title: Results of long-term retrograde rectal cleansing in patients with constipation or fecal incontinence.
abstract: BACKGROUND
  The aim of the present study was to determine the success rate, quality of life and predictive factors of success associated with long-term rectal cleansing (RC) for defecatory disorders.
  
  
  METHODS
  All patients who started RC between January 2010 and August 2014 in our referral hospital were sent questionnaires concerning actual RC, Short Form 36 Health Survey (SF-36), Fecal Incontinence Quality of Life (FI-QoL) and the Beck Depression Inventory (BDI). In addition, they were contacted in May and December 2015 for further follow-up information.
  
  
  RESULTS
  Eighty-six patients were offered RC, and 60 patients (45 women, 15 men) started RC. Thirty-three (55 %) patients stopped RC after a median time of 6 months. Twenty-seven (45 %) continued for a median time of 12 months. Forty-three (72 %) patients responded to the questionnaires. SF-36 showed that patients still using RC had more energy and were less fatigued than patients who discontinued therapy. No significant difference was found between patients who stopped and continued RC concerning age, gender, defecation disturbance, underlying disorders, anorectal function, colon-transit time, FI-QoL or BDI-score. Twenty-three patients (38 %) were still performing RC after 21 months, 22 patients (37 %) after 28 months and 1 patient was lost to follow-up.
  
  
  CONCLUSIONS
  RC is a moderately effective long-term alternative in patients who do not respond to medical therapy and biofeedback exercises. There is a high dropout rate in the first months, but a moderate rate of continuation in the period hereafter. No predictive factors for continuation were found in medical history or function tests. Those who continued RC performed better on the SF-36 subscale energy/fatigue.
authors.affiliation: Department of Gastroenterology and Hepatology, VU Medical Center Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands. p.vollebregt@vumc.nl.
authors.forename: P F
authors.initials: PF
authors.lastname: Vollebregt
authors.affiliation: Department of Surgery, VU Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: A K E
authors.initials: AK
authors.lastname: Elfrink
authors.affiliation: Department of Surgery, VU Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: W J H J
authors.initials: WJ
authors.lastname: Meijerink
authors.affiliation: Department of Gastroenterology and Hepatology, VU Medical Center Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
authors.forename: R J F
authors.initials: RJ
authors.lastname: Felt-Bersma
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000503:physiopathology / Q000628:therapy*; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
keywords: Colonic irrigation; Constipation; Fecal incontinence; Quality of life; Rectal cleansing; Transanal irrigation