Clinical documentation

Anal Irrigation is a well documented method that brings bowel management into the 21st century by providing people with a simple and effective way to empty their bowels, whilst preserving patient dignity. Below are some of the most recent articles to be published on the subject.

1.
Title: A randomized Controlled Trial of Transanal Irrigation Versus Conservative Bowel Management in Spinal Cord Injured Patients
Author/s: Christensen P., Bazzocchi G., Coggrave M., Abel R., Hultling C., Krogh K., Media S., Laurberg S. Gastroenterology 2006;131: 738-747.
Aim: To provide a control trial of different bowel methods and compare transanal irrigation (using Peristeen Anal Irrigation) with conservative bowel management (best supportive bowel care without irrigation).
Method: The trial was a prospective, randomised and controlled, which took place in five specialised European spinal cord centres. 87 patients were randomly assigned to either transanal irrigation (42 patients) or conservative bowel management (45 patients) over a ten week period.
Results: Anal Irrigation scored better in all three bowel function scoring systems than conservative bowel management.
Conclusion: Compared with conservative bowel management, transanal irrigation improves constipation, faecal incontinence, and symptom-related quality of life.

2.
Title: Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation
Author/s: Christensen P., Olsen N., Krogh K, Bacher T., Laurberg S. Diseases of the Colon and Rectum 2003: 46:68-76.
Aim: To evaluate the colorectal luminal transport obtained by retrograde colonic washout with a new scintigraphic technique.
Method: 19 patients treated with retrograde colonic washout were given traceable pellets to track their bowel contents. Scintigraphy was performed before and after a standardised washout procedure and a bowel defecation score was established by dividing the colon into four segments and measuring the directional segmental transport
Results: Patients with spinal cord lesions or idiopathic faecal incontinence were able to empty most of the rectosigmoid and most of the descending colon. Those with idiopathic constipation could only empty 59% of the rectosigmoid.
Conclusion: The effect of the retrograde colonic washout significantly better in spinal cord lesion and idiopathic faecal incontinence than in idiopathic constipation.

3.
Title: Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients.
Author/s: P Christensen, J Andreasen and L Ehlers, Spinal Cord 2008 1-6.
Aim: To estimate the cost effectiveness of transanal irrigation using a self-administered irrigation system when compared with conservative bowel management.
Method: Efficacy outcomes were drawn from a randomised clinical trial conducted from 2003-2005,which took place at five spinal centres in Europe. Costs were calculated based on results from the clinical trial and on 24 interviews conducted in Germany. Unit costs were obtained from the Federal Statistical Office Germany and product list prices.
Results: When comparing outcome measures at termination, transanal irrigation significantly reduced symptoms of neurogenic bowel dysfunction. Although product-related costs were higher for transanal irrigation using the self-administered system, the total cost to society is lower when patients use transanal irrigation due to the fact that costs for a carer to help with bowel management and changes/washing due to leakage were lower, costs associated with urinary tract infections were lower and patient time spent on bowel management was reduced.
Conclusion: Transanal irrigation using a self-administered system reduces symptoms of neurogenic bowel dysfunction and results in a lower total cost to society than conservative bowel management.

4.
Title: Treatment of neurogenic bowel dysfunction using transanal irrigation: a multi centre Italian study
Author/s: Del Popolo G., Mosiello G., Pilati C., Lamartina M., Battaglino F., Buffa P., Redaelli T., Lamberti G., Menarini M., Di Bendetto P., De Gennaro M., Spinal Cord 2008 1-6.
Aim: To evaluate the effects of Peristeen Anal Irrigation on NBD and patient quality of life (QoL)
Method: Lesion level, ambulatory status and hand functionality were determined in all patients. NBD symptoms and QoL were evaluated before and after treatment, using a specific questionnaire. Statistical analysis was performed using MCNemar Test and Sign Test.
Results: At the end of the treatment, some or the majority of patients noticed; decreased or elimination of the use of pharmaceuticals, less dependency on caregivers, increase in intestinal functionality, increased quality of life.
Conclusion: Peristeen Anal Irrigation is a simple therapeutic method for managing NBD and improving QoL. It should be considered as the treatment of choice for NBD, playing a role in the neurogenic bowel analogous to that of intermittent clean catheterization in bladder treatment.