Consensus review of best practice of transanal irrigation in adults

Study design:Review article.Objectives:To provide a consensus expert review of the treatment modality for transanal irrigation (TAI).Methods:A consensus group of specialists from a range of nations and disciplines who have experience in prescribing and monitoring patients using TAI worked together assimilating both the emerging literature and rapidly accruing clinical expertise. Consensus was reached by a round table discussion process, with individual members leading the article write-up in the sections where they had particular expertise.Results:Detailed trouble-shooting tips and an algorithm of care to assist professionals with patient selection, management and follow-up was developed.Conclusion:This expert review provides a practical adjunct to training for the emerging therapeutic area of TAI. Careful patient selection, directly supervised training and sustained follow-up are key to optimise outcomes with the technique. Adopting a tailored, stepped approach to care is important in the heterogeneous patient groups to whom TAI may be applied.Sponsorship:The review was financially supported by Coloplast A/S.

[1]  B. Roche,et al.  Transanal irrigation improves quality of life in patients with low anterior resection syndrome , 2011, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[2]  M. Kamm,et al.  Bowel dysfunction in spinal-cord-injury patients , 1996, The Lancet.

[3]  F. Biering-Sørensen,et al.  Rectum perforation during transanal irrigation: a case story , 2009, Spinal Cord.

[4]  B. Govaert,et al.  Retrograde colonic irrigation for faecal incontinence after low anterior resection , 2009, International Journal of Colorectal Disease.

[5]  W. Hop,et al.  Long‐term follow‐up of retrograde colonic irrigation for defaecation disturbances , 2005, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[6]  S. Laurberg,et al.  Outcome Of Transanal Irrigation For Bowel Dysfunction 1N Patients With Spinal Cord Injury , 2008, The journal of spinal cord medicine.

[7]  S. Apter,et al.  Perforations of the rectosigmoid colon induced by cleansing enema: CT findings in 14 patients , 2002, Abdominal Imaging.

[8]  K. Krogh,et al.  Transanal irrigation for disordered defecation: A systematic review , 2010, Scandinavian journal of gastroenterology.

[9]  T. Iwama,et al.  Self washout method for defecational complaints following low anterior rectal resection , 1989, The Japanese journal of surgery.

[10]  H. Paran,et al.  Enema-induced perforation of the rectum in chronically constipated patients , 1999, Diseases of the colon and rectum.

[11]  L. Goetz,et al.  Neurogenic Bowel Dysfunction , 2008 .

[12]  S. Laurberg,et al.  Colorectal function in patients with spinal cord lesions , 1997, Diseases of the colon and rectum.

[13]  R. Gilmour,et al.  The enema continence catheter in spina bifida: successful bowel management. , 1987, Journal of pediatric surgery.

[14]  M. Cain,et al.  Tap water irrigation and additives to optimize success with the Malone antegrade continence enema: the Indiana University algorithm. , 2008, The Journal of urology.

[15]  D. Bartolo,et al.  A retrospective evaluation of rectal irrigation in the treatment of disorders of faecal continence , 2004, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[16]  J. Wilson‐Barnett,et al.  Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom , 2009, Spinal Cord.

[17]  S. Laurberg,et al.  A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. , 2006, Gastroenterology.

[18]  J. Wardle,et al.  Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial , 2002, The Lancet.

[19]  S. Laurberg,et al.  Long-Term Outcome and Safety of Transanal Irrigation for Constipation and Fecal Incontinence , 2009, Diseases of the colon and rectum.

[20]  A. Aalto,et al.  Impact of Functional Results on Quality of Life After Rectal Cancer Surgery , 2006, Diseases of the colon and rectum.

[21]  S. Laurberg,et al.  Anorectal function after long‐term transanal colonic irrigation , 2010, Colorectal Disease.

[22]  A. Wald,et al.  Prevalence of bowel dysfunction in multiple sclerosis. A population survey. , 1990, Gastroenterology.

[23]  S. Laurberg,et al.  Clinical aspects of bowel symptoms in Parkinson’s disease , 2007, Acta neurologica Scandinavica.

[24]  S. Laurberg,et al.  Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction , 2009, Spinal Cord.

[25]  R. Loffeld,et al.  Incidence and causes of colonoscopic perforations: a single-center case series. , 2011, Endoscopy.

[26]  K. Krogh,et al.  Scintigraphic Assessment of Retrograde Colonic Washout in Fecal Incontinence and Constipation , 2003, Diseases of the colon and rectum.

[27]  A. Emmanuel,et al.  Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction , 2010, Spinal Cord.

[28]  A. Emmanuel,et al.  Transanal Irrigation for Bowel Symptoms in Patients with Multiple Sclerosis , 2012, Diseases of the colon and rectum.

[29]  Shih-Ching Chen,et al.  Relationship between neurogenic bowel dysfunction and health-related quality of life in persons with spinal cord injury. , 2009, Journal of rehabilitation medicine.

[30]  S. Davis,et al.  Functional treatments in multiple sclerosis. , 2011, Current opinion in neurology.

[31]  S. Smits,et al.  Clinical value of colonic irrigation in patients with continence disturbances , 1997, Diseases of the colon and rectum.

[32]  J. Haringsma,et al.  Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy , 2009, Endoscopy.

[33]  C. Doré,et al.  Experimental study of faecal continence and colostomy irrigation , 2000, The British journal of surgery.

[34]  S. Laurberg,et al.  The pattern of colorectal dysfunction changes with time since spinal cord injury , 2008, Spinal Cord.