Transanal irrigation for intractable faecal incontinence and constipation: outcomes, quality of life and predicting non-adopters

Ng J1, Ford K, Dalton S, McDowell S, Charlesworth P, Cleeve S. Pediatr Surg Int. 2015 Jul 11. [Epub ahead of print]
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1Department of Paediatric Surgery, The Royal London Hospital, London, UK, jessicaykng@outlook.com.


PURPOSE: Intractable faecal incontinence (FI) and constipation is a challenging condition to manage in children. Transanal irrigation (TAI) is a non-operative treatment option. This study presents our experience with TAI with the aim of finding predictive factors of non-compliance.

METHODS: This is an outcome and quality of life (QoL) study of a prospectively maintained database of patients < 17 years old commenced on TAI for intractable FI/constipation between 2008 and 2014. Outcome measures were: (1) compliance-classified as non-adopter (use of TAI stopped within 1 month after commencement) or adopter; (2) functional outcome-classified as responder (totally continent or occasional soiling) or non-responder; (3) Rintala score; and (4) QoL score (PedsQL™ 4.0 Generic Core Scale). Analysis to determine predictive factors was also performed.

RESULTS: 42 patients were started on TAI [74 % male, median age of commencement was 7 (3-16) years]. Underlying diagnoses were: idiopathic constipation (62 %), anorectal malformation (26 %), Hirschsprung disease (5 %), spina bifida (5 %) and gastroschisis (2 %). Median follow-up period was 14 (3-78) months. 24 % were non-adopters. 84 % of the adopters responded to treatment. Rintala scores (mean ± SD) pre- and post-TAI were 6.7 ± 3.5 and 11.2 ± 4.8, respectively (P < 0.001). QoL scores pre- and post-TAI were 55.6 ± 24.1 and 65.5 ± 23.7, respectively (P < 0.001). Median age at which TAI was commenced in the non-adopter and adopter group were 6 (IQR 4.5-8.25) and 8 (IQR 7-12), respectively (P = 0.008).

CONCLUSION: TAI is a safe and effective treatment for intractable constipation/FI in children. If tolerated, it can significantly improve quality of life. Age and underlying diagnosis are important factors when recommending TAI to children with intractable FI/constipation.

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