Hypothesis / aims of study
Transanal irrigation (TAI) is increasingly used to manage functional bowel disorders, especially in patients with chronic constipation unresponsive to standard therapies. Key indications include obstructed defecation syndrome (ODS), endometriosis-related constipation, low anterior resection syndrome (LARS), and pelvic floor dyssynergia.
While TAI is gaining traction in non-neurogenic populations, its most established role remains in neurogenic bowel dysfunction, such as in spinal cord injury, multiple sclerosis, or spina bifida. In these cases, it improves bowel control, reduces fecal incontinence, and enhances quality of life.
Despite broader adoption, questions persist about optimal protocols, perceived effectiveness, and long-term tolerability.
Study design, materials and methods
A retrospective study was conducted on a cohort of patients diagnosed with functional bowel disorders who underwent transanal irrigation (TAI) and were followed at a specialized pelvic floor rehabilitation clinic between 2022 and 2024.
For each patient, the following data were collected:
-Functional clinical diagnosis
-Type of TAI device used (high-volume or low-volume system; anal cone or balloon catheter)
-Average volume of water used per session
-Frequency of TAI administration (number of irrigations per week)
Clinical outcomes were assessed using validated tools, including: Wexner Constipation Score, LARS Score, SF-36, and a weekly bowel diary including Bristol Stool Chart ratings.
In addition, patient adherence to treatment, level of autonomy in performing the TAI procedure, and the occurrence of any adverse events were reported.
Results
We retrospectively analyzed clinical data from 17 patients who underwent transanal irrigation (TAI) for functional bowel disorders.
Diagnoses included:
• LARS following cancer: 6 patients (35.29%)
• ODS due to pelvic organ prolapse: 4 (23.53%)
• ODS due to pelvic floor dyssynergia: 2 (11.76%)
• Chronic constipation due to slow transit: 2 (11.76%)
• Chronic constipation secondary to endometriosis: 1 (5.88%)
• LARS associated with endometriosis: 2 (11.76%)
Two irrigation systems were used:
• High-volume devices (cone-based): 62.5%
• Low-volume devices: 37.5%
Volume usage:
• High volume (>300 mL): 70.59%
• Low volume (≤300 mL): 29.41%
By diagnosis:
• LARS patients used both volumes, with a slight preference for low-volume.
• Patients with chronic constipation and prolapse-related ODS were treated mostly with high-volume irrigation, suggesting better outcomes in complex anatomical cases.
TAI proved effective, with significant improvements in clinical scores:
• Wexner Score: mean reduced from 14.0–16.0 to 5.0 (over 60% improvement)
• LARS Score:
o Post-cancer group: from 28.75 to 7.25
o Endometriosis group: from 28.0 to 11.0
At 12 months, 7 patients continued therapy, 2 discontinued. No dropouts occurred in the 6-month follow-up group. No adverse effects were reported, indicating good adherence and tolerability.
Interpretation of results
The retrospective analysis of 17 patients treated with transanal irrigation (TAI) for functional bowel disorders showed significant clinical improvement. LARS scores decreased from 28.75 to 7.25 in post-cancer cases and from 28.0 to 11.0 in patients with endometriosis. Endometriosis-related dysfunction showed less improvement, likely due to associated gut microbiota alterations and severe constipation. Wexner scores dropped from 14.0–16.0 to 5.0, reflecting marked relief from constipation across all patients. No side effects were reported, and adherence was good, supporting TAI as an effective and well-tolerated option for managing complex bowel dysfunctions.