Transanal irrigation: is it the magic intervention for bowel management in individuals with bowel dysfunction?

Transanal irrigation (TAI) is the insertion of tepid tap water (36-38°C) (Henderson et al, 2018) into the lower bowel using either a rectal catheter or a cone device. It is usually self-administered by the individual or performed by a carer or health professional. The procedure has also been referred to as rectal irrigation or as bowel washouts. It has recently been approved by the National Institute for Health and Care Excellence (NICE) (2018) as a form of bowel treatment in individuals who suffer bowel dysfunction of either constipation or faecal incontinence.

Although it may be a relatively new intervention for bowel dysfunction, anal irrigation itself is an old concept. The Roman writer Pliny the Elder (AD23-79) recorded that the ancient Egyptians are believed to have watched and learnt from the sacred ibis who used its long beak to insert water into its anus to wash out decaying material (Doyle, 2005; Yates, 2019). The sacred ibis was associated with their god of wisdom, Thoth, who was said to have devised the use of enemas to relieve bowel problems. TAI has been used over the centuries to treat a long list of symptoms, including nausea, fatigue, depression, headache, anxiety, rheumatism and constipation, and it has been used as a ritual and part of the modern social phenomenon of colonic irrigation (Doyle, 2005; Yates 2019). Individuals who may present with bowel dysfunction would include people with neuropathic bowel disorders, such as multiple sclerosis, spinal injuries, spina bifida, Parkinson's and other conditions that affect sphincter control or bowel motility disorders. Bowel dysfunction can also include injury to the rectum, sphincter or bowel, slow transit times, evacuation difficulties or prolapse due to a weak/damaged pelvic floor (Emmanuel et al, 2013), and chronic faecal incontinence (NICE, 2018). However, there are numerous factors that may influence an individual's ability to use the device as a clinical treatment option. These factors are discussed in this article.