Outcome Of Transanal Irrigation For Bowel Dysfunction 1N Patients With Spinal Cord Injury

Abstract

Background/Objective: To compare symptoms of neurogenic bowel dysfunction in patients with spinal cord injury (SCI) at baseline and after 10 weeks of treatment with transanal irrigation and to identify possible factors that could predict outcome of the treatment. Methods: Sixty-two patients with SCI (45 men and 17 women; mean age, 47.5 6 15.5 [SD] years) from 5 specialized European SCI centers were offered treatment with transanal irrigation for a 10-week period. Bowel function was assessed at baseline and at termination using the Cleveland Clinic Constipation Scoring System (CCCSS; 0-30, 30 ¼ severe symptoms), St. Mark's Fecal Incontinence Grading System (FIGS; 0-24, 24 ¼ severe symptoms), and the Neurogenic Bowel Dysfunction score (NBD; 0-47, 47 severe symptoms). Factors predicting improvement in bowel function scores were identified using a general linear model. Results: Severity of symptoms at termination was significantly reduced compared with baseline values (CCCSS: À3.4; 95% confidence interval [CI], À4.6 to À2.2; FIGS:-4.1; 95% CI, À5.2 to À2.9; NBD: À4.5; 95% CI, À6.6 to À2.4; all P , 0.0001). Although several factors were associated with positive outcome, no consistent and readily explainable pattern could be identified. Surprisingly, hand function, level of dependency, predominant symptom, and colonic transit time were not associated with outcome. Conclusions: Transanal irrigation in patients with SCI reduces constipation, improves anal continence, and improves symptom-related quality of life. No readily obtainable factors could predict outcome, which might be because of the relatively low number of patients. This supports the use of trial and error as a strategy in deciding on a bowel management method for neurogenic bowel dysfunction.

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

“…18 The outcome of this extension study confirmed the clinical outcomes of the initial report (Table 1). An attempt to define predictors of which patients may succeed using TAI did not identify any factors (such as demographic, symptomatic or injury related) using a general linear model.…”

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

“…28 Uchikawa et al 28 developed a new procedure to induce bowel movements using a toilet set equipped with an electronic bidet that provides water flow to (Table 7). [29][30][31][32][33][34] There is Level 4 evidence (from one case-series study evaluating 31 persons with SCI) that supports using pulsed water irrigation (intermittent rapid pulses) to remove stool in individuals with SCI. 29 There is also Level 1 evidence (from one large good-quality multisite RCT with 87 subjects), 30 Level 4 evidence (from two pre-post study evaluating 55 and 32 persons with SCI), 31,32 and Level 5 evidence (from an observational study) 33 that support the use of the transanal irrigation systems.…”

“…[29][30][31][32][33][34] There is Level 4 evidence (from one case-series study evaluating 31 persons with SCI) that supports using pulsed water irrigation (intermittent rapid pulses) to remove stool in individuals with SCI. 29 There is also Level 1 evidence (from one large good-quality multisite RCT with 87 subjects), 30 Level 4 evidence (from two pre-post study evaluating 55 and 32 persons with SCI), 31,32 and Level 5 evidence (from an observational study) 33 that support the use of the transanal irrigation systems. In the RCT, the Peristeen Anal Irrigation system (Coloplast A/S, Kokkedal, Denmark) showed reduced frequency of lower urinary traction, improved fecal continence, and reduced constipation after 10 weeks of use when compared with the conservative bowel treatment (Paralyzed Veterans of America Clinical Practice Guidelines for Bowel Management).…”

“…Findings were similar after 10 and 3 weeks of use in the two pre-post studies. 31,32 In the Del Popolo et al 32 study, 9 out of 32 study subjects also either reduced or eliminated their use of pharmaceuticals. In the observational study, Faaborg et al 33 found 98 of the 211 patients had successful outcomes after a mean follow-up of 19 months, and 74 patients were successfully using irrigation techniques after 3 years.…”

The Sir Ludwig Guttmann Lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries

“…The centre collaborated on a multicentre, international, prospective, randomized, controlled study of transanal irrigation. 12,13 A study by Coggrave et al 14 examined the management of neurogenic bowel dysfunction in the community after spinal cord injury through a national postal survey. Coggrave and Norton 15 studied the need for manual evacuation and oral laxatives in a randomised controlled trial of a stepwise protocol, and Coggrave et al 16 described the impact of stoma for bowel management.…”