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Falletto E, Martellucci J, Rossitti P, Bondurri A, Zaffaroni G, Ascanelli S, Chimisso L, Lauretta A, Mirafiori M, Clementi I, Ripetti V, Lufarelli P, Cestaro G, Bottini C, Bellini M, Lambiase C, Di Candido F, Zattoni D, Cornaglia S, Tonello P, Zucchi E. Transanal irrigation in functional bowel disorders and LARS: short-term results from an Italian national study. Tech Coloproctol 2023; 27:481-490. [PMID: 37160596 DOI: 10.1007/s10151-023-02800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To evaluate the potential benefits associated with the short-term (6 months) treatment with transanal irrigation (TAI) in patients suffering from functional constipation (FC), functional fecal incontinence (FI), and low anterior resection syndrome (LARS). METHODS A multicenter observational study (12 centers; 369 patients) was conducted to assess the following primary and secondary objectives: to evaluate the level of satisfaction regarding bowel control and quality of life (QoL); to evaluate bowel symptoms severity and dropout frequency and reason. To this aim, validated questionnaires were provided to the patients at baseline (T0) and after 6 months of TAI treatment (T6) performed with the medical device Peristeen® Plus (Coloplast A/S, Denmark). Statistical analyses were conducted to compare the outcomes obtained at T0 and T6. RESULTS A 6-month treatment with TAI enabled a statistically significant (p < 0.05) improvement of QoL scores, satisfaction scores regarding bowel control, and severity indexes of disorder-related symptoms in patients suffering from FC, FI, and LARS. Globally, 8.0% of patients discontinued the treatment after 6 months as a result of occurrence of symptoms (2.4%) or other justifications (3.8%) such as personal reasons. None of the dropouts were due to treatment inefficacy. CONCLUSION Results of the present study suggest that short-term TAI treatment is beneficial for patients suffering from functional bowel disorders and LARS. Future analysis of prospective data will focus on the clinical outcomes associated with the long-term use (up to 24 months) of TAI when dealing with these types of medical conditions.
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Affiliation(s)
- E Falletto
- Department of Surgical Sciences, Città Della Salute e Della Scienza, University of Torino, Turin, Italy.
| | - J Martellucci
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - P Rossitti
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| | - A Bondurri
- Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco", "Luigi Sacco" University Hospital, Milan, Italy
| | - G Zaffaroni
- Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco", "Luigi Sacco" University Hospital, Milan, Italy
| | - S Ascanelli
- Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy
| | - L Chimisso
- Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy
| | - A Lauretta
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - M Mirafiori
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - I Clementi
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I "Sapienza", University of Rome, Rome, Italy
| | - V Ripetti
- Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - P Lufarelli
- Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - G Cestaro
- General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy
| | - C Bottini
- General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy
| | - M Bellini
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | - C Lambiase
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | - F Di Candido
- Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy
| | - D Zattoni
- Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy
| | - S Cornaglia
- General Surgery Division, Koelliker Hospital, Turin, Italy
| | - P Tonello
- General Surgery Division, Koelliker Hospital, Turin, Italy
| | - E Zucchi
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
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Boman E, Nylander M, Oja J, Olofsson B. Transanal Irrigation for People With Neurogenic Bowel Dysfunction: An Integrative Literature Review. Gastroenterol Nurs 2022; 45:211-230. [PMID: 35833736 DOI: 10.1097/sga.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022] Open
Abstract
Transanal irrigation has been introduced as a complement to standard bowel care for people with neurogenic bowel dysfunction. There is no contemporary integrative review of the effectiveness and feasibility of transanal irrigation from a holistic nursing perspective, only fragments of evidence to date. The aim was to investigate the effectiveness and feasibility of transanal irrigation for people with neurogenic bowel dysfunction. An integrative literature review was conducted. Nineteen studies were included. According to the results, transanal irrigation can reduce difficulties associated with defecation, episodes of incontinence, and the time needed for evacuation and bowel care. Transanal irrigation can increase general satisfaction with bowel habits and quality of life and decrease level of dependency. However, there are practical problems to overcome and adverse effects to manage. Discontinuation is relatively common. The results support the effectiveness of transanal irrigation, but feasibility is inconclusive. Users, including caregivers, report practical problems, and compliance was not always easy to achieve. It is important that users, including caregivers, are well informed and supported during transanal irrigation treatment, especially during introduction. The quality of the studies found was generally weak; therefore, high-quality quantitative and qualitative studies are needed on the topic.
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Affiliation(s)
- Erika Boman
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Malin Nylander
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Josefine Oja
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Chesnel C, Hentzen C, Haddad R, Charlanes A, Le Breton F, Turmel N, Amarenco G. Adherence to transanal irrigation in older adults: first-year assessment. Tech Coloproctol 2021; 25:1055-1063. [PMID: 34185193 DOI: 10.1007/s10151-021-02479-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND While the prevalence of chronic constipation and fecal incontinence increases with age, few data on transanal irrigation in older adults are available. The aim of this study was to assess the adherence and predictive factors for adherence to transanal irrigation during the first year of use in older adults. METHODS This retrospective study included all patients over 65 years old, who had therapeutic education for transanal irrigation with the Peristeen® device between January 2010 and July 2019 in a neuro-urology department of a university hospital in France. The adherence rate was assessed at 1, 3, 6, and 12 months. Predictive factors for adherence were looked for by comparing persistent population and non-persistent population at 1, 3, 6, and 12 months. RESULTS Sixty-nine patients over 65 years old were included. The adherence rate was 73.9% at 1 month, 55.1% at 3 months, 46.4% at 6 months, and 40.1% at 1 year. No predictive factor for adherence to transanal irrigation was identified. CONCLUSIONS Adherence to transanal irrigation during the first year in older adults remains close to that in the adult general population. Predictive factors of adherence remain unclear.
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Affiliation(s)
- C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France. .,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France. .,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France.
| | - C Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - R Haddad
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - A Charlanes
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - F Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France
| | - N Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury Suggested citation: Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Mark Korsten. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Journal of Spinal Cord Med. 2021. Doi:10.1080/10790268.2021.1883385. J Spinal Cord Med 2021; 44:442-510. [PMID: 33905316 PMCID: PMC8115581 DOI: 10.1080/10790268.2021.1883385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeffery Johns
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Haller
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas, USA
| | | | - Walter Longo
- Department of Surgery, Division of Gastrointestinal Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Mark Korsten
- Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, Division of Gastroenterology, New York, New York, USA
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Mekhael M, Kristensen HØ, Larsen HM, Juul T, Emmanuel A, Krogh K, Christensen P. Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review. J Clin Med 2021; 10:jcm10040753. [PMID: 33668658 PMCID: PMC7918662 DOI: 10.3390/jcm10040753] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Transanal irrigation (TAI) has received increasing attention as a treatment option in patients with bowel dysfunction. This systematic review was conducted according to the PRISMA guidelines and evaluates the effect of TAI in neurogenic bowel dysfunction (NBD), low anterior resection syndrome (LARS), faecal incontinence (FI) and chronic constipation (CC). The primary outcome was the effect of TAI on bowel function. Secondary outcomes included details on TAI, quality of life (QoL), the discontinuation rate, adverse events, predictive factors for a successful outcome, and health economics. A systematic search for articles reporting original data on the effect of TAI on bowel function was performed, and 27 eligible studies including 1435 individuals were included. Three randomised controlled trials, one non-randomised trial, and 23 observational studies were included; 70% of the studies were assessed to be of excellent or good methodological quality. Results showed an improvement in bowel function among patients with NBD, LARS, FI, and CC with some studies showing improvement in QoL. However, discontinuation rates were high. Side effects were common, but equally prevalent among comparative treatments. No consistent predictive factors for a successful outcome were identified. Results from this review show that TAI improves bowel function and potentially QoL; however, evidence remains limited.
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Affiliation(s)
- Mira Mekhael
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
- Correspondence:
| | - Helle Ø Kristensen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
| | - Helene Mathilde Larsen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
| | - Therese Juul
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
| | - Anton Emmanuel
- GI Physiology Unit, University College London Hospital, London NW1 2BU, UK;
| | - Klaus Krogh
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK8200 Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Wilson C, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2021; 27:75-151. [PMID: 34108835 PMCID: PMC8152174 DOI: 10.46292/sci2702-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffery Johns
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | | | - Janice Eng
- University of British Columbia, Vancouver Canada
| | | | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas USA
| | | | | | | | - Catherine Wilson
- Diplomate, American Board of Professional Psychology (RP) Private Practice, Denver, Colorado
| | - Mark Korsten
- Icahn School of Medicine @ Mt Sinai, New York, New York USA
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Impact of Transanal Irrigation Device in the Management of Children With Fecal Incontinence and Constipation. J Pediatr Gastroenterol Nutr 2020; 71:292-297. [PMID: 32404764 DOI: 10.1097/mpg.0000000000002785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Children with fecal incontinence and constipation can be classified into 3 groups: neurogenic bowel dysfunction (NBD) related to spinal cord defects (NBD), refractory constipation (RC), or anorectal malformations (ARMs). The transanal irrigation (TAI) device (Peristeen) was approved in 2012 by the Food and Drug Administration. This system uses a pump rather than gravity to instill water as a colonic irrigant and uses balloon occlusion of the rectum. Our aim was to evaluate the effectiveness of TAI (Peristeen) in children who failed to respond to conservative measures for stool incontinence and constipation. METHODS Retrospective study of 147 patients prescribed TAI between January 2014 and January 2020. Data collected included demographics, prior bowel regimen, symptoms before and after, patient satisfaction scores, and NBD scores. RESULTS Of the 147 patients initiated, 114 remain active users (13 lost to follow-up and 20 discontinued use). Multiple bowel regimens including laxatives (n = 139), cone enema (n = 40), and cecostomy (n = 7) were tried previously. The majority of our patients (n = 85) have NBD, primarily spina bifida, followed by RC (n = 43), and ARM (n = 19). For all patient groups, there was significant improvement in symptoms of fecal incontinence and constipation (P ≤ 0.001). Abdominal pain was improved in the NBD and RC group, but not significantly in the ARM group. CONCLUSIONS We provide a single-center review of a large pediatric cohort using TAI (Peristeen) for management of fecal incontinence and constipation. Peristeen offered significant improvement in patients with NBD, RC, and ARM.
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Negosanti L, Sgarzani R, Linguerri R, Vetrone G, Liotta S, Bazzocchi G, Balloni M. "Imola-Montecatone" subtotal colectomy to improve bowel management in spinal cord injury patients. Retrospective analysis in 19 cases. Spinal Cord Ser Cases 2020; 6:59. [PMID: 32636361 PMCID: PMC7341834 DOI: 10.1038/s41394-020-0311-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/29/2022] Open
Abstract
STUDY DESIGN Retrospective single-center study. OBJECTIVES Persons with spinal cord injury live with neurogenic bowel dysfunction. Difficulties with management of neurogenic bowel can increase over time with age and time post injury, with a negative impact on autonomy and quality of life. Many conservative treatments are available to improve bowel management; however, in case of failure, a colostomy may be considered. SETTING Specialized Care Unit, Montecatone Rehabilitation Institute and General Surgery Division, Imola Hospital, Imola, Italy. METHODS From 2016 to 2019, selected patients affected by SCI and bowel dysfunction failing conservative care were treated with subtotal colectomy associated with placement of a bioabsorbable prosthesis, to prevent parastomal hernia. The surgical procedure is presented along with results. RESULTS Overall, 19 individuals underwent the described procedure; after 1 year of follow-up, we observed four minor complications: two cases of dehiscence of the abdominal incision, easily treated during hospital stay, and two cases of leakage of mucorrhoea. CONCLUSION Our results demonstrate the efficacy of the procedure to improve bowel management in persons with spinal cord injury.
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Affiliation(s)
| | | | | | | | - Sigrid Liotta
- Division of General Surgery, Imola Hospital, Imola, Italy
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9
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Yates A. Transanal irrigation: is it the magic intervention for bowel management in individuals with bowel dysfunction? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:393-398. [PMID: 32279546 DOI: 10.12968/bjon.2020.29.7.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Historically, the use of colonic irrigation or transanal irrigation (TAI) has been viewed as an alternative therapy for the treatment of a wide variety of conditions not relating to bowel dysfunction, including nausea, fatigue, depression, headache, anxiety and rheumatism. However, these days it is viewed as an effective treatment in individuals who may present with bowel dysfunction and related symptoms of constipation and faecal incontinence. Such individuals would include people with neuropathic bowel disorders, conditions that affect sphincter control or bowel motility disorders. injury to the rectum, sphincter or bowel, slow transit times, evacuation difficulties or prolapse due to a weak/damaged pelvic floor, and chronic faecal incontinence. TAI may be performed by the person with bowel dysfunction, or by a carer or health professional. An individual's ability to use a device to undertake the procedure will be influenced by a range of factors, which are explored in this article.
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Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board, Cardiff
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10
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Yates A. Transanal irrigation: an alternative therapy for bowel dysfunction? ACTA ACUST UNITED AC 2019; 28:426-428. [DOI: 10.12968/bjon.2019.28.7.426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board
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Dale M, Morgan H, Carter K, White J, Carolan-Rees G. Peristeen Transanal Irrigation System to Manage Bowel Dysfunction: A NICE Medical Technology Guidance. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:25-34. [PMID: 30426450 PMCID: PMC6345726 DOI: 10.1007/s40258-018-0447-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Peristeen transanal irrigation system is intended to allow people with bowel dysfunction to flush out the lower part of the bowel as part of their bowel management strategy. Peristeen was the subject of an evaluation by the National Institute for Health and Care Excellence, through its Medical Technologies Evaluation Programme, for the management of bowel dysfunction. The company, Coloplast, submitted a case for adoption of the technology, claiming that the technology improves the severity of chronic constipation or faecal incontinence and improves quality of life for people with bowel dysfunction. Other claimed benefits included reduced frequency of UTIs, stoma surgery and hospitalisation rates, as well as reduced costs. The submission was critiqued by Cedar. The clinical evidence assessed included one randomised controlled trial, and 12 observational studies for adults and 11 studies for children. Although there are limitations in the evidence, the assessed studies show some improvement in outcomes for patients who choose to continue using Peristeen. The committee heard from patient experts that Peristeen had improved their lives and allowed them increased independence. The submitted economic evidence had numerous flaws, however following Cedar's changes to the model, and additional sensitivity analysis, the use of Peristeen was judged unlikely to be cost incurring compared with standard bowel care. The Peristeen transanal irrigation system received a positive recommendation in Medical Technologies Guidance 36.
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Affiliation(s)
- Megan Dale
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Kimberly Carter
- National Institute for Health and Care Excellence, Manchester, UK
| | - Judith White
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
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12
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Abstract
PURPOSE OF REVIEW To evaluate and report current evidence regarding the management of bowel dysfunction in spinal cord injury. There is a paucity of high-quality large studies on which to base management advice. RECENT FINDINGS Recent research has focused on defining the nature of symptomatology of bowel dysfunction in SCI and describing the effects on quality of life and social interactions. Technical aspects of colonoscopy have received attention, and aspects of understanding the pathophysiology in relation to both neural and non-neural dysfunction have been studied. There has been refinement and expansion of the pharmacological and non-pharmacological treatment options for bowel dysfunction in SCI. Management of bowel dysfunction in SCI requires a comprehensive and individualized approach, encompassing lifestyle, toileting routine, stimulation, diet, medications, and surgery. Further high-quality research is required to inform best practice.
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Affiliation(s)
- Zhengyan Qi
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- The University of Sydney, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Kolling Institute of Medical Research, Level 12, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Allison Malcolm
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- The University of Sydney, Sydney, Australia.
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Long-term outcome of transanal irrigation for children with spina bifida. Spinal Cord 2014; 53:216-220. [DOI: 10.1038/sc.2014.234] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 11/15/2014] [Accepted: 11/22/2014] [Indexed: 11/09/2022]
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Abstract
Spinal cord injuries are common in the United States, affecting approximately 12,000 people per year. Most of these patients lack normal bowel function. The pattern of dysfunction varies with the spinal level involved. Most patients use a bowel management program, and elements of successful programs are discussed. Surgical treatment, when indicated, could include sacral nerve stimulation, Malone antegrade continence enema, and colostomy.
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