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Review
. 2024 Mar 7;13(6):1527.
doi: 10.3390/jcm13061527.

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

Gianna Rodriguez  1 , Steven Kirshblum  2 , Mai Thao  3 , Mackenzie McArthur  4 , Michael Camilleri  5
Affiliations
Review

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

Gianna Rodriguez et al. J Clin Med. .

Abstract

Defecation function is negatively impacted in patients with neurogenic bowel dysfunction (NBD), who require effective bowel care for stool evacuation. NBD comprises fecal incontinence and/or constipation, which can reduce the quality of life and dignity. Transanal irrigation (TAI) is recommended by several clinical guidelines as the second-line treatment after conservative treatment and before surgical options are considered. As the only class in the second-line treatment with an established safety and efficacy profile, the mechanism of action of TAI has not fully been elucidated when administered through a rectal catheter with a balloon. This review examines the current understanding regarding the mechanism of action of TAI, with a focus on the pathophysiology of neurogenic bowel and irregular defecation. By understanding the functional implications of TAI, clinicians may be better able to integrate this modality into bowel care programs, especially for patients with NBD who have significant constipation due to delayed colonic motility and impaired stool emptying with loss of voluntary control of defecation, and those who are unresponsive to conservative treatment, including enemas.

Keywords: chronic constipation; colonic motility disorder; fecal incontinence; impaired anal sphincters; neurogastroenterology; neurogenic bowel dysfunction; transanal irrigation.

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Conflict of interest statement

M.T. is a Senior Medical Affairs Program Manager at Coloplast A/S, which manufactures the Peristeen system. G.R., S.K., M.M. and M.C. have been involved as consultants at Coloplast A/S.

Figures

Figure 1
Figure 1
Proposed mechanism of action of TAI. (A) Gut with NBD which has fecal impaction and loss of anal sphincter functions (i.e., internal anal sphincter [IAS] and external anal sphincter [EAS]). (B) Transanal irrigation delivered via a rectal catheter with a balloon. The balloon is inflated, replacing the function of the impaired anal sphincters, and peristalsis is stimulated in the colon. The balloon also triggers the rectoanal inhibitory reflex, causing IAS relaxation. (C) The balloon is deflated, and evacuation is completed following removal of the rectal catheter.
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