Transanal irrigation
Transanal irrigation (TAI, also termed retrograde irrigation)[nb 1] of the rectum and colon is designed to assist the evacuation of feces from the bowel by introducing water into these compartments via the anus.[1]
It is a treatment for persons with bowel dysfunction, including fecal incontinence and/or constipation (especially obstructed defecation). The impact of transanal irrigation varies considerably. Some individuals experience complete control of incontinence, and other report little or no benefit.[1] Evidence show this treatment may be considered for children as well.[2]
When diet and medication has proven ineffective, transanal irrigation is used.[1][3]
Advantages and disadvantages
Possible advantages:
- Avoids surgery, medications, or other procedures
- By regularly emptying the bowel using transanal irrigation, controlled bowel function is often re-established to a high degree in patients with bowel dysfunction. This enables the users to develop a consistent bowel routine by choosing the time and place of evacuation.[1]
- In patients with constipation, regular evacuation of the lower part of colon and rectum can accelerate transit through the entire colon.[4] There has, perhaps unsurprisingly, been a rapid uptake of transanal irrigation methods in highly symptomatic patient groups with anorectal symptoms.[5]
- In individuals with fecal incontinence, efficient emptying of the lower part of colon and rectum means that new feces may not reach the rectum for up to 2 days, which may prevent leakage between irrigations.[6]
Possible disadvantages:
- Requires training so individual understands how to use the equipment
- A degree of dexterity is required to perform transanal irrigation at home. If the individual cannot perform the irrigation themselves, a carer may be required
- Periodic sterilization (e.g. with sodium hypochlorite solution) and replacement of the equipment is needed, or microbial biofilms may start grow inside the tubing, contaminating the irrigation fluid
- Persistent leaking of residual irrigation fluid after the irrigation may occur and make this option unhelpful as liquids are more difficult to retain than solids in persons with fecal incontinence.[7]
- Complications such as electrolyte imbalance and perforation (rare).
Notes
- ↑ The term retrograde irrigation distinguishes this procedure from the Malone antegrade continence enema, where irrigation fluid is introduced into the colon proximal to the anus via a surgically created irrigation port
References
- 1 2 3 4 Emmanuel, A V; Krogh, K; Bazzocchi, G; Leroi, A-M; Bremers, A; Leder, D; van Kuppevelt, D; Mosiello, G; Vogel, M; Perrouin-Verbe, B; Coggrave, M; Christensen, P (20 August 2013). "Consensus review of best practice of transanal irrigation in adults" (PDF). Spinal Cord. 51 (10): 732–738. doi:10.1038/sc.2013.86. PMID 23958927.
- ↑ Corbett, P V; Denny, A; Dick, K; Malone, PS; Griffin, S; Stanton, MP (April 2014). "Peristeen integrated transanal irrigation system treats feacel incontinence in children". Pediatric urology. 10 (2): 219–22. doi:10.1016/j.jpurol.2013.08.006. PMID 24439630.
- ↑ (UK), National Collaborating Centre for Acute Care (2007). Faecal incontinence the management of faecal incontinence in adults. London: National Collaborating Centre for Acute Care (UK). ISBN 0-9549760-4-5.
- ↑ Colonic emptying after transanal irrigation Bazzocchi G, Poletti E, Pillastrini
- ↑ Christensen, P; Krogh, K; Buntzen, S; Payandeh, F; Laurberg, S (Feb 2009). "Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence.". Diseases of the colon and rectum. 52 (2): 286–92. doi:10.1007/DCR.0b013e3181979341. PMID 19279425.
- ↑ Christensen, P; Olsen, N; Krogh, K; Bacher, T; Laurberg, S (Jan 2003). "Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation.". Diseases of the colon and rectum. 46 (1): 68–76. doi:10.1097/01.DCR.0000038104.66269.99. PMID 12544524.
- ↑ Bruce G. Wolff et al., eds. (2007). The ASCRS textbook of colon and rectal surgery. New York: Springer. pp. 653–664. ISBN 0-387-24846-3.
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