Transanal irrigation in clinical practice: a scoping review.

Abstract

Purpose: Transanal irrigation is a treatment that promotes predictable bowel emptying and enhances daily management of incontinence and constipation for individuals with bowel disorders. We aimed to map the application of transanal irrigation in clinical practice.

Methods: This scoping review followed the PRISMA-ScR guideline, and the protocol was a priori registered at Open Science Framework. A systematic literature search was performed in PubMed, Embase, CINAHL, and Cochrane CENTRAL. We included original studies on adults (≥ 18 years) treated with self-administered transanal irrigation in outpatient settings. The review investigated irrigation protocols, equipment, patient selection, outcome measures, and reported harms.

Results: Ninety-two studies, including 4,821 adults (41% female), were included. Most studies were observational (51%), and 57% were published in the last decade. Transanal irrigation was most often used for neurogenic bowel dysfunction (36%) and post-surgical conditions (27%). Irrigation volumes ranged from 400 to 2400 ml. Time spent on irrigation typically ranged from 20 to 70 min. Irrigation was commonly performed daily or on alternate days. The Peristeen® system was the most frequently used device. Outcome measures were inconsistent, with 40 different tools used. Most harms reported were minor; however, very rare but serious complications, such as rectal perforation, were reported.

Conclusion: Transanal irrigation was widely used in adult outpatient care, particularly for neurogenic and post-surgical bowel dysfunction, with recurring patterns in irrigation practices. However, heterogeneous outcome reporting limits comparability, highlighting the need for standardized measures and clearer clinical guidance.