Transanal irrigation (TAI) in the paediatric population: Literature review and consensus of an Italian multicentre working group


Submitted: 5 January 2021
Accepted: 20 April 2021
Published: 7 May 2021
Abstract Views: 2760
PDF: 536
HTML: 59
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Constipation and fecal incontinence in pediatric patients are conditions due to either functional or organic bowel dysfunction and may represent a challenging situation both for parents, pediatricians, and pediatric surgeons. Different treatments have been proposed throughout the past decades with partial and alternant results and, among all proposed techniques, in the adult population the Transanal Irrigation (TAI) has become popular. However, little is known about its efficacy in children. Therefore, a group of Italian pediatric surgeons from different centers, all experts in bowel management, performed a literature review and discussed the best-practice for the use of TAI in the pediatric population. This article suggests some tips, such as the careful patients’ selection, a structured training with expert in pediatric colorectal diseases, and a continuous follow-up, that are considered crucial for the full success of treatment.


Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults, a systematic review. Best Pract Res Clin Gastroenterol 2011;25:3-18. DOI: https://doi.org/10.1016/j.bpg.2010.12.010

Chase JW, Homsy Y, Siggaard C, et al. Functional constipation in children. J Urol 2004;171:2641. DOI: https://doi.org/10.1097/01.ju.0000109743.12526.42

Rajindrajith S, Devanarayana NM, Benninga MA. Review article: faecal incontinence in children: epidemiology, pathophysiology, clinical evaluation and management. Aliment Pharmacol Ther 2013;37:37–48. DOI: https://doi.org/10.1111/apt.12103

López Pereira P, Salvador OP, Arcas JA, et al. Transanal irrigation for the treatment of neu-ropathic bowel dysfunction. J Pediatr Urol 2010;6:134-8. DOI: https://doi.org/10.1016/j.jpurol.2009.07.004

Pena A, Guardino K, Tovilla JM, et al. Bowel management for fecal incontinence in patients with anorectal malformations. J Pediatr Surg 1998;33:133-7.

Keshtgar AS, Ward HC, Clayden GS, de Sousa NM. Investigations for incontinence and constipation after surgery for Hirschsprung’s disease. Ped Surg Int 2003;19:4-8. DOI: https://doi.org/10.1007/s00383-002-0897-x

Shandling B, Gilmour RF. The enema continence catheter in spina bifida: successful bowel management. J Pediatr Surg 1987;22:271-3.

Del Popolo G, Mosiello G, Pilati C, et al. Treatment of neurogenic bowel dysfunction using transanal irrigation: a multi center Italian study. Spinal Cord 2008;46:517-22. DOI: https://doi.org/10.1038/sj.sc.3102167

Emmanuel A. Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction. Spinal Cord 2010;48:664-73. DOI: https://doi.org/10.1038/sc.2010.5

Bray L, Sanders C. An evidence-based review of the use of transanal irrigation in children and young people with neurogenic bowel. Spinal Cord 2013;51:88-93. DOI: https://doi.org/10.1038/sc.2012.146

Christensen P, Krogh K, Buntzen S, et al. Long-term outcome and safety of transanal irriga-tion for constipation and fecal incontinence. Dis Colon Rectum 2009;52:286-92. DOI: https://doi.org/10.1007/DCR.0b013e3181979341

Midrio P, Mosiello G, Ausili C, et al. Peristeen® transanal irrigation in pediatric patients with anorectal malformations and spinal cord lesions: a multicentre Italian study. Colorectal Dis 2016;18:86-93. DOI: https://doi.org/10.1111/codi.13101

Emmanuel AV, Krogh K, Bazzocchi G, et al. Consensus review of best practice of transanal irrigation in adults. Spinal Cord 2013;51:732-8. DOI: https://doi.org/10.1038/sc.2013.86

Coggrave M. Neurogenic continence. Part 3: bowel management strategies. Br J Nurs 2008;17:962-8. DOI: https://doi.org/10.12968/bjon.2008.17.15.30698

Corbett P, Denny A, Dick K, et al. Peristeen integrated transanal irrigation system success-fully treats fecal incontinence in children. J Pediatr Urol 2014;10:219-22. DOI: https://doi.org/10.1016/j.jpurol.2013.08.006

Chapman W, Hill M, Shurtleff DB. Management of neurogenic bowel and bladder. Oak Brook, ILL: Eterna Press; 1979.

Puet TA, Jackson H, Amy S. Use of pulsed irrigation evacuation in the management of the neuropathic bowel. Spinal Cord 1997;35:694-9. DOI: https://doi.org/10.1038/sj.sc.3100491

Christensen P, Bazzocchi G, Coggrave M, et al. A randomized controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology 2006;131:738-47. DOI: https://doi.org/10.1053/j.gastro.2006.06.004

Ausili E, Focarelli B, Tabacco F, et al. Transanal irrigation in myelomeningocele children: an alternative, safe and valid approach for neurogenic constipation. Spinal Cord 2010;48:560-5. DOI: https://doi.org/10.1038/sc.2009.186

Blair GK, Djonlic K, Fraser GC, et al. The bowel management tube: an effective means for controlling fecal incontinence. J Pediatr Surg 1992;27:1269-72. DOI: https://doi.org/10.1016/0022-3468(92)90271-8

Choi EK, Shin SH, Im YJ, et al. The effects of transanal irrigation as a stepwise bowel man-agement program on the quality of life of children with spina bifida and their caregivers. Spinal Cord 2013;51:384-8. DOI: https://doi.org/10.1038/sc.2013.8

Eire PF, Cives RV, Gago MC. Faecal incontinence in children with spina bifida: the best conservative treatment. Spinal Cord 1998;36:774-6. DOI: https://doi.org/10.1038/sj.sc.3100694

King SK, Stathopoulos L, Pinnuck L,et al. Retrograde continence enema in children with spina bifida: not as effective as first thought. J Paediatr Child Health 2017;53:386-90. DOI: https://doi.org/10.1111/jpc.13408

Liptak GS, Revell GM. Management of bowel dysfunction in children with spinal cord dis-ease or injury by means of the enema continence catheter. J Pediatr 1992;120:190-4. DOI: https://doi.org/10.1016/S0022-3476(05)80425-1

Märzheuser S, Karsten K, Rothe K. Improvements in incontinence with self-management in patients with anorectal malformations. Eur J Pediatr Surg 2016;26:186-91. DOI: https://doi.org/10.1055/s-0034-1544050

Matsuno D, Yamazaki Y, Shiroyanagi Y, et al. The role of the retrograde colonic enema in children with spina bifida: is it inferior to the antegrade continence enema? Pediatr Surg Int 2010;26:529-33. DOI: https://doi.org/10.1007/s00383-010-2585-6

Mattsson S, Gladh G. Tap-water enema for children with myelomeningocele and neurogenic bowel dysfunction. Acta Paediatr 2006;95:369-74. DOI: https://doi.org/10.1080/08035250500437507

Nasher O, Hill RE, Peeraully R, et al. Peristeen (â“’) transanal irrigation system for paediatric faecal incontinence: a single centre experience. Int J Pediatr 2014;2014:954315. DOI: https://doi.org/10.1155/2014/954315

Ng J, Ford K, Dalton S, et al. Transanal irrigation for intractable faecal incontinence and constipation: outcomes, quality of life and predicting non-adopters. Pediatr Surg Int 2015;31:729-34. DOI: https://doi.org/10.1007/s00383-015-3735-7

Peña A, Guardino K, Tovilla JM, et al. Bowel management for fecal incontinence in patients with anorectal malformations. J Pediatr Surg 1998;33:133-7. DOI: https://doi.org/10.1016/S0022-3468(98)90380-3

Shandling B, Gilmour RF. The enema continence catheter in spina bifida: successful bowel management. J Pediatr Surg 1987;22:271-3. DOI: https://doi.org/10.1016/S0022-3468(87)80345-7

Schöller-Gyüre M, Nesselaar C, van Wieringen H, van Gool JD. Treatment of defecation disorders by colonic enemas in children with spina bifida. Eur J Pediatr Surg 1996;6 Suppl 1:32-4. DOI: https://doi.org/10.1055/s-2008-1071036

Vande Velde S, Van Biervliet S, Van Renterghem K, et al. Achieving fecal continence in pa-tients with spina bifida: a descriptive cohort study. J Urol 2007;178:2640-4. DOI: https://doi.org/10.1016/j.juro.2007.07.060

Walker J, Webster P. Successful management of faecal incontinence using the enema conti-nence catheter. Z Kinderchir 1989;44:44-5. DOI: https://doi.org/10.1055/s-2008-1043293

Willis RA. Faecal incontinence--Willis Home Bowel Washout Programme. Z Kinderchir 1989;44:46-7. DOI: https://doi.org/10.1055/s-2008-1043294

Velde SV, Biervliet SV, Bruyne RD, Winckel MV. A systematic review on bowel manage-ment and the success rate of the various treatment modalities in spina bifida patients. Spinal Cord 2013;51:873-81. DOI: https://doi.org/10.1038/sc.2013.123

Koppen IJ, Kuizenga-Wessel S, Voogt HW, et al. Transanal irrigation in the treatment of children with intractable functional constipation. J Pediatr Gastroenterol Nutr 2017;64:225-29. DOI: https://doi.org/10.1097/MPG.0000000000001236

Norton C. Guidelines for the use of rectal irrigation for healthcare professionals. St Mark’s Hospital and Burdett Institute of Gastrointestinal Nursing editor, 2009.

Biering-Sorensen F, Bing J, Berggreen P, Olesen GM. Rectum perforation during transanal irrigation: a case story. Spinal Cord 2009;47:266-7. DOI: https://doi.org/10.1038/sc.2008.95

Paran H, Butnaru G, Neufel D, et al. Enema-induced perforation of the rectum in chronically constipated patient. Dis Colon Rectum 1999;42:1609-12. DOI: https://doi.org/10.1007/BF02236216

Marek I, Benz K, Kusnik S, et al. Phosphate intoxication after application of enema--a life-threatening iatrogenic complication. Klin Padiatr 2015;227:235-8. DOI: https://doi.org/10.1055/s-0035-1548839

Caponcelli, E., Meroni, M., Brisighelli, G., Rendeli, C., Ausili, E., Gamba, P., Marte, A., Iacobelli, B. D., Lombardi, L., Leva, E., & Midrio, P. (2021). Transanal irrigation (TAI) in the paediatric population: Literature review and consensus of an Italian multicentre working group. La Pediatria Medica E Chirurgica, 43(1). https://doi.org/10.4081/pmc.2021.250

Downloads

Download data is not yet available.

Citations