Recurrent urinary tract infections (r-UTIs) represent a significant clinical burden, particularly in patients with bowel dysfunction, neurogenic bladder or pelvic floor disorders. A close functional interplay between bowel and lower urinary tract has gained increasing attention, supporting integrated therapeutic approaches. Transanal irrigation (TAI) is an established treatment for chronic constipation and neurogenic bowel dysfunction, but its role in preventing r-UTIs remains underexplored. This study aimed to evaluate the impact of TAI on r-UTI frequency in patients with concomitant bowel dysfunction.

Patients with documented r-UTIs (confirmed by positive urine cultures) and associated chronic constipation or neurogenic bowel dysfunction were prospectively enrolled in a structured TAI program. Baseline evaluation included medical history, r-UTI frequency, urinalysis, urine culture, antibiotic and laxative use, Wexner constipation score, Bristol Stool Form Scale, and VAS score (to evaluate constipation-related quality of life- QoL). Rectoscopy was performed when indicated. Follow- up evaluations were conducted at 1, 3 and 6 months to assess clinical outcomes and treatment adherence.

Thirty patients (9 males, 21 females; mean age: 61.4 ± 18.8 y.o.) were included. At baseline, mean r-UTI frequency was 6 episodes/year. Chronic constipation was present in 12 patients and neurogenic bowel dysfunction in 18. Following TAI initiation, a significant reduction in r-UTIs was observed, with mean episodes decreasing to 2.1 at 1 month, 1.4 at 3 months, and 0.9 at 6 months (p< 0.001). Bowel function improved significantly, with Wexner score reduction from 18.2 ± 4.6 to 7.1 ± 3.9 at 6 months (p< 0.001). Stool consistency normalized in 24/30 patients (80%). Antibiotic use decreased in 22/30 cases (73%), and VAS score improved from 7.2 ± 1.4 to 3.1 ± 1.6 at 6 months (p< 0.001). Treatment adherence was high (85%), with no major adverse events reported.

The reduction in r-UTIs appears strongly associated with improved bowel emptying and reduced fecal retention, suggesting a key role of bowel management in modulating urinary infection risk. These findings support the concept of a bowel-bladder axis and highlight TAI as a potential preventive strategy. Additionally, improved rectal evacuation may reduce bacterial reservoir and perineal contamination, further contributing to the decrease in urinary infections.

TAI was associated with a significant reduction in r-UTIs, improved bowel function, and decreased antibiotic consumption. These findings highlight the importance of an integrated bowel-bladder approach and suggest TAI as a valuable adjunctive strategy in the prevention and functional management of r-UTIs. Further studies on larger cohorts are warranted.