Science Alert: Transanal irrigation: between conservative bowel management and surgery

Posted by Sofi Sigvardsson, September 26, 2017

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There are many conservative options and combinations of methods when it comes to bowel management for people with neurogenic bowel disorder (NBD). 

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Usually they involve diet, exercise, laxatives, as well as other methods. For some people who have struggled with conservative bowel management, surgery has been the only alternative, but surgery is generally best avoided as there may be a number of complications associated with it.

In the last decade, treatment using an alternative therapy, transanal irrigation (TAI), has increased. It is considered neither conservative nor surgery, and where it is known, an increasing number of patients are using devices associated with this therapy.

Recently, a review article was published covering a wide range of topics, including which indications TAI is intended for, how to initiate a patient, and an overview over which devices are available on the market. Several abstracts presented over the summer add to the reporting of positive effects of TAI, for example by showing that TAI reduces the number of urinary tract infections in patients with NBD. However, continence advisors in the UK still believe there is a need for more education in the bowel management area, as shown in an article published this month. Better education may enable TAI to become available to more patients struggling with conservative methods and considering surgery.

 Download Science Alert – Sep 2017


Summary of Publications


 

A review of transanal irrigation in adults.

https://www.ncbi.nlm.nih.gov/pubmed/28792840

Author and Origin 

Wilson M. UK

Summary

A review describing transanal irrigation (TAI), clinical conditions that may be treated, how it works and a comparison of different systems available. The review also discusses problems, solutions, and education for nurses, as well as how to teach patients.

Conclusions

Quality of life can be improved for all patients who become successful users of TAI, even when it is not problem-free.

Comments

A comprehensive review from a nurse’s perspective, containing a comparison of all available TAI systems.




Current practice of continence advisors in managing faecal incontinence in the United Kingdom: results of an online survey

https://www.ncbi.nlm.nih.gov/pubmed/28736932

Author and Origin 

Leo CA, Maeda Y, Collins B, Thomas GP, Hodgkinson JD, Murphy J, Vaizey CJ. UK

Summary

A survey study of 226 out of 448 continence advisors, addressing the practice of each continence advisor, their knowledge of continence management and the adequacy of their training.

Conclusions

The majority (77 %) of the continence advisors treated both fecal and urinary incontinence. They had a broad range of conservative treatment options but almost half of the advisors who answered the survey felt inadequately trained.

Comments

Survey study of the knowledge, management and adequacy of training of continence advisors in the UK.




Navina™ Smart - A new option for transanal irrigation in treatment - refractory neurogenic bowel dysfunction

https://www.ics.org/2017/abstract/78

Author and Origin 

Emmanuel A, Passananti V, Raeburn A, Gripenland J, Nordin M, Hultling C. UK, Sweden

Summary

A prospective study with 29 patients with neurogenic bowel disorder (NBD), investigating compliance, satisfaction, perception and safety of Navina Smart.

Conclusions

The Navina Smart system was well accepted and effective in 74 % of the patients (68 %) that continued for 4 weeks. Handling of the system was considered easy for 81 % of the patients and there were no safety concerns.

Comments

First study investigating perception, satisfaction, safety and compliance of the Navina Smart system for transanal irrigation in patients with NBD.




Reduction of urinary tract infections related to trans-anal irrigation (TAI): Results on long term in a single centre.

http://onlinelibrary.wiley.com/doi/10.1002/nau.23302/abstract

Author and Origin 

Mombelli G, Chiarulli EF, Rossini M, Sentina M, Tagliabue A, Fuse A, Muraca I, Sandri SD. Italy

Summary

A retrospective study of 58 patients with neurogenic bowel dysfunction, investigating the effect on the yearly frequency of urinary tract infections when using transanal irrigation (TAI).

Conclusions

Reported symptomatic urinary tract infections leading to the prescription of antibiotics were 6 (2-15) per year before TAI. The number of UTIs was reduced to 2.5 (0-7) episodes per year after a mean period of 51 (8-93) months.

Comments

A retrospective study showing the reduction in frequency of UTIs when using TAI.




Adherence to trans-anal irrigation (TAI): Long term follow up analysis in a single centre.

http://onlinelibrary.wiley.com/doi/10.1002/nau.23302/abstract

Author and Origin 

Mombelli G, Chiarulli EF, Rossini M, Sentina M, Tagliabue A, Fuse A, Muraca I, Sandri SD. Italy

Summary

A retrospective study of 61 patients with neurogenic bowel dysfunction (NBD), investigating adherence to transanal irrigation (TAI) after a mean period of 55 (6-102) months.

Conclusions

Adherence to TAI was 64 % after a mean follow-up of 55 (6-102) months. The main reasons for discontinuing TAI were:
• Unsatisfactory effect
• Trouble using the system (Peristeen)
• Difficulty in accessing the system.

Comments

A retrospective study showing adherence to TAI.




 

Download Science Alert – Sep 2017


This blog post is an extract of the Science Alert from Sep 2017 (76040-USX-1709)

Topics: Science Alert, Bowel management, Transanal irrigation (TAI)