Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review

Abstract

Transanal irrigation (TAI) has received increasing attention as a treatment option in patients with bowel dysfunction. This systematic review was conducted according to the PRISMA guidelines and evaluates the effect of TAI in neurogenic bowel dysfunction (NBD), low anterior resection syndrome (LARS), faecal incontinence (FI) and chronic constipation (CC). The primary outcome was the effect of TAI on bowel function. Secondary outcomes included details on TAI, quality of life (QoL), the discontinuation rate, adverse events, predictive factors for a successful outcome, and health economics. A systematic search for articles reporting original data on the effect of TAI on bowel function was performed, and 27 eligible studies including 1435 individuals were included. Three randomised controlled trials, one non-randomised trial, and 23 observational studies were included; 70% of the studies were assessed to be of excellent or good methodological quality. Results showed an improvement in bowel function among patients with NBD, LARS, FI, and CC with some studies showing improvement in QoL. However, discontinuation rates were high. Side effects were common, but equally prevalent among comparative treatments. No consistent predictive factors for a successful outcome were identified. Results from this review show that TAI improves bowel function and potentially QoL; however, evidence remains limited.

Sacral and Percutaneous Tibial Nerve Stimulation, Stem Cell Therapy, and Transanal Irrigation Device

“…Most published studies analyze the efficacy of TAI simultaneously on FI and CC [31]. Alterations in lifestyle, coping, depression, social isolation and embarrassment are the fundamental elements lowering the QoL of patients suffering from FI [32].…”

Quality of life and function after rectal cancer surgery with and without sphincter preservation

“…A recent pilot study in rectal cancer patients after SPS reported that standardized interventions for bowel dysfunction led by trained personnel in specialized clinics may successfully ameliorate symptoms ( 24 ). Additionally, transanal irrigation has been receiving increased attention as a treatment option in patients with bowel dysfunction following SPS ( 25 ). These efforts may result in improvements in QOL after SPS and are important areas for future research.…”

Pan‐colonic ischemia after transanal irrigation: unexpected side effect

“…TAI has been gaining acceptance as a treatment option for different bowel dysfunctions such as neurogenic disorders, chronic constipation, faecal incontinence and low anterior resection syndrome. It has been demonstrated to be an inexpensive and effective technique, comparing with conservative management and other not invasive therapies such as tibial nerve stimulation 1 . Minor side effects include cramps, bloating, nausea and anorectal pain or bleeding.…”

“…It has been demonstrated to be an inexpensive and effective technique, comparing with conservative management and other not invasive therapies such as tibial nerve stimulation. 1 Minor side effects include cramps, bloating, nausea and anorectal pain or bleeding. Nevertheless, serious complications have been reported, as well: 49 cases of bowel perforation of which 35 with Peristeen system 2 and one case of colo-vaginal fistula.…”