Consensus Review of Best Practice of Transanal Irrigation in Children

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 64; no. 3; pp. 343 - 352
• Main Authors: Mosiello, Giovanni, Marshall, David, Rolle, Udo, Crétolle, Célia, Santacruz, Bruno G., Frischer, Jason, Benninga, Marc A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: United States by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology 01.03.2017
• Subjects: Adolescent; Anal Canal; anorectal malformation; best practice; bowel dysfunction; Child; Child, Preschool; children; Constipation - therapy; Fecal Incontinence - therapy; Humans; Infant; neurogenic bowel; Patient Selection; Therapeutic Irrigation - adverse effects; Therapeutic Irrigation - methods; transanal irrigation; Treatment Outcome; Young Adult
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0000000000001483

ABSTRACT Pediatric patients with either functional or organic bowel dysfunction may suffer from constipation and fecal incontinence and represent a complex group in whom management is often difficult. Many noninvasive and invasive treatments have been proposed, with variable efficacy and adverse effects. Transanal irrigation (TAI) is now an accepted alternative, in both children and adults, for bowel dysfunction that has not responded to conservative and medical therapies. There is, however, still some uncertainty about the use of TAI in pediatric populations. Hence, a group of specialists from different nations and pediatric disciplines, all with long‐standing experience of bowel management in children, performed a literature search and had round table discussions to determine the best‐practice use of TAI in the pediatric patient population. Based on these findings, this article provides best‐practice recommendations on indications, patient selection, important considerations before treatment, patient and family training, treatment regimens, troubleshooting, and practical aspects of TAI. We conclude that careful patient selection, a tailored approach, directly supervised training, and sustained follow‐up are key to optimize outcomes with TAI in children with functional or organic bowel dysfunction.