Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence.
OBJECTIVE
This study evaluated long-term results of transanal irrigation for defecation disturbances.


METHODS
Three hundred and forty-eight patients [248 women and 100 men; median age 52 years (range, 5-85)] suffering from constipation and fecal incontinence were introduced to transanal irrigation. Patients using transanal irrigation at follow-up received a mailed questionnaire describing bowel function and practical procedures. Results from patients not responding and patients no longer using transanal irrigation were drawn from hospital records and telephone interviews. Background variables were analysed using multivariate logistic regression.


RESULTS
After a mean follow-up of 21 months (range, 1-116) 163 of 348 patients (47 percent) had a successful outcome from treatment with transanal irrigation. Success rates varied between patients with different underlying pathology: neurogenic bowel dysfunction, 67 of 107 (63 percent); anal insufficiency, 36 of 70 (51 percent); sequela to anorectal surgery, 14 of 48 (29 percent); idiopathic constipation, 27 of 79 (34 percent); and miscellaneous, 19 of 44 (43 percent). Factors correlating with positive outcome were neurogenic bowel dysfunction and anal insufficiency as underlying pathology, low rectal volume at urge to defecate, low maximal rectal capacity, and low anal squeeze pressure increment. Two nonfatal bowel perforations were found in approximately 110,000 irrigation procedures.


CONCLUSIONS
Transanal irrigation is simple and safe for long-term treatment for defecation disturbances with greatest benefit in patients with neurogenic bowel dysfunction.
Christensen
Peter
P
Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
Krogh
Klaus
K
Buntzen
Steen
S
Payandeh
Fariborz
F
Laurberg
Søren
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004733:Enema; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods; D055815:Young Adult