title: Transanal irrigation for intractable faecal incontinence and constipation: outcomes, quality of life and predicting non-adopters.
abstract: OBJECTIVE
  Intractable faecal incontinence (FI) and constipation is a challenging condition to manage in children. Transanal irrigation (TAI) is a non-operative treatment option. This study presents our experience with TAI with the aim of finding predictive factors of non-compliance.
  
  
  METHODS
  This is an outcome and quality of life (QoL) study of a prospectively maintained database of patients < 17 years old commenced on TAI for intractable FI/constipation between 2008 and 2014. Outcome measures were: (1) compliance-classified as non-adopter (use of TAI stopped within 1 month after commencement) or adopter; (2) functional outcome-classified as responder (totally continent or occasional soiling) or non-responder; (3) Rintala score; and (4) QoL score (PedsQL™ 4.0 Generic Core Scale). Analysis to determine predictive factors was also performed.
  
  
  RESULTS
  42 patients were started on TAI [74% male, median age of commencement was 7 (3-16) years]. Underlying diagnoses were: idiopathic constipation (62%), anorectal malformation (26%), Hirschsprung disease (5%), spina bifida (5%) and gastroschisis (2%). Median follow-up period was 14 (3-78) months. 24% were non-adopters. 84% of the adopters responded to treatment. Rintala scores (mean ± SD) pre- and post-TAI were 6.7 ± 3.5 and 11.2 ± 4.8, respectively (P < 0.001). QoL scores pre- and post-TAI were 55.6 ± 24.1 and 65.5 ± 23.7, respectively (P < 0.001). Median age at which TAI was commenced in the non-adopter and adopter group were 6 (IQR 4.5-8.25) and 8 (IQR 7-12), respectively (P = 0.008).
  
  
  CONCLUSIONS
  TAI is a safe and effective treatment for intractable constipation/FI in children. If tolerated, it can significantly improve quality of life. Age and underlying diagnosis are important factors when recommending TAI to children with intractable FI/constipation.
authors.affiliation: Department of Paediatric Surgery, The Royal London Hospital, London, UK, jessicaykng@outlook.com.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ng
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ford
authors.forename: Sally
authors.initials: S
authors.lastname: Dalton
authors.forename: Susan
authors.initials: S
authors.lastname: McDowell
authors.forename: Paul
authors.initials: P
authors.lastname: Charlesworth
authors.forename: Stewart
authors.initials: S
authors.lastname: Cleeve
mesh_terms: D000293:Adolescent; D001003:Anal Canal; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000628:therapy*; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome