Consensus review of best practice of transanal irrigation in adults

Study design: Review article.Objectives: To provide a consensus expert review of the treatment modality for transanal irrigation (TAI).Methods: A consensus group of specialists from a range of nations and disciplines who have experience in prescribing and monitoringpatients using TAI worked together assimilating both the emerging literature and rapidly accruing clinical expertise. Consensus wasreached by a round table discussion process, with individual members leading the article write-up in the sections where they hadparticular expertise.Results: Detailed trouble-shooting tips and an algorithm of care to assist professionals with patient selection, management andfollow-up was developed.Conclusion: This expert review provides a practical adjunct to training for the emerging therapeutic area of TAI. Careful patientselection, directly supervised training and sustained follow-up are key to optimise outcomes with the technique. Adopting a tailored,stepped approach to care is important in the heterogeneous patient groups to whom TAI may be applied.Sponsorship: The review was financially supported by Coloplast A/S.Spinal Cord (2013) 51, 732–738; doi:10.1038/sc.2013.86; published online 20 August 2013Keywords: transanal irrigation; expert review; consensus review; neurogenic bowel dysfunction; functional bowel disorders; PeristeenINTRODUCTIONTransanal irrigation (TAI) of the rectum and colon is designed toassist the evacuation of faeces from the bowel by introducing waterinto these compartments via the anus. In this article, we refer to theuse of purpose-made device-assisted irrigation methods of whichseveral are commercially available. By regularly emptying the bowelusing TAI, controlled bowel function is often re-established to a highdegree in patients with bowel dysfunction. This enables the users todevelop a consistent bowel routine by choosing the time and place ofevacuation. In patients with faecal incontinence, efficient emptying ofthe distal colon and rectum means that new faeces do not reach therectum for an average of 2 days,