Treatment of neurogenic bowel dysfunction using transanal irrigation: a multicenter Italian study

Abstract

Study design: Thirty-six patients with unsatisfactory treatment of neurogenic bowel dysfunctions (NBD) were enrolled from Spinal Units and Rehabilitation Centers in Italy. Treatment was for 3 weeks using a newly developed integrated system with an enema continence catheter for transanal irrigation (Peristeen, Coloplast A/S Kokkedal Denmark). Objectives: To evaluate the effects of Peristeen Anal Irrigation on NBD and patient quality of life (QoL). Setting: Italy. Methods: Lesion level, ambulatory status and hand functionality were determined in all patients. NBD symptoms and QoL were evaluated before and after treatment, using a specific questionnaire. Statistical analysis was performed using McNemar Test and Sign Test. Results: Thirty-six patients were enrolled, and 32 patients completed the study. At the end of the treatment, 28.6% of patients reduced or eliminated their use of pharmaceuticals. Twenty-four patients became less dependent on their caregiver. There was a significant increase in patients' opinion of their intestinal functionality (P ¼ 0.001), QoL score (P ¼ 0.001) and their answers regarding their degree of satisfaction (P ¼ 0.001). A successful outcome was recorded for 68% of patients with fecal incontinence, and for 63% of patients with constipation. Conclusion: Peristeen Anal Irrigation is a simple therapeutic method for managing NBD and improving QoL. It should be considered as the treatment of choice for NBD, playing a role in the neurogenic bowel analogous to that of intermittent clean catheterization in bladder treatment.

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

“…Taken together, these data show that for patients with SCI, TAI is more effective than conservative bowel management, 17 resulting in an improvement in symptoms 18,19 and quality of life, 19 and that success is maintained in the long term. 16,20,21 Efficacy of TAI in patients with spina bifida Data on the efficacy of TAI in patients with spina bifida consist mainly of observational studies in children (or youths) with faecal incontinence (Table 1).…”

“…19 Success rates were similar for faecal incontinence (68%) and constipation (63%), and a reduction in pharmaceutical use, time spent on evacuation and dependence on caregivers was observed. Follow-up studies have described the successful long-term use of TAI in the SCI population.…”

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.…”