Rectal irrigation: a useful tool in the armamentarium for functional bowel disorders

Chan, David; Saklani, Avanish; Shah, Parth; Lewis, Maria; Haray, P. N.

doi:10.1111/j.1463-1318.2011.02797.x

Cited by 21 publications

(22 citation statements)

References 16 publications

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“…Of 292 abstracts and citations reviewed, 19 full-text articles were retrieved. Of these, six were suitable to be included in the review [ 9 , 13 – 17 ]. Reference lists of these articles were reviewed and a further eligible article was identified [ 18 ], giving a total of 7 articles (Fig.…”

Section: Resultsmentioning

confidence: 99%

Trans-anal irrigation therapy to treat adult chronic functional constipation: systematic review and meta-analysis

Emmett

Yiannakou

et al. 2015

BMC Gastroenterol

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BackgroundTrans-anal irrigation (TAI) is used widely to treat bowel dysfunction, although evidence for its use in adult chronic functional constipation remains unclear. Long-term outcome data are lacking, and the effectiveness of therapy in this patient group is not definitively known.MethodsEvidence for effectiveness and safety was reviewed and the quality of studies was assessed. Primary research articles of patients with chronic functional constipation, treated with TAI as outpatients and published in English in indexed journals were eligible. Searching included major bibliographical databases and search terms: bowel dysfunction, defecation, constipation and irrigation. Fixed- and random-effect meta-analyses were performed.ResultsSeven eligible uncontrolled studies, including 254 patients, of retrospective or prospective design were identified. The definition of treatment response varied and was investigator-determined. The fixed-effect pooled response rate (the proportion of patients with a positive outcome based on investigator-reported response for each study) was 50.4 % (95 % CI: 44.3–56.5 %) but featured substantial heterogeneity (I2 = 67.1 %). A random-effects estimate was similar: 50.9 % (95 % CI: 39.4–62.3 %). Adverse events were inconsistently reported but were commonplace and minor.ConclusionsThe reported success rate of irrigation for functional constipation is about 50 %, comparable to or better than the response seen in trials of pharmacological therapies. TAI is a safe treatment benefitting some patients with functional constipation, which is a chronic refractory condition. However findings for TAI vary, possibly due to varying methodology and context. Well-designed prospective trials are required to improve the current weak evidence base.

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Section: Resultsmentioning

confidence: 99%

Trans-anal irrigation therapy to treat adult chronic functional constipation: systematic review and meta-analysis

Emmett

Yiannakou

et al. 2015

BMC Gastroenterol

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“…The proportion of patients with a positive outcome with TAI ranges from 30%[16] to 78%[17]. The large difference in reported response rates may be due to three main inherent factors of the study designs: (1) the success criteria; (2) the TAI system and training modalities; and (3) the duration of the follow-up.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders

Bildstein

Melchior

Gourcerol

et al. 2017

WJG

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AIMTo investigate compliance with transanal irrigation (TAI) one year after a training session and to identify predictive factors for compliance.METHODSThe compliance of one hundred eight patients [87 women and 21 men; median age 55 years (range 18-83)] suffering from constipation or fecal incontinence (FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and training progress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTSForty-six of the 108 (43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy (41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems (catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training (OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSIONThe progress of the training session was the only factor that predicted patient compliance with TAI.

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“…53,55 Nonpharmacologic treatment options, which have demonstrated success in small series, include biofeedback, rectal irrigation, and acupuncture. 57,58 Biofeedback may be of use in cases of STC associated with pelvic floor dysfunction; however, there is no clear evidence as to the efficacy of the biofeedback techniques in the management of isolated STC and reported results are conflicting. [59][60][61][62] Brown et al report the successful treatment of four individuals with isolated STC using just four biofeedback sessions.…”

Section: Medical Managementmentioning

confidence: 99%

Functional Disorders: Slow-Transit Constipation

Tillou

Poylin

2016

Clinics in Colon and Rectal Surgery

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Constipation is a very common complaint, with slow-transit constipation (STC) accounting for a significant proportion of cases. Old age, female gender, psychiatric illness, and history of sexual abuse are all associated with STC. The exact cause of STC remains elusive; however, multiple immune and cellular changes have been demonstrated. Diagnosis requires evidence of slowed colonic transit which may be achieved via numerous modalities. While a variety of medical therapies exist, these are often met with limited success and a minority of patients ultimately require operative intervention. When evaluating a patient with STC, it is important to determine the presence of concomitant obstructed defecation or other forms of enteric dysmotility, as this may affect treatment decisions. Although a variety of surgical procedures have been reported, subtotal colectomy with ileorectal anastomosis is the most commonly performed and well-studied procedure, with the best track record of success.

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Rectal irrigation: a useful tool in the armamentarium for functional bowel disorders

Abstract: Rectal irrigation can be a useful tool in the management of functional bowel disorders and should be tried prior to the consideration of any surgery. However, further work is needed to define the precise indications and patient selection criteria.

Cited by 21 publications

References 16 publications

Trans-anal irrigation therapy to treat adult chronic functional constipation: systematic review and meta-analysis

Trans-anal irrigation therapy to treat adult chronic functional constipation: systematic review and meta-analysis

Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders

Functional Disorders: Slow-Transit Constipation

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