Hypothesis / aims of study
Rectal irrigation is recommended for constipation and faecal incontinence refractory to conservative measures, yet uptake and sustained use vary. Non-clinical barriers such as social stigma, lack of awareness, device usability, and logistical constraints remain underexplored. This study aimed to identify patient centred barriers to rectal irrigation through focused group sessions to inform service improvements that support adherence and quality of life.
Study design, materials and methods
We conducted a qualitative study using semi-structured focused group sessions at a tertiary pelvic floor unit. Adults with defaecatory difficulties, who had failed nurse-led biofeedback and were current, former or declined users of rectal irrigation were eligible. Participants were purposively sampled to achieve diversity in age, gender, ethnicity and socioeconomic status. Groups of up to four participants met in person or virtually; sessions were audio recorded, transcribed verbatim, and inductively analysed. A predefined list of hypothesised barriers guided discussion; new barriers identified were added to subsequent sessions until thematic saturation was reached. Data were synthesised into thematic domains with illustrative patient quotations. Ethical approval was granted (IRAS number 336619).
Results
Six interview sessions with 23 participants were conducted, revealing seven interrelated themes that shape patients’ willingness, barriers, and ability to use rectal irrigation.
First, risk perception and a hands-on competence gap created anxiety about long-term harm (e.g. perforation), correct technique and immediate bodily responses such as bloating or pain; patients reported that written information alone was insufficient and sought supervised practice.
Second, routine integration and treatment burden varied: some incorporated irrigation into daily routines, while others found high-volume systems time-consuming due to setup, cleanup, and waiting times.
Third, usability and practical challenges: poor ergonomics, painful pumping for those with hand conditions, leakage, splashing, and device detachment led to physical discomfort and embarrassment.
Fourth, privacy, stigma and emotional burden led many to conceal equipment and avoid disclosure. Equipment, wet tubing in the toilet and deliveries were frequent triggers for secrecy.
Fifth, disclosure was selective, with most patients telling close family or clinicians but being guarded in wider disclosure. The disclosure was influenced by perceived understanding, age norms and cultural taboos.
Sixth, managing irrigation outside the home was experienced as burdensome due to small or unfamiliar bathrooms, lack of hot water, and device bulk prompted avoidance of travel or work use. Many expressed a preference for low-volume systems when away from home due to their ease of use and compactness.
Seventh, interestingly, awareness of rectal irrigation prior to clinician discussion was low; most participants first learned of the option at specialist referral rather than in primary care.
Interpretation of results
Patients experience rectal irrigation as a complex intervention whose acceptability depends on device design, practical training, logistical supports and social context. Service responses should combine hands-on training and follow-up to close the competence gap, offer device options matched to patients’ physical abilities and lifestyles (including travel-friendly, low-volume kits), and reduce visibility through discreet packaging and storage guidance. Clinicians should proactively inform eligible patients earlier in care pathways and normalise discussions to reduce stigma.