The Functional Implications of Transanal Irrigation: Insights from Pathophysiology and Clinical Studies of Neurogenic Bowel Dysfunction

J. Clin. Med., 2024 · DOI: 10.3390/jcm13061527 · Published: March 7, 2024

Simple Explanation

Neurogenic bowel dysfunction (NBD) affects defecation, leading to fecal incontinence and/or constipation, which reduces quality of life. Transanal irrigation (TAI) is a recommended treatment. This review examines how TAI works, focusing on neurogenic bowel pathophysiology. Understanding TAI's functional implications helps clinicians integrate it into bowel care programs, especially for patients with constipation due to delayed colonic motility and impaired stool emptying. TAI, using a rectal catheter with a balloon, may act as a prosthetic device, functionally replacing impaired anal sphincter functions, stimulating peristalsis, and activating the rectoanal inhibitory reflex, thus promoting successful stool evacuation.

Study Duration

Not specified

Participants

1435 individuals across 27 studies (systematic review)

Evidence Level

Review

Key Findings

1
TAI with a rectal catheter and balloon improves bowel symptoms compared to conservative management, including improvements in the NBD Score, Cleveland Clinic Constipation Score, and St. Mark’s Fecal Incontinence Score.
2
Patients using TAI spend less time on bowel management and may reduce or eliminate the need for pharmaceuticals.
3
TAI may remodel the gut microbiota, increasing diversity and decreasing pathobionts, providing an added benefit beyond improving bowel dysfunction.

Research Summary

This review synthesizes the functional implications of TAI delivered via a rectal catheter with a balloon for managing NBD. Understanding its mechanism of action can bolster its utilization in bowel management programs, particularly for those unresponsive to conservative treatments. TAI is a safe and effective treatment for NBD, reducing fecal incontinence and/or constipation and improving quality of life. Systematic education on TAI application is key to long-term adherence. Further research is needed to understand how NBD alters the GI microbiome, neurotransmitters, and immune responses. This will ensure increasingly individualized and effective treatment options.

Practical Implications

Improved Bowel Management

TAI can be effectively integrated into bowel management programs for patients with NBD, especially those who have inadequate results with enemas or other conservative treatment options.

Enhanced Quality of Life

By reducing fecal incontinence and constipation, TAI improves the quality of life for individuals with NBD, providing them with more predictable evacuation and control over their bowel habits.

Personalized Treatment Strategies

Understanding the MOA of TAI allows for the customization of bowel programs to address individual patient needs and optimize treatment outcomes.

Study Limitations

1
High discontinuation rates due to inefficacy, pain, or practical problems.
2
Potential side effects such as abdominal cramps, anorectal pain, and bowel perforation (rare).
3
Variability in study methodologies and limited data in systematic reviews.

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