References

Bazzocchi G, Corazziari ES, Staiano A Position paper on transanal irrigation in chronic non-organic constipation. Dig Liver Dis. 2024; 56:(5)770-7 https://doi.org/10.1016/j.dld.2024.02.006

Bolia R, Goel A, Thapar N Transanal irrigation in children with functional constipation: a systematic review and meta-analysis. J Pediatr Gastroenterol Nutr. 2024; 78:(5)1108-15 https://doi.org/10.1002/jpn3.12200

Bouali M, Ballati A, El Bakouri A Phytobezoar: an unusual cause of small bowel obstruction. Ann Med Surg. 2021; 62:323-5 https://doi.org/10.1016/j.amsu.2021.01.048

Emmett CD, Close HJ, Yiannakou Y, Mason JM Trans-anal irrigation therapy to treat adult chronic functional constipation: systematic review and meta-analysis. BMC Gastroenterol. 2015; 15 https://doi.org/10.1186/s12876-015-0354-7

O'Donnell MT, Haviland SM Functional constipation and obstructed defecation. Surg Clin North Am. 2024; 104:(3)565-78 https://doi.org/10.1016/j.suc.2023.11.007

Tamvakeras P, Horrobin C, Chang J, Chapman M Long-term outcomes of transanal irrigation for bowel dysfunction. Cureus. 2023; 15:(7) https://doi.org/10.7759/cureus.42507

Transanal irrigation: best practice in the community

02 July 2024
Volume 29 · Issue 7

Abstract

Chronic constipation, which is common and often difficult to treat, has numerous origins, including neurological and other conditions, and adverse reactions to drugs, especially opioids. Chronic functional constipation lacks a clear underlying cause. Increasing evidence suggests that transanal irrigation (TAI) aids faecal evacuation and is well tolerated in many people with bowel dysfunction who do not adequately respond to first-line treatments. Recent papers offer insights that help nurses and other healthcare professionals implement best practice in the community, including discussing any need for assistance before starting TAI, agreeing the most appropriate device with patients and optimising the irrigation protocol. Training, careful follow-up and ongoing supervision improve adherence and success. Further studies are needed, however, and patients who do not respond adequately or are unable to tolerate TAI should be referred to a specialist service.

Every community healthcare professional (HCP) probably manages chronic constipation, characterised by infrequent stools, difficultly passing faeces or both for at least 3 months (Emmett et al, 2015). About 9.5% of children (Bolia et, 2024) and 14% of adults (Emmett et al, 2015) experience chronic functional constipation. Unless treated, chronic constipation can markedly impair quality of life, result in irreversible anatomical changes, such as megarectum and megacolon, and cause severe complications, including intestinal obstruction and bowel perforation (Bazzocchi et al, 2024).

Chronic constipation has numerous causes, including neurological (eg spinal cord injury or tumour, stroke, Parkinson's disease, multiple sclerosis) and other conditions, such as diabetes, hypothyroidism and hypopituitary disorders (Emmett et al, 2015, O'Donnell and Haviland, 2024). Several medicines can also cause or exacerbate constipation (Emmett et al, 2015; O'Donnell and Haviland, 2024). For example, up to 80% of opioid users experience constipation (O'Donnell and Haviland, 2024).

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