Transanal irrigation systems for managing bowel dysfunction: a review

Abstract

Transanal irrigation (TAI) is used to treat bowel dysfunction, including faecal incontinence and constipation, where physical exercises, dietary changes and/or medication alone are insufficient. During TAI, water is instilled via the anal canal into the distal colon, and the water expels the faecal contents via wash out and/or stimulating colonic peristalsis. This can reduce the severity and frequency of bowel dysfunction, hospitalisation rate, management time and treatment costs and promotes dignity, independence and quality of life. Different TAI systems are available that instil a low or high volume of water, through a balloon catheter or a cone, using a manual or electric pump or a gravity feed. Balloon catheters are secure, convenient and comfortable, while cone systems may be considered less invasive but require patient or carer dexterity to be held in place. Low-volume systems are compact and convenient, but high-volume systems achieve better results for some conditions. Gravity-fed systems need to be suspended above the user, while electric pumps may be cumbersome. Bed systems are designed for patients who are bedbound or require hoisting. The optimal system should be selected based on assessment, informed by clinical need and patient preference. Users must be assessed by a specialist clinician for contraindications, comorbidities and capacity to consent. The clinician should then provide selected patients with ongoing structured training and support to ensure safe and effective use.