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Early transanal irrigation in spinal cord injury-related neurogenic bowel dysfunction: preliminary insights

Spinal Cord Series and Cases volume 12, Article number: 7 (2026) Cite this article

Subjects

Abstract

Study design

Prospective, randomized, open-label, multicenter, parallel group study.

Objectives

Neurogenic bowel dysfunction (NBD) is a common complication in spinal cord injury (SCI) patients, severely affecting quality of life. While transanal irrigation (TAI) has shown superior efficacy over conservative treatments (CT), its early adoption during the first hospitalization post-injury remains unexplored. This study aimed to compare early TAI initiation versus CT in managing NBD in SCI patients.

Setting

This study involved four spinal units across Italy.

Methods

SCI patients were randomized to receive TAI or CT during a four-week hospital stay, followed by continued treatment at home for 6 months. Bowel function, constipation, and continence were assessed using the Wexner scales, while quality of life was measured using the EQ-5D-5L and Spinal Cord Independence Measure (SCIM) questionnaires. Stool transit time and patient independence were also monitored.

Results

Twenty-two patients were enrolled, with the TAI group showing significant improvements in constipation (Wexner score reduction from 13.43 ± 4.24 at baseline to 7.55 ± 2.38 and 8.80 ± 4.16 at 4 weeks and 6 months, p = 0.02) and a trend toward continence improvement. A significant increase in the total SCIM score was observed in the TAI group (p = 0.02), particularly in respiratory and sphincter management. Quality of life improved in both groups, with a notable enhancement in self-care activities for the TAI group (p = 0.006).

Conclusions

These preliminary results suggest early TAI adoption improves bowel management, especially constipation, and enhances patient independence. Larger studies are needed to validate these findings and assess long-term benefits.

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Fig. 1: Study flow chart.
The alternative text for this image may have been generated using AI.
Fig. 2: Evaluation of constipation and incontinence.
The alternative text for this image may have been generated using AI.
Fig. 3: SCIM version III questionnaire in TAI and CT groups (mean ± SD).
The alternative text for this image may have been generated using AI.
Fig. 4: Effect of TAI and CT on patients’ quality of life according to EQ-5D-5L questionnaire (mean ± SD).
The alternative text for this image may have been generated using AI.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Qi Z, Middleton JW, Malcolm A. Bowel dysfunction in spinal cord injury. Curr Gastroenterol Rep. 2018;20:47.

    Article  PubMed  Google Scholar 

  2. Krogh K, Nielsen J, Djurhuus JC, Mosdal C, Sabroe S, Laurberg S. Colorectal function in patients with spinal cord lesions. Dis Colon Rectum. 1997;40:1233–9.

    Article  CAS  PubMed  Google Scholar 

  3. Kurze I, Geng V, Böthig R. Guideline for the management of neurogenic bowel dysfunction in spinal cord injury/disease. Spinal Cord. 2022;60:435–43.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, et al. Management of neurogenic bowel dysfunction in adults after spinal cord injury: clinical practice guideline for health care providers. Top Spinal Cord Inj Rehabil. 2021;27:75–151.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Emmanuel A. Neurogenic bowel dysfunction. F1000Res. 2019;8:F1000 Faculty Rev-1800.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Del Popolo G, Mosiello G, Pilati C, Lamartina M, Battaglino F, Buffa P, et al. Treatment of neurogenic bowel dysfunction using transanal irrigation: a multicenter Italian study. Spinal Cord. 2008;46:517–22.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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;131:738–47.

    Article  PubMed  Google Scholar 

  9. Mekhael M, Kristensen HØ, Larsen HM, Juul T, Emmanuel A, Krogh K, et al. Transanal irrigation for neurogenic bowel disease, low anterior resection syndrome, faecal incontinence and chronic constipation: a systematic review. J Clin Med. 2021;10:753.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ditunno JF, Cardenas DD, Formal C, Dalal K. Advances in the rehabilitation management of acute spinal cord injury. Handb Clin Neurol. 2012;109:181–95.

    Article  PubMed  Google Scholar 

  11. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Peristeen Transanal Irrigation IFU [Internet]. https://www.coloplast.us/Global/US/MarketAccess/Peristeen/Peristeen_Transanal_Irrigation_IFU.pdf.

  13. Krogh K, Emmanuel A, Perrouin-Verbe B, Korsten MA, Mulcahey MJ, Biering-Sørensen F. International spinal cord injury bowel function basic data set (Version 2.0). Spinal Cord. 2017;55:692–8.

    Article  CAS  PubMed  Google Scholar 

  14. Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996;39:681–5.

    Article  CAS  PubMed  Google Scholar 

  15. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.

    Article  CAS  PubMed  Google Scholar 

  16. EQ-5D-5L questionnaire [Internet]. https://euroqol.org/information-and-support/euroqol-instruments/eq-5d-5l/.

  17. Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, et al. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil. 2007;29:1926–33.

    Article  CAS  PubMed  Google Scholar 

  18. Abrahamsson H, Antov S, Bosaeus I. Gastrointestinal and colonic segmental transit time evaluated by a single abdominal x-ray in healthy subjects and constipated patients. Scand J Gastroenterol Suppl. 1988;152:72–80.

    Article  CAS  PubMed  Google Scholar 

  19. Media S, Christensen P, Lauge I, Al-Hashimi M, Laurberg S, Krogh K. Reproducibility and validity of radiographically determined gastrointestinal and segmental colonic transit times in spinal cord-injured patients. Spinal Cord. 2009;47:72–5.

    Article  CAS  PubMed  Google Scholar 

  20. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32:920–4.

    Article  CAS  PubMed  Google Scholar 

  21. Mosiello G, Marshall D, Rolle U, Crétolle C, Santacruz BG, Frischer J, et al. Consensus review of best practice of transanal irrigation in children. J Pediatr Gastroenterol Nutr. 2017;64:343–52.

    Article  PubMed  Google Scholar 

  22. Rosen HR, Kneist W, Fürst A, Krämer G, Hebenstreit J, Schiemer JF. Randomized clinical trial of prophylactic transanal irrigation versus supportive therapy to prevent symptoms of low anterior resection syndrome after rectal resection. BJS Open. 2019;3:461–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Rosen HR, Boedecker C, Fürst A, Krämer G, Hebenstreit J, Kneist W. «Prophylactic» transanal irrigation (TAI) to prevent symptoms of low anterior resection syndrome (LARS) after rectal resection: results at 12-month follow-up of a controlled randomized multicenter trial. Tech Coloproctol. 2020;24:1247–53.

    Article  CAS  PubMed  Google Scholar 

  24. Christensen P, Bazzocchi G, Coggrave M, Abel R, Hulting C, Krogh K, et al. Outcome of transanal irrigation for bowel dysfunction in patients with spinal cord injury. J Spinal Cord Med. 2008;31:560–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kim HR, Lee BS, Lee JE, Shin HI. Application of transanal irrigation for patients with spinal cord injury in South Korea: a 6-month follow-up study. Spinal Cord. 2013;51:389–94.

    Article  CAS  PubMed  Google Scholar 

  26. Martellucci J, Sturiale A, Bergamini C, Boni L, Cianchi F, Coratti A, et al. Role of transanal irrigation in the treatment of anterior resection syndrome. Tech Coloproctol. 2018;22:519–27.

    Article  CAS  PubMed  Google Scholar 

  27. Ture SD, Ozkaya G, Sivrioglu K. Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury. J Spinal Cord Med. 2023;46:424–32.

    Article  PubMed  Google Scholar 

  28. Bazzocchi G, Corazziari ES, Staiano A, Bassotti G, Bellini M, Chiarioni G, et al. Position paper on transanal irrigation in chronic non-organic constipation. Dig Liver Dis. 2024;56:770–7.

    Article  CAS  PubMed  Google Scholar 

  29. Ethans K, Smith K, Khandelwal A, Nankar M, Shea J, Casey A. Transanal irrigation bowel routine for people with Cauda Equina Syndrome. J Spinal Cord Med. 2024;47:263–9.

    Article  PubMed  Google Scholar 

  30. Brochard C, Jezequel M, Blanchard-Dauphin A, Kerdraon J, Perrouin-Verbe B, Leroi AM, et al. Transanal irrigation is a better choice for bowel dysfunction in adults with Spina bifida: A randomised controlled trial. Colorectal Dis. 2023;25:1267–76.

    Article  CAS  PubMed  Google Scholar 

  31. Juul T, Christensen P. Prospective evaluation of transanal irrigation for fecal incontinence and constipation. Tech Coloproctol. 2017;21:363–371.

    Article  CAS  PubMed  Google Scholar 

  32. Boman E, Nylander M, Oja J, Olofsson B. Transanal irrigation for people with neurogenic bowel dysfunction: an integrative literature review. Gastroenterol Nurs. 2022;45:211–230.

    Article  PubMed  Google Scholar 

  33. Valeska Halstead N, Hirsch J, Rosoklija I, Rague JT, Kim S, Meyer T, et al. Association between quality of life and neurogenic bowel symptoms by bowel management program in Spina Bifida. Urology. 2024;184:228–34.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to express their sincere gratitude to Dr. Giorgio Scivoletto for his valuable contribution and support during the conduct of the study.

Funding

No financial assistance was received in support of the study.

Author information

Authors and Affiliations

  1. Unità Spinale Unipolare e Unità di Medicina Fisica e Riabilitazione, A.O.U. Policlinico Giovanni XXIII, Bari, Italy

    Giuseppina Frasca & Luisa De Palma

  2. Dipartimento di Biomedicina Traslazionale e Neuroscienze-Università Aldo Moro, Bari, Italy

    Marisa Megna

  3. Unità Spinale Unipolare presidio CTO, Dipartimento di Ortopedia Traumatologica e Riabilitazione Città della Salute e della Scienza di Torino, Torino, Italy

    Ilaria Rosso, Lorella Cocchini & Gianluca Medina

  4. Unità Spinale, Azienda Ospedaliero-Universitaria di Careggi, Firenze, Italy

    Gabriele Righi, Annalisa Baroni & Giulio Del Popolo

  5. Unità Operativa di Urologia e Unità Spinale di Catania, Azienda Ospedaliera Cannizzaro, Catania, Italy

    Astrid Bonaccorsi, Francesco Savoca & Angela Costa

Authors
  1. Giuseppina Frasca
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  2. Luisa De Palma
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  3. Marisa Megna
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  4. Ilaria Rosso
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  12. Angela Costa
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Contributions

All authors contributed to the design and conceptualization of the research protocol. GS, LDP, MM, IR, LC, GM, GR, ABaroni, GDP, ABonaccorsi, FS, AC recruited the patients, collected and analysed their data. GS, LDP, MM, IR, LC, GM, GR, ABaroni, GDP, ABonaccorsi, FS, AC contributed to drafting the manuscript. All authors revised and approved the manuscript.

Corresponding author

Correspondence to Giuseppina Frasca.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

The study was approved by the relevant ethics committees: Comitato Etico Indipendente (Protocol n. 0086080 dated October 17, 2019), Comitato Etico Catania 1 (Protocol n. 0030887 dated July 09, 2019). The study was conducted following the principles outlined in the Declaration of Helsinki and the Good Clinical Practices concerning clinical investigations of medical devices for human subjects (ISO 14155 and CPMP/ICH/135/95, ICH-E6).

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All participants provided written informed consent for participation.

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Frasca, G., De Palma, L., Megna, M. et al. Early transanal irrigation in spinal cord injury-related neurogenic bowel dysfunction: preliminary insights. Spinal Cord Ser Cases 12, 7 (2026). https://doi.org/10.1038/s41394-026-00733-5

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