Transanal irrigation in clinical practice: a scoping review

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Rehabilitation Medicine

Background:

• Transanal irrigation (TAI) is a key treatment for managing bowel dysfunction, improving bowel emptying and continence.
• Its application in clinical practice for conditions like neurogenic bowel dysfunction and post-surgical recovery is significant.

Purpose of the Study:

• To systematically map the current application of transanal irrigation in adult outpatient clinical practice.
• To investigate TAI protocols, equipment, patient selection, outcome measures, and reported harms.

Main Methods:

• A comprehensive scoping review adhering to PRISMA-ScR guidelines.
• Systematic literature search across major databases (PubMed, Embase, CINAHL, Cochrane CENTRAL).
• Inclusion of original studies on self-administered TAI in adults (≥18 years) in outpatient settings.

Main Results:

• Ninety-two studies involving 4,821 adults were analyzed, with most studies being observational and published recently.
• TAI predominantly used for neurogenic bowel dysfunction (36%) and post-surgical conditions (27%).
• Common irrigation parameters include volumes of 400-2400 ml, 20-70 min duration, daily/alternate-day frequency, with Peristeen® being the most used device. Outcome measures were highly inconsistent (40 tools), and reported harms were mostly minor, with rare serious complications.

Conclusions:

• Transanal irrigation is extensively applied in adult outpatient settings, especially for neurogenic and post-surgical bowel issues, showing consistent practice patterns.
• The heterogeneity in outcome reporting hinders comparability, underscoring the need for standardized outcome measures.
• Clearer clinical guidelines and standardized outcome reporting are essential for optimizing transanal irrigation practices and research.