Consensus on Safe Initiation and Monitoring of Transanal Irrigation to Optimize Adherence With Therapy.

Background: Transanal irrigation is a well-established minimally invasive therapy that addresses symptoms of both constipation and incontinence. The therapy has been extended from just neurogenic bowel dysfunction patients to those with disorders of brain-gut interaction and postsurgical conditions.

Aim: To summarized the literature on transanal irrigation and update the contraindication profile.

Materials and methods: We undertook a literature review of transanal irrigation complications and outcomes.

Results: Initiation of therapy as part of a bowel care regime is becoming more common outside specialist centers. In addition, the concept of both high- and low-volume irrigation schedules has entered the treatment paradigm, and it is clear that there is a differing safety profile. We present an update from the previous long list of contraindications.

Discussion: We describe how optimizing long-term adherence depends on these factors in addition to a structured follow-up programme.

Conclusion: Transanal irrigation is an increasingly used therapy, with a good safety profile, further improved by the advent of low-volume irrigation options. Key to safe and effective usage of transanal irrigation is careful patient selection allied to tailored initial training of the patient.