Study design, materials and methods
Data was collected from a prospectively maintained database between 2016 and 2021 for socio-demographics, presenting complaints, investigations, type of irrigation (low versus high volume), adverse events from irrigation, and outcome of TAI. The outcome was ascertained based on the patient reporting improvement in symptoms. Patients were considered treated successfully when they attended scheduled appointments, reported improvement in symptoms, and were discharged. They were reported as lost to follow-up if they missed two consecutive appointments.
Results
TAI was initiated in 449 patients with a female predominance (89.1%) and a median age of 56 years. The most common ethnicity was White British (60.7%) while the most common presenting complaint was constipation (55.5%). Nearly half of the patients belonged to the lower socioeconomic status (SES).
After using TAI 247 (63.7%) patients reported improvement in symptoms. Issues were reported by 20.9% of patients where technical difficulties were most reported. Patients with poor function on pelvic floor ultrasound were more likely to report improvement in symptoms compared to those with good function, p-value = 0.018. The median length of follow-up for patients after using irrigation was 17 months. Scheduled appointments were attended by 221 patients who were discharged after satisfactory improvement in symptoms, whereas 217 patients were lost to follow-up.
Low-volume irrigation (LVI) was used by 307 patients and high-volume (HVI) by 142. Improvement in symptoms was reported by 61.2% patients after using LVI and 68.4% after using HVI. A quarter of patients switched irrigation during their treatment. Patients started on LVRI were more likely to switch than those on HVRI (24, 16.9%), p-value = 0.005. Patients presenting with constipation were more likely to switch from LVI to HVI, p-value = 0.030.
Patients using LVI were more likely to have rectal hypersensitivity while those using HVI who were more likely to have rectal hyposensitivity, p-value 0.005. Issues were reported by 20% patients using LVI and 22.5% using HVI. Technical difficulties, rectal bleeding and irrigation fluid leakage were more likely to be reported by patients using LVI, whereas anal pain, abdominal bloating and cramps were more likely to be reported by patients using HVI, p-value = 0.036.
Scheduled appointments were attended by 52.4% patients on LVI and 46.5% on HVI who were then discharged after satisfactory improvement in symptoms, whereas 47.6% of patients on LVI and 53.5% on HVI were lost to follow up, p-value = 0.249.
Interpretation of results
To our knowledge this is the first study comparing the impact of LVI versus HVI on symptoms outcome and issues associated. It also provides sub-group analysis based on presenting symptoms. Improvement in symptoms reported by patients as well as the issues are consistent with the literature.