A recent retrospective study (S Patel et al. JPGN 2020; 71: 292-297. Impact of Transanal Irrigation Device in the Management of Children With Fecal Incontinence and Constipation) provides some useful experience in the management of constipation related to bowel dysfunction (n=147), including patients with neurogenic bowel dysfunction (NBD) related to spinal cord defects (NBD, n=85), refractory constipation (RC, n=43), or anorectal malformations (ARMs, n=19).
The authors elaborate on their protocol which includes flushing with warm tap water (on average) 15 mL/kg, generally once a day. They note that the device is contraindicated in patients <2 years of age and/or within 3 months of anal/colorectal surgery. The Peristeen device has been FDA approved since 2012.
- For all patient groups, there was significant improvement in symptoms of fecal incontinence and constipation (P ≤ 0.001).
- Abdominal pain was improved in the NBD and RC group, but not significantly in the ARM group.
My take: As with other treatment options for these problems, the key to success is adequate upfront training. The authors note that their training sessions typically last 1-2 hours. A limiting factor with this treatment can be cost.
Useful link: Peristeen Bowel Management
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