Application of transanal irrigation for patients with spinal cord injury in South Korea: a 6-month follow-up study

Abstract

Study design: A 6-month follow-up study. Objectives: To investigate the outcome of transanal irrigation (TAI) in patients with spinal cord injury (SCI) and to identify factors significantly related to clinical success. Setting: Survey for community-dwelling patients with SCI in South Korea. Methods: Between December 2010 and March 2012, TAI was initiated with 52 patients (41 men; age: 44.5 ± 11.0 years) with neurogenic bowel dysfunction (NBD). At 1, 3 and 6 months after initiation, a telephone interview was conducted. Data were collected on patient-specific bowel management and TAI performance as a new procedure. Results: Only 18 patients (34%) used TAI for at least 6 months, which was a lower compliance rate than similar studies in some European countries. Relative to the compliant group, the noncompliant group contained a higher proportion of tetraplegia than paraplegia (P ¼ 0.031), and a higher proportion dependent on physical help (P ¼ 0.034). In all, 33 of the 52 patients (63.5%) complained of practical problems with the TAI procedure such as expulsion of the rectal catheter. Fifteen patients (28.8%) presented with adverse effects. The incidence of practical problems or adverse effects did not alter the frequency of patient-reported successful outcome. Conclusion: Korean participants showed a relatively lower compliance rate with TAI. We conclude that TAI, combined with adequate patient instruction and physical assistance, has potential as a management tool for NBD in Korea.

Long-term outcome of transanal irrigation for children with spina bifida

“…Most experienced practical problems such as burster/expulsion of the rectal catheter and financial problems. These results were similar to those of Kim's study 26 that indicated practical problems with TAI in 63.5% of patients; in 48.1%, the problem was expulsion of the rectal catheter. Balloon burst and expulsion have already been reported previously in the literature (33-77%).…”

“…6,10,11,15,26 However, anorectal pain, nausea, headache and other symptoms were not reported in any case in this study. There are documented risks associated with TAI, which include systemic reactions to irrigation solutions and rectal perforation, 9 but these adverse effects were not noted in our study.…”

“…The rate of continuous TAI use at long-term follow-up was generally reported in the range of 34.6-62.5% in adult studies. [23][24][25][26] We surmise that the successful rate of a safe long-term use of TAI was because of the role of parents and specialized nurse practitioners. In studies of children, the role of parents is very important until they reach adolescence, and the caregivers are responsible for a child's continence.…”

“…31 Financial burden is another problem, as TAI is not reimbursed by the Korean national health insurance program, meaning that participants had to cover all the expenses of the TAI device. 26 Comparing two types of TAI in Korea, the price of the cone-based TAI is approximately 80 dollars, and it can be recycled for 1 year. However, the price of the catheter-based TAI system is approximately 300 dollars, and individual catheters, which cost 10 dollars each, cannot be used again.…”

Bowel Management in Spinal Cord Injury Patients

“…Unfortunately, other authors have shown that patient compliance with this method can decrease over time. 15 Digital rectal stimulation, another bowel management technique, involves the use of a gloved finger inserted into the anorectal canal. This has been shown to enhance contractions of the descending colon and rectum, contributing to bowel evacuation.…”