Trans-Anal Irrigation for Defaecatory Disorders: Results from a Tertiary Care Institution

Gala T1, Fernandes A1, Yeoh S2, Ferdinand S1, Igbedioh C1, Schizas A1, Ferrari L1, Hainsworth A1

Research Type

Clinical

Abstract Category

Anorectal / Bowel Dysfunction

Abstract 227
Conservative 3 - Catheters and Conservative Bowel Management
Scientific Podium Short Oral Session 19
Friday 19th September 2025
17:15 - 17:22
Parallel Hall 3
Anal Incontinence Conservative Treatment Bowel Evacuation Dysfunction Multiple Sclerosis Pelvic Floor
1. Guy's and St Thomas' NHS Foundation Trust, 2. King's College London
Presenter
Links

Abstract

Hypothesis / aims of study
Defaecatory disorders (DD) affect one in ten people and 20% of the female population(2). Trans-anal irrigation (TAI) is the introduction of warm tap water through the anal canal into the rectum to initiate defaecation and is recommended in patients with DD refractory to preliminary conservative treatment (4). Comparison between the outcomes of the two types of TAI (low versus high) needs exploring. We determined the outcome of TAI in patients with defaecatory disorders and also determined if the outcome differed depending on the type of TAI used.
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.
Concluding message
TAI is a safe way to manage defaecatory difficulties with satisfactory improvement in symptoms. Side effects associated are not minimal, however with good training and robust in community follow-up, patients can continue to be compliant. Future prospective studies are needed to compare both types of irrigation to ascertain if either is superior for a particular pathology, so patients do not have to switch between them and barriers to TAI with reasons for discontinuation need to be explored.
Figure 1 Table 1 shows a comparison of demographics and clinical details of patients using low-volume versus high-volume irrigation for defaecatory disorders
Figure 2 Table 2 shows a comparison of outcome of patients using low-volume versus high-volume irrigation for defaecatory disorders
References
  1. Christensen P, Krogh K. Transanal irrigation for disordered defecation: a systematic review. Scand J Gastroenterol. 2010 May;45(5):517–27.
  2. Knowles CH, Booth L, Brown SR, Cross S, Eldridge S, Emmett C, et al. Work programme 3: trial 2 – pragmatic randomised trial of low-volume compared with high-volume initiated transanal irrigation therapy in adults with chronic constipation. In: Non-drug therapies for the management of chronic constipation in adults: the CapaCiTY research programme including three RCTs [Internet]. NIHR Journals Library; 2021 [cited 2025 Feb 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK575604/
  3. British Journal of Nursing [Internet]. [cited 2023 Oct 29]. British Journal of Nursing - An overview of transanal irrigation devices: an update. Available from: https://www.britishjournalofnursing.com/content/focus/an-overview-of-transanal-irrigation-devices-an-update/
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd This study was registered as a quality improvement project with the Quality and Assurance Directorate at Guy’s and St Thomas’ NHS Foundation Trust. It did not require ethical approval or patient consent. Helsinki Yes Informed Consent No
03/07/2025 21:53:13