Anal plugs and retrograde colonic irrigation are helpful in fecal incontinence or constipation

Abstract

AIM:To evaluate the feasibility, clinical effect and predicting factors for favorable outcome of treatment with anal plugs in fecal incontinence and retrograde colonic irrigation (RCI) in patients with fecal incontinence or constipation. METHODS:Patients who received treatment with an anal plug or RCI between 1980 and 2005 were investigated with a questionnaire. RESULTS:Of the 201 patients (93 adults, 108 children), 101 (50%) responded. Adults: anal plugs (8), five stopped immediately, one stopped after 20 mo and two used it for 12-15 mo. RCI (40, 28 fecal incontinence, 12 constipation), 63% are still using it (mean 8.5 years), 88% was satisfied. Younger adults (< 40 years) were more satisfied with RCI (94 % vs 65%, P = 0.05).Children: anal plugs (7), 5 used it on demand for an average of 2.5 years with satisfactory results, one stopped immediately and one after 5 years. RCI (26 fecal incontinence, 22 constipation), 90% are still using it (mean time 6.8 years) and felt satisfied. Children tend to be more satisfied (P = 0.001). Besides age, no predictive factors for success were found. There was no difference in the outcome between patients with fecal incontinence or constipation. CONCLUSION:RCI is more often applied than anal plugs and is helpful in patients with fecal incontinence or constipation, especially for younger patients. Anal plugs can be used incidentally for fecal incontinence, especially in children.

An evidence-based review of the use of transanal irrigation in children and young people with neurogenic bowel

“…Definitions and criteria to judge incontinence varied from any episodes or incidences of staining, soiling or faecal incontinence, 4,6,9,11,12,19 soiling once a month, 10 soiling three times a month, 16 not needing to wear pads for stool incontinence 13 to no information being supplied on how the studies had characterised continence or incontinence. 5,14,15,17,18 This review has correlated with the studies, whose report rates of continence were achieved. In order to combine the findings, a successful outcome of transanal irrigation is defined in this narrative review as an increased level of continence in those children still using transanal irrigation at the point of follow-up.…”

“…Some of the studies administered questionnaires to collect data on reported clinical symptoms, 4-9 Neurogenic Bowel Dysfunction Scale, 10,11 quality of life 5,10,11 and patient satisfaction Likert scales. 5,10,12 Only the Neurogenic Bowel Dysfunction Scale is a validated instrument (in adult patients), the other questionnaires used in the reported studies were locally developed and non-validated. There was a general lack of information within the papers on who completed the questionnaires.…”

“…The majority of questionnaires appeared to be completed by parents either within the clinical setting as part of the child's normal health care follow-up [9][10][11] or over the telephone. 4,5,12,13 Several of the studies reported data collected retrospectively from medical case notes 6,13,14 or reported findings based on data without it being stated how data had been obtained. 6,[15][16][17][18] The follow-up of children after initiation of transanal irrigation varied widely both within and across the studies.…”

“…13 Saline (either isotonic or made by families within the home) was used to irrigate the bowel in 8 of the 17 studies, 4,7,12,[15][16][17][18][19] which included 495 children. Tap water was used in 7 of the studies, 5,6,8,[9][10][11]14 which in total included 270 children. One paper did not report the type of solution used to irrigate the bowel.…”

“…10 All parents (100%, n ¼ 43) of children using transanal irrigation reported over the telephone that they were satisfied with the regime (scale 1-3), although 29 (60%) of these complained that the regime impacted on their social life. 5 Thirty five parents rated their child's quality of life and grade of satisfaction (on one joint scale from 0-10, 0 ¼ great reduction, 10 ¼ great improvement) as improved (mean 7.3) after using transanal irrigation. 11 Another questionnaire study reported that 35 out of 40 parents found transanal irrigation satisfactory (although no information is provided on the scale used) and reported positive improvements in their child's wellbeing (open comments at the end of the questionnaire).…”