Abstract
Study design:
Thirty-six patients with unsatisfactory treatment of neurogenic bowel dysfunctions (NBD) were enrolled from Spinal Units and Rehabilitation Centers in Italy. Treatment was for 3 weeks using a newly developed integrated system with an enema continence catheter for transanal irrigation (Peristeen, Coloplast A/S Kokkedal Denmark).
Objectives:
To evaluate the effects of Peristeen Anal Irrigation on NBD and patient quality of life (QoL).
Setting:
Italy.
Methods:
Lesion level, ambulatory status and hand functionality were determined in all patients. NBD symptoms and QoL were evaluated before and after treatment, using a specific questionnaire. Statistical analysis was performed using McNemar Test and Sign Test.
Results:
Thirty-six patients were enrolled, and 32 patients completed the study. At the end of the treatment, 28.6% of patients reduced or eliminated their use of pharmaceuticals. Twenty-four patients became less dependent on their caregiver. There was a significant increase in patients' opinion of their intestinal functionality (P=0.001), QoL score (P=0.001) and their answers regarding their degree of satisfaction (P=0.001). A successful outcome was recorded for 68% of patients with fecal incontinence, and for 63% of patients with constipation.
Conclusion:
Peristeen Anal Irrigation is a simple therapeutic method for managing NBD and improving QoL. It should be considered as the treatment of choice for NBD, playing a role in the neurogenic bowel analogous to that of intermittent clean catheterization in bladder treatment.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Christensen P, Olsen N, Krogh K, Bacher T, Laurberg S . Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation. Dis Colon Rectum 2003; 46: 68–76.
Christensen P, Olsen N, Krogh K, Laurberg S . Scintigraphic assessment of antegrade colonic irrigation through an appendicostomy or a neoappendicostomy. Br J Surg 2002; 89: 1275–1280.
Glickman S, Kamm MA . Bowel dysfunction in spinal-cord injury patients. Lancet 1996; 347: 1651–1653.
Krogh K, Nielsen J, Djurhuus JC, Mosdal C, Sabroe S, Laurberg S . Colorectal function in patients with spinal cord lesions. Dis Colon Rectum 1997; 40: 1233–1239.
Harari D, Sarkarati M, Gurwitz JH, McGlinchey-Berroth G, Minaker KL . Constipation-related symptoms and bowel program concerning individuals with spinal cord injury. Spinal Cord 1997; 35: 394–401.
Malone PS, Wheeler RA, Williams JE . Continence in patients with spina bifida: long term results. Arch Dis Child 1994; 70: 107–110.
Bakke A, Myhr KM, Gronning M, Nyland H . Bladder, bowel and sexual dysfunction in patients with multiple sclerosis a cohort study. Scand J Urol Nephrol Suppl 1996; 179: 61–66.
Menter R, Weitzenkamp D, Cooper D, Bingley J, Charlifue S, Whiteneck G . Bowel management outcomes in individuals with long-term spinal cord injuries. Spinal Cord 1997; 35: 608–612.
Whitehead WE, Wald A, Norton NJ . Treatment options for fecal incontinence. Dis Colon Rectum 2001; 44: 131–142.
Binnie NJ, Creasey GH, Edmond P, Smith AN . The action of Cisapride on the chronic constipation of paraplegia. Paraplegia 1988; 26: 151–158.
Loening-Baucke V, Desch L, Wolraich M . Biofeedback training for patients with myelomeningocele and fecal incontinence. Dev Med Child Neurol 1988; 30: 781–790.
Christensen P, Kvitzau B, Krogh K, Buntzen S, Laurberg S . Neurogenic colorectal dysfunction—use of new antegrade and retrograde colonic wash-out methods. Spinal Cord 2000; 38: 255–261.
Squire R, Kiely EM, Carr B, Ransley PG, Duffy PG . The clinical application of the Malone antegrade colonic enema. J Pediatr Surg 1993; 28: 1012–1015.
Krogh K, Laurberg S . Malone antegrade continence enema for faecal incontinence and constipation in adults. Br J Surg 1998; 85: 974–977.
Rosen HR, Urbarz C, Holzer B, Novi G, Schiessel R . Sacral nerve stimulation as treatment for fecal incontinence. Gastroenterology 2001; 121: 536–541.
Marshall DF, Boston VE . Altered bladder and bowel function following cutaneous electrical field stimulation in children with spina bifida—interim results of a randomized double-blind placebo controlled trial. Eur J Pediatr Surg 1997; 7 (Suppl 1): 41–43.
Coggrave M, Wiesel PH, Norton C . Management of faecal incontinence and constipations in adults with central neurological diseases. Cochrane Database Syst Rev 2006 (February 22 (2)); CD002115, Review.
Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K et al. A randomized controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology 2006; 131: 738–747.
American Spinal Injury Association. Manual for the International Standards for Neurological Classification of Spinal Cord Injury. American Spinal Injury Association: Chicago, 2003.
Krogh K, Christensen P, Sabroe S, Laurberg S . Neurogenic bowel dysfunction score. Spinal Cord 2006; 44: 625–631.
Acknowledgements
We thank Dr Cristian Cintori, Dr Achille Grisetti and Dr Alessandro Porciani for their support in data collection and analysis. We thank Dianthus Medical Limited for providing medical writing services. This research was supported for data analysis by Coloplast Italia.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Del Popolo, G., Mosiello, G., Pilati, C. et al. Treatment of neurogenic bowel dysfunction using transanal irrigation: a multicenter Italian study. Spinal Cord 46, 517–522 (2008). https://doi.org/10.1038/sj.sc.3102167
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.sc.3102167
Keywords
This article is cited by
-
Neurogenic Bowel: Traditional Approaches and Clinical Pearls
Current Physical Medicine and Rehabilitation Reports (2020)
-
Peristeen Transanal Irrigation System to Manage Bowel Dysfunction: A NICE Medical Technology Guidance
Applied Health Economics and Health Policy (2019)
-
From misbelieve to proofs in transanal irrigation for functional bowel problems
Techniques in Coloproctology (2016)
-
Application of transanal irrigation for patients with spinal cord injury in South Korea: a 6-month follow-up study
Spinal Cord (2013)
-
The effects of transanal irrigation as a stepwise bowel management program on the quality of life of children with spina bifida and their caregivers
Spinal Cord (2013)


