Hypothesis / aims of study
Trans-anal irrigation (TAI) is recommended as a second-line treatment for defaecatory difficulties after initial preliminary conservative management fails [1, 2]. TAI involves instilling lukewarm tap water into the rectum via a trans-anal balloon catheter or cone. Adequate knowledge, training, and patient support are important factors for patient compliance [3] when using TAI; however, drop-out rates are high [4].
We initiated group-based educational sessions (GBE) on TAI to support patients with practical aspects of rectal irrigation and provide a safe environment to share their experiences of living with a bowel disorder and educate them on TAI as an option to manage their bowel symptoms.
Study design, materials and methods
GBE for rectal irrigation have been running since 2008. The sessions (outlined in Figure 1) are one hour long, are sex-segregated, and are led by a bowel specialist nurse. The bowel specialist nurse explains the relevant anatomy of the bowel, symptoms of defaecatory dysfunction (constipation/incontinence) and initial conservative treatment (changes to diet, physiotherapy, medication, biofeedback, and education on correct defaecatory technique). This is followed by an overview of TAI, indications for TAI and associated risks, the different types of TAI, and how TAI is performed. A dietician gives dietary input, and a clinical fellow is present to address clinical questions. Medical representatives from all manufacturers are invited to set up TAI kits in separate rooms to showcase the different products available on NHS prescription. Leaflets are provided to patients, and they can choose to register to start TAI on the day if this has been recommended by their bowel specialist nurse. This is followed by a discussion and Q+A closes the session. From April 2023, feedback was collected at the end of the session.
Results
TAI educational group sessions have been held since 2008 with, 2-3 sessions per year. Between 2017 and 2024, 75 patients attended. Demographics are shown in Table 1. Patients were aged between 24 and 92, with a median age of 62 years. The majority, 62 (82.7%), of patients attending were female and 47 (77.0%) were white. There was representation of patients from a wide range of socioeconomic status.
The most common reason for patients attending was constipation (68%), followed by anal incontinence (25%). Of those who attended, 44 (59%) patients went on to trial a new product (29 immediately, and 15 after specialist nurse follow-up).
Feedback was collected from patients attending between April 2023 and May 2024. The feedback questionnaire was completed by 41 patients; the results are shown in table 2.
The feedback was overwhelmingly positive. The majority of patients found the session very useful (62.5%) and easy to attend (87.8%), useful to attend a session with other people experiencing the same symptoms (92.5%), and better able to deal with their symptoms (75.6%). All of the patients said they would recommend the session to family and friends.
Interpretation of results
Our results support that GBE provides a safe space for patients to share their experiences, reducing feelings of stigma and isolation. Only a third of patients suggested an improvement to the GBE sessions, and changes have been implemented to address some of the suggestions.
Holding group sessions facilitated the demonstration of a range of different products by medical representatives, a service that could not be offered to patients during individual appointments. Feedback on this was good, with ten patients highlighting this as a positive of the session, and 75.6% feeling better able to manage their symptoms following the session.