Science Alert: Transanal irrigation - A rising star

Posted by Sofi Sigvardsson, October 30, 2018

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Transanal irrigation (TAI) is a rising star in the sky of bowel management.

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Transanal irrigation (TAI) had its breakthrough in patients requiring neurogenic bowel management, and many studies have been done which confirm its effect and success with these patients. It is now mentioned in both reviews of bowel management in patients with neurogenic bowel dysfunction that were published during the summer.

Unfortunately, there are some issues with adherence and several studies have tried to elucidate the reason for this, but with little success so far. Over the summer, several studies have been published investigating the effect of TAI, both comparing the effect on NBD and functional bowel and investigating newer indications such as myelomeningocele and lower anterior resection syndrome (LARS). All gave good results; in the case of patients with LARS, there even seemed to be better adherence to TAI.

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Summary of Publications


Title

Neurogenic bowel management for the adult spinal cord injury patient. 
https://www.ncbi.nlm.nih.gov/pubmed/29951791 

Author and Origin

Stoffel JT, Van der Aa F, Wittmann D, Yande S, Elliott S.
US

Summary

Review of neurogenic bowel management for patients with spinal cord injury (SCI). It covers physiology, treatments such as diet, irrigation and surgery.

Conclusions

It is important to understand physiology and different treatment options to achieve the maximum quality of life.

Comments and Access

Review or bowel management in SCI patients with neurogenic bowel dysfunction.


Title

Short versus mid-long-term outcome of transanal irrigation in children with spina bifida and anorectal malformations. 
https://www.ncbi.nlm.nih.gov/pubmed/29948136  

Author and Origin

Ausili E, Marte A, Brisighelli G, Midrio P, Mosiello G, La Pergola E, Lombardi L, Iacobelli BD, Caponcelli E, Meroni M, Leva E, Rendeli C.
Italy

Summary

Prospective multicenter study with 72 children with spina bifida (SB) or anorectal malformation (ARM), investigating 3 months and around 2 years of treatment by transanal irrigation (TAI).

Conclusions

Consistent improvement in bowel management and quality of life in both groups was observed. To maintain adherence, patient training and careful follow-up is proposed.

Comments and Access

Prospective study of TAI in children with spina bifida and anorectal malformation.

 


Title

Role of transanal irrigation in the treatment of anterior resection syndrome. 
https://www.ncbi.nlm.nih.gov/pubmed/30083782   

Author and Origin

Martellucci J, Sturiale A, Bergamini C, Boni L, Cianchi F, Coratti A, Valeri A.
Italy

Summary

A prospective study with 33 patients with lower anterior resection syndrome (LARS) evaluating the effect of transanal irrigation (TAI) after 6 months.

Conclusions

TAI is an effective treatment for LARS, both for continence and quality of life.

Comments and Access

Study evaluating the effect of TAI in patients with LARS.

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Title

Bowel Dysfunction in Spinal Cord Injury. 
https://www.ncbi.nlm.nih.gov/pubmed/30159690  

Author and Origin

Qi Z, Middleton JW, Malcolm A.
Australia

Summary

Review of current evidence on bowel management in patients with spinal cord injury (SCI). The review includes epidemiology, pathophysiology, investigations and treatments.

Conclusions

There is strong support for individualized bowel management plans. However, there is a lack of high-level evidence regarding the optimal management.

Comments and Access

Review of neurogenic bowel management in patients with SCI.

 


Title

Prospective evaluation of peristeen® transanal irrigation system in multiple sclerosis patients: Results from a multicentre Italian study. 
https://onlinelibrary.wiley.com/doi/abs/10.1002/nau.23706  

Author and Origin

Balsamo R, Arcaniolo D, Illiano E, Torella M, Fusco F, Costantini E, De Sio M.
Italy

Summary

Prospective study with 60 patients with multiple sclerosis (MS) investigating the effect of transanal irrigation (TAI) on bowel dysfunction, urinary tract infections (UTI), quality of life (QoL) and sexual dysfunction.

Conclusions

TAI improves bowel function and QoL, and seems to reduce the risk of UTI in patients with MS.

Comments and Access

Prospective study on MS patients with bowel dysfunction, investigating UTI risk.

 


Title

Comparison of clinical effectiveness and compliance with transanal irrigation treatment: Neurogenic v.s functional bowel disorders. 
https://gut.bmj.com/content/67/Suppl_1/A267.1    

Author and Origin

Yiu J, Pesce M, Storrie J, Emmanuel A, Zarate N.
UK

Summary

Retrospective study comparing the effect of transanal irrigation on patients with neurogenic bowel dysfunction (NBD) and functional bowel disorders (FBD) (mainly irritable bowel syndrome with constipation (IBS-C).).

Conclusions

TAI is an effective treatment in patients with FBD, showing a similar efficacy to NBD.

Comments and Access

Retrospective comparative study of the effect of TAI between patients with NBD or FBD.

 


Title

Standardization of the technique to perform the transanal therapeutic irrigation. 

https://www.sciencedirect.com/science/article/pii/S2237936318300704
   

Author and Origin

Silva Rodrigues BD, de Lacerda KC, Buzatti R, Quintão NPD, Oliveira GM, Pinheiro MM, Rodrigues FP, Gomes da Silva R.
Brazil

Summary

Presentation of a standardized protocol of introduction to transanal irrigation (TAI). The protocol includes preparation of the patient, an interdisciplinary approach, and training.

Conclusions

TAI is an effective, well-tolerated and safe procedure.

Comments and Access

Protocol of how to introduce TAI to patients.

 


Title

Long-term results using a transanal irrigation system (Peristeen®) for treatment of stool incontinence in children with myelomeningocele. 
https://www.sciencedirect.com/science/article/pii/S1477513118304765     

Author and Origin

Alhazmi H, Trbay M, Alqarni N, Alyami F, Khatab A, Almannie R, Neel KF
Saudi Arabia

Summary

Retrospective study of the effect of transanal irrigation (TAI) in 109 children with myelomeningocele (MMC).

Conclusions

Complete stool continence was achieved in 90% of the children after a mean follow-up period of 48 months.

Comments and Access

Retrospective study showing a high effectivity rate of TAI in children with MMC.

 


 

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Topics: Bowel management, Transanal irrigation (TAI)