Transanal irrigation for disordered defecation: A systematic review

Abstract

Transanal irrigation for treatment of disordered defecation has been widely used among caregivers. Unique in its simplicity, reversible and minimally invasive, transanal irrigation has begun to find its place in the treatment hierarchy. Scheduled transanal irrigation aims to ensure emptying of the left colon and rectum. This prevents faecal leakage between washouts, providing a state of pseudocontinence, and re-establishes control over the time and place of defecation. Furthermore, regular evacuation of the rectosigmoid prevents constipation. The studies presented in this review represent the continuum of increasing evidence and knowledge of transanal irrigation for disordered defecation: from proof in principle through better knowledge of the physiology, towards establishing the indications and ensuring the safety of the treatment. Evidence of the superiority of transanal irrigation in spinal cord injury patients with neurogenic bowel dysfunction is provided, also from a health-economic perspective. Finally, a proposal is presented for an algorithm for the introduction of transanal irrigation for disordered defecation before irreversible surgery is considered.

Key Words::

• Constipation
• disordered defecation
• enema
• faecal incontinence
• neurogenic bowel dysfunction
• review
• transanal irrigation

Declaration of interest: Both authors have previously received grant support from Coloplast A/S, Humlebaek, Denmark. Both authors are members of the Coloplast Global Advisory Board on bowel management.