Prospective evaluation of transanal irrigation for fecal incontinence and constipation

T. Juul, P. Christensen

The aim of the present study was to evaluate the effect of transanal irrigation on bowel function and quality of life in a prospective cohort of Danish patients with fecal incontinence or constipation. Patients with fecal incontinence or constipation of heterogeneous origin were treated by a specialist nurse at the Anal Physiology Clinic/Department of Surgery at Aarhus University Hospital, Aarhus, Denmark. If satisfactory results were not obtained after conservative bowel management, patients were instructed in the use the transanal irrigation procedure and were consecutively recruited for this observational cohort study in the period from March 2010 to September 2013. Patients completed questionnaires regarding bowel function, quality of life and the transanal irrigation procedure at baseline and after 12 months. A total of 507 were introduced to transanal irrigation. Eighty-three percent were females. The median age was 56 (range 19-86) years. At follow-up, 216 (43%) patients still used transanal irrigation, 174 (34%) reported that they had discontinued the treatment for various reasons, while no response was obtained from the remaining 117 (23%) patients. The main reason for not adhering to the treatment was an unsatisfactory outcome, which was reported by 86 (49.4%) of those who discontinued the treatment. Among patients still using the procedure at follow-up, a statistically significant improvement of bowel function scores (St. Marks/Wexner incontinence score, Wexner constipation score and obstructed defecation syndrome score) was detected: the Wexner incontinence score decreased from 12.4 at baseline to 10.2 at follow-up (p < 0.001); the St. Marks incontinence score decreased from 14.9 to 12.7 (p < 0.001); the Wexner constipation score decreased from 14.3 to 12.4 (p < 0.001); and the obstructed defecation syndrome score also dropped, from 15.1 to 11.8 (p < 0.001). Furthermore, the influence of bowel dysfunction on daily activities and quality of life diminished significantly, while the general satisfaction with bowel function increased significantly (p < 0.001 in all three measures). Bowel function and quality of life improved in the group of patients adhering to transanal irrigation after 12 months. However, more than one-third of the patients discontinued the treatment within the first year with transanal irrigation. Thus, further studies are needed in order to identify factors predicting success and failure with this treatment and to improve supervision during initiation and follow-up.