Transanal irrigation therapy: selection and support are the keys to success

Transanal irrigation (TAI) is a simple, safe, reversible treatment option and proven to be effective in treating neurogenic bowel dysfunction (in patients with multiple sclerosis, spina bifida or spinal cord injury), faecal incontinence and constipation (Christensen et al, 2009; Christensen and Krogh, 2010; Emmanuel; 2010; Emmett et al, 2015). TAI can be used to manage obstructed defecation, functional defecation disorder, chronic idiopathic constipation and constipation-predominant irritable bowel syndrome (IBS-C), as well as idiopathic post-traumatic constipation. It may also be considered in patients who have not responded to medical management.

TAI involves instilling tap water into the rectum via the anus using either a balloon catheter or a cone delivery system attached via a plastic tube to an irrigation bag holding up to 2 litres of water. Alternatively, a low-volume system consisting of a hand pump and a cone may be employed. By regularly emptying the bowel this way, TAI is intended to reduce leakage, help re-establish controlled bowel function, and enable the user to choose the time and place for rectal evacuation. The effect of TAI varies among patients; some report full satisfaction and improvements in quality of life, whereas others have poor efficacy and abandon treatment. Response to treatment depends not only on the correct indications but also on the patient's motivation and their degree of manual dexterity. A digital rectal examination is mandatory before using TAI to exclude localised anal disorders, and to assess for faecal impaction, as well as sphincter function and co-ordination. Comprehensive training of the patient is central to safe long-term use of TAI.