Transanal irrigation for intractable faecal incontinence and constipation: outcomes, quality of life and predicting non-adopters

Ng, Jessica; Ford, Kathryn; Dalton, Sally; McDowell, Susan A.; Charlesworth, Paul; Cleeve, Stewart

doi:10.1007/s00383-015-3735-7

Cited by 40 publications

(32 citation statements)

References 9 publications

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“…Social and pseudo-continence increased from 73% with CT to 90% after two weeks of PT use. The good continence rate was in line with other studies (3,4,(6)(7)(8)(9)(10), however, longterm results still need to be evaluated.…”

Section: Discussionsupporting

confidence: 88%

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Prospective switch study comparing two irrigation systems for transanal irrigation in children

Renterghem

Sladkov

Matthyssens

et al. 2021

AGEB

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Background and study aims: Transanal irrigation (TAI) is used in children to treat constipation and incontinence. Belgium has 2 systems available: Colotip® (cheaper, however not designed for TAI) or Peristeen®. Patients and methods: This patient-control switch study is the first to compare 2 TAI systems. Children regularly using Colotip® for TAI were asked to participate, after consent, a visual analogue scale (VAS) rating the system and a 2-week diary (fecal continence, self-reliance, time spent on the toilet, pain, Bristol stool scale, irrigation volume and frequency of enema) were completed. Non-parametric statistics were used. Results: Out of 26 children using Colotip®, 18 (69%) children participated and 5 refused (fear n=1, satisfaction Colotip® system n=7). Of these 18 children (interquartile range: 3-18 years, median 12.5 years, 9 girls) 5 patients stopped Peristeen® (pain n=1, fear n=1 and balloon loss n=3) and 2 were lost from follow up. Dropouts and included patients showed no statistical difference. In the 11 remaining patients, pseudo-continence (p 0.015), independence (p 0.01) and VAS score (p 0.007) were significantly better with Peristeen®, no difference was found in time spent on the toilet (p 0.288) and presence of pain (p 0.785). Conclusions: In children Peristeen® offered significantly higher pseudo-continence and independency. 30% refused participation because of satisfaction with the Colotip® and 30% spina bifida patients reported rectal balloon loss due to sphincter hypotony. To diminish Peristeen® failure, a test-catheter could be of value. Considering Colotip® satisfaction, both systems should be available. Patient selection for Peristeen® needs further research.

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Section: Discussionsupporting

confidence: 88%

“…Fecal continence and independence of caregivers were important patient driven outcomes reported in studies on quality of life after TAI (4)(5)(6)(7)(8). Therefore, this study compared continence and self-reliance as primary outcomes when comparing both irrigation systems.…”

Section: Discussionmentioning

confidence: 99%

Prospective switch study comparing two irrigation systems for transanal irrigation in children

Renterghem

Sladkov

Matthyssens

et al. 2021

AGEB

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“…Importantly, introduction or modification of a treatment by transanal irrigation was significantly associated with improvement of fecal continence. The effectiveness and the safety of this treatment had been documented in the treatment of constipation and FI of children, adults, and spinal cord‐injured patients . This study highlights the effectiveness of transanal irrigation on FI of SB patients in real life.…”

Section: Discussionmentioning

confidence: 63%

“…The effectiveness and the safety of this treatment had been documented in the treatment of constipation and FI of children, adults, and spinal cordinjured patients. [23][24][25][26] This study highlights the effectiveness of transanal irrigation on FI of SB patients in real life. On the other hand, the combination of laxatives or softeners with transanal irrigation is no more effective than the use of transanal irrigation alone.…”

Section: Discussionmentioning

confidence: 72%

Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches

Brochard

Peyronnet

Hascoët

et al. 2018

Neurourology and Urodynamics

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Aims Spina Bifida (SB) is a rare congenital condition that frequently impairs the neurological control of both fecal continence and defecation. Several therapeutic strategies have been proposed but impact assessment is lacking. Our objectives were to quantify the symptomatic improvement and to determine the optimal strategy in this rare condition where randomized controlled trials are difficult to conduct. Methods Data were extracted from a prospective database. The present analysis focused on patients having undergone at least two gastroenterological assessments. A standardized therapeutic approach was used from the first visit. Improvement was quantified by the variation of quantified symptomatic scores. Results The data of of 57 adults with SB (gender F/M: 30/27 [52.6/47.4%]; mean age: 33.8 [18.5] years) were extracted. After a mean follow‐up of 46 months, 23/57 patients (40.4%) had at least improvement of one point of the Cleveland Clinic Incontinence score (CCIS); 13/57 (22.8%) reported a significant improvement of continence (delta score >50%). Five of the twelve patients (41.6%) with CCIS < 5 at baseline became incontinent over time. The neurological level was not associated with a worse continence outcome. Work on stool consistency and transanal irrigation were the most useful strategies in those with significant improvement of continence. Conclusions Using conventional strategies, a benefit on fecal continence occurs in only one out of five patients suffering from Spina Bifida and continent patients at baseline can develop fecal incontinence over time. A strategy targeting improved control of defecation (transanal irrigation) and a standardization of follow‐up protocol might be beneficial.

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“…Even when the probability of a successful test treatment is only 50%, SNM still meets broadly accepted standards for cost-effective care (about €20 000/QALY). Although we were unable to retrieve data from the literature on the impact of CRC or SNM in terms of QALYs, the available literature does suggest that CRC in children and adolescents has a substantial impact on the quality of life of these patients [18][19][20][21][22][23][24][25][26][27].…”

Section: Limitationsmentioning

confidence: 99%

Cost‐effectiveness of sacral neuromodulation for chronic refractory constipation in children and adolescents: a Markov model analysis

Wilt

Groenewoud

Benninga³

et al. 2017

Colorectal Disease

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Transanal irrigation for intractable faecal incontinence and constipation: outcomes, quality of life and predicting non-adopters

Abstract: TAI is a safe and effective treatment for intractable constipation/FI in children. If tolerated, it can significantly improve quality of life. Age and underlying diagnosis are important factors when recommending TAI to children with intractable FI/constipation.

Cited by 40 publications

References 9 publications

Prospective switch study comparing two irrigation systems for transanal irrigation in children

Prospective switch study comparing two irrigation systems for transanal irrigation in children

Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches

Cost‐effectiveness of sacral neuromodulation for chronic refractory constipation in children and adolescents: a Markov model analysis

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