Transanal Irrigation in Children

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 75; no. 2; pp. 166 - 172
• Main Authors: Baaleman, Desiree F., Wegh, Carrie A. M., Hoogveld, Maxime T. A., Benninga, Marc A., Koppen, Ilan J. N.
• Format: Journal Article
• Language: English
• Published: 01.08.2022
• Subjects: child; constipation; fecal incontinence; transanal irrigation
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0000000000003515

Objectives: To investigate the clinical effectiveness and patient experience of transanal irrigation (TAI) in children with constipation or fecal incontinence. Methods: Combined retrospective and cross‐sectional study including pediatric patients who used a Navina TAI system. We retrospectively collected baseline characteristics and data on treatment success at 1‐ and 6‐month follow‐up (FU). Treatment success was defined as defecating at least 3 times per week and having less than 1 episode of fecal incontinence per week. We cross‐sectionally assessed health‐related quality of life (HRQoL), treatment adherence, treatment satisfaction (Treatment Satisfaction Questionnaire for Medication [TSQM]), illness perceptions, medication beliefs, and patient empowerment with validated questionnaires. Results: Thirty‐four patients were included (median age at start TAI: 11 years old [range, 6–18]), 32 in the retrospective review, and 26 in the cross‐sectional survey (median of 3 years after initiation). Most patients were diagnosed with functional constipation (n = 26; 76%) or a neurogenic bowel disorder (n = 6; 18%). Treatment success rates significantly improved at each FU compared with baseline (baseline: 4/25 [16%]; 1‐month FU: 12/16 [75%], P = 0.008; 6‐month FU: 11/18 [61%], P = 0.016; cross‐sectional FU: 13/26 [50%], P = 0.008). HRQoL scores were high (PedsQL median, 73 [IQR, 54–85]). Adherence (defined as Medication Adherence Report Scale [MARS] ≥ 23) was low (36%), whereas TSQM effectiveness scores were high (median, 69 [IQR, 47–86]). The majority of children (61%) reported an increase in independence since TAI treatment. Patient empowerment (GYPES) levels were similar to those reported in children with other chronic conditions. Conclusions: TAI with a Navina system is an effective bowel management system for children with intractable constipation or fecal incontinence.