterity is required to perform transanal irrigation at home. If the individual cannot perform the irrigation themselves, a carer may be required
  • Periodic replacement of the equipment is needed, or microbial biofilms may start grow inside the tubing, contaminating the irrigation fluid. Current TAI devices offer single-use rectal catheters or cones.
  • Persistent leaking of residual irrigation fluid after the irrigation may occur and make this option unhelpful as liquids are more difficult to retain than solids in persons with fecal incontinence.[10]
  • Complications such as electrolyte imbalance (not demonstrated when using either tap water or saline solution) and perforation (very rare).[11]

Notes
  1. The term retrograde irrigation distinguishes this procedure from the Malone antegrade continence enema, where irrigation fluid is introduced into the colon proximal to the anus via a surgically created irrigation port

References
  1. Emmanuel, A V; Krogh, K; Bazzocchi, G; Leroi, A-M; Bremers, A; Leder, D; van Kuppevelt, D; Mosiello, G; Vogel, M; Perrouin-Verbe, B; Coggrave, M; Christensen, P (20 August 2013). "Consensus review of best practice of transanal irrigation in adults" (PDF). Spinal Cord. 51 (10): 732–738. doi:10.1038/sc.2013.86. PMID 23958927.
  2. Corbett, P V; Denny, A; Dick, K; Malone, PS; Griffin, S; Stanton, MP (April 2014). "Peristeen integrated transanal irrigation system treats feacel incontinence in children". Pediatric Urology. 10 (2): 219–22. doi:10.1016/j.jpurol.2013.08.006. PMID 24439630.
  3. Mosiello, Giovanni; Marshall, David; Rolle, Udo; Crétolle, Célia; Santacruz, Bruno G.; Frischer, Jason; Benninga, Marc A. (2017). "Consensus Review of Best Practice of Transanal Irrigation in Children". Journal of Pediatric Gastroenterology and Nutrition. 64 (3): 343–352. doi:10.1097/mpg.0000000000001483. PMID 27977546. S2CID 34911976.
  4. (UK), National Collaborating Centre for Acute Care (2007). Faecal incontinence the management of faecal incontinence in adults. London: National Collaborating Centre for Acute Care (UK). ISBN 978-0-9549760-4-0.
  5. Emmanuel, Anton; Kumar, Gayathri; Christensen, Peter; Mealing, Stuart; Størling, Zenia M.; Andersen, Frederikke; Kirshblum, Steven (2016-08-24). "Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction". PLOS ONE. 11 (8): e0159394. doi:10.1371/journal.pone.0159394. ISSN 1932-6203. PMC 4996513. PMID 27557052.
  6. Colonic emptying after transanal irrigation Bazzocchi G, Poletti E, Pillastrini
  7. Christensen, P; Krogh, K; Buntzen, S; Payandeh, F; Laurberg, S (Feb 2009). "Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence". Diseases of the Colon and Rectum. 52 (2): 286–92. doi:10.1007/DCR.0b013e3181979341. PMID 19279425. S2CID 24381352.
  8. Christensen, P; Olsen, N; Krogh, K; Bacher, T; Laurberg, S (Jan 2003). "Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation". Diseases of the Colon and Rectum. 46 (1): 68–76. doi:10.1007/s10350-004-6498-0. PMID 12544524. S2CID 32754686.
  9. Christensen, Peter; Bazzocchi, Gabriele; Coggrave, Maureen; Abel, Rainer; Hultling, Claes; Krogh, Klaus; Media, Shwan; Laurberg, Søren (2006). "A Randomized, Controlled Trial of Transanal Irrigation Versus Conservative Bowel Management in Spinal Cord–Injured Patients". Gastroenterology. 131 (3): 738–747. doi:10.1053/j.gastro.2006.06.004. PMID 16952543.
  10. Wolff, Bruce G.; et al., eds. (2007). The ASCRS textbook of colon and rectal surgery. New York: Springer. pp. 653–664. ISBN 978-0-387-24846-2.
  11. Christensen, P.; Krogh, K.; Perrouin-Verbe, B.; Leder, D.; Bazzocchi, G.; Jakobsen, B. Petersen; Emmanuel, A. V. (2015-11-16). "Global audit on bowel perforations related to transanal irrigation". Techniques in Coloproctology. 20 (2): 109–115. doi:10.1007/s10151-015-1400-8. ISSN 1123-6337. PMID 26573811. S2CID 32617368.
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