Introduction Rectal irrigation was developed to treat patients with neurogenic bowel dysfunction. More recently its application in the management of functional bowel disorders has increased but published outcome data are scarce. Our pelvic floor unit offers a novel tertiary referral service (the Healthy Bowel Clinic) and has employed rectal irrigation within a Bowel Care Pathway for the last 6 years to treat a variety of functional bowel symptoms, including constipation, faecal incontinence and obstructive defecation syndromes (ODS). As part of our service evaluation we aimed to audit patient-reported outcome using a postal questionnaire survey.
Methods We identified a cohort of 101 consecutive patients (85 female; 16 male) who had commenced rectal irrigation and attended the service for at least 12 weeks (mean: 55 weeks; range 12–70). The cohort included 45 with predominant constipation, 27 with faecal incontinence and 29 with ODS. A cross-sectional postal survey was undertaken using a questionnaire which first asked whether irrigation was continuing at this time or not. Patients reporting continued use were asked to record it’s frequency, water volume and a pre- and post-treatment symptom score (VAS Scale:0–10). Those reporting cessation of treatment were asked to indicate their reasons for stopping. Reasons for discontinuation of irrigation were recorded.
Results 68 of 101 patients (67.3%) reported continuing use of rectal irrigation. Of the patients still irrigating, 24 were in the constipated group, 18 were in the faecal incontinence group and 26 were in the ODS group. Their mean (sd) pre-treatment symptom score was 9.1 (1.5), confirming a high symptom burden among patients selected for treatment, and the post-treatment rating of current symptoms was significantly improved at 4.2 (2.3) (p < 0.001). The mean irrigation volume was ~800 mls (range: 150–2000) and 41 patients (60%) reported daily use. Of 33 patients who stopped using irrigation, 11 (33.3%) cited a failure to address symptoms as the reason for cessation (Constipation: 21; Faecal Incontinence: 9; ODS: 3).
Conclusion The results show that rectal irrigation is a viable treatment option for patients presenting with a range of functional bowel symptoms. Efficacy was achieved across a variety of sub-groups. It was acceptable and well-tolerated as indicated by frequent and prolonged use in many patients. Further research is needed to identify clinical criteria to guide patient selection and predictors of success.
Disclosure of Interest None Declared.