Recurrent urinary tract infections (r-UTIs) are common in neurological patients and are closely associated with neurogenic bowel dysfunction. The bowel- bladder interaction suggests that impaired rectal emptying contributes to urinary infection risk. The aim of the study was to evaluate the impact of transanal irrigation (TAI), on r-UTIs frequency in patients with neurogenic bowel dysfunction.

Patients with neurological disease (Parkinson’s Disease [PD], Multiple Sclerosis [MS], spinal cord injury [SCI]), neurogenic bowel dysfunction, and documented r-UTIs (defined as 2 episodes within 6 months or 3 within 12 months, confirmed by positive urine cultures and associated with urinary symptoms) were prospectively enrolled in a structured TAI program. Baseline assessment included medical history, r-UTI frequency, urinalysis, urine culture, antibiotic use, Wexner constipation score, Bristol Stool Form Scale, and VAS for bowel-related quality of life (QoL; 0= worst, 10= best). Rectoscopy was performed when indicated. Follow-up was performed at 1, 3, and 6 months. The primary outcome was change in r-UTI frequency; secondary outcomes included bowel function, antibiotic use, QoL, adherence, and safety.

Twenty patients (8 males, 12 females; mean age: 65.1 ± 7.2 years) with neurological disease (10 PD, 4 MS, 6 SCI) were enrolled. Mean baseline r-UTI frequency was 6.2 ± 1.1 episodes/year. After TAI initiation, r-UTI frequency significantly decreased to 2 ± 0.7, 1.1 ± 0.6, and 0.7 ± 0.6 episodes per month at 1, 3, and 6 months, respectively (p<0.001). Bowel function significantly improved (Wexner score: 18.4 ± 4.4 vs 7.2 ± 3.5 at 6 months, p<0.001), with normalization of stool consistency according to the Bristol Stool Form Scale. Antibiotic use decreased in in 17/20 cases (85%). VAS score significantly improved from 3.5 ± 1.9 to 7.4 ± 1.9 at 6 months (p< 0.001). Treatment adherence was high (89%), and no major adverse events were reported.

The marked reduction in r-UTIs observed after TAI initiation appears closely related to improved bowel emptying and reduced fecal retention in this neurological population. These findings support the clinical relevance of the bowel- bladder interaction in neurogenic dysfunction. Optimizing bowel management may therefore play a key role in reducing urinary infectious burden and antibiotic exposure.

TAI was associated with a significant and sustained reduction in r-UTIs in neurological patients with neurogenic bowel dysfunction, together with improvement in bowel function and QoL. These findings support an integrated bowel- bladder approach and suggest that bowel management should be considered a therapeutic target in the prevention of recurrent urinary tract infections.