Understanding the barriers to Rectal Irrigation
Research type
Research Study
Full title
Understanding the barriers to Rectal Irrigation in patients with defaecatory dysfunction
IRAS ID
336619
Contact name
Alison Hainsworth
Contact email
Sponsor organisation
Guys and St. Thomas' NHS Foundation Trust
Duration of Study in the UK
0 years, 6 months, 29 days
Research summary
Rectal irrigation is the introduction of warm tap water through the anal canal into the rectum to initiate defaecation. Proposed mechanisms of action include simple mechanical washout, colonic movement stimulated by the washout, or a combination of these(1).
By regularly emptying the bowel in this manner, rectal irrigation helps re-establish control of bowel function and enables the patients to choose the time and place of evacuation thus re-instating more predictable bowel movement (2) and therefore allowing them to have a better quality of life.
It has been available in clinical practice since the late 1980’s, being used in children with spina bifida (3). It was initially used in adults with neurogenic bowel dysfunction after conservative management had failed (4) but is now used in a wider variety of conditions (1). Rectal irrigation is reported to benefit some patients with faecal incontinence, evacuation disorders, rectocoele and constipation (5,6). According to the pelvic floor report in 2021, 6.5 million people suffered with bowel problems in the UK with 85% of patients not reporting symptoms of faecal incontinence to their doctor and 57,000 required hospital admissions in England due to constipation in 2010/2011(7).National Institute for Health and Care Excellence recommends that rectal irrigation be considered in patients with constipation(8) and faecal incontinence (9) refractory to conservative measures such as lifestyle advice and pharmacological therapy, and bio-feedback therapy which is a treatment to help patients learn to strengthen or relax their pelvic floor muscles to improve bowel or bladder function by retraining the pelvic floor muscles and provides psychosocial support(10).
Studies have looked at outcomes of rectal irrigation in patients with defaecatory difficulties (6,11,12) where improvement in symptoms or quality of life in patients after using irrigation has been reported. Christensen reported that 52% of the patients used rectal irrigation for a median of 8 months before discontinuing treatment(11) where reasons for discontinuation were unsatisfactory effect, faecal incontinence, time consumption, disliking for treatment, side effects, leakage of irrigation fluid and expulsion of rectal catheter. Tamvakeras reported four (22%) out of eighteen patients discontinued rectal irrigation in a median length of 4.8 months. Three of the four patients who discontinued rectal irrigation found it ineffective while the fourth patient discontinued due to resolution of symptoms(12).
Barriers to using rectal irrigation other than side-effects or unsatisfactory outcome still need to be explored such as cultural or social reasons and lack of knowledge or fear about the treatment.
We aim to organize focused group sessions and cognitive interviews of patients to understand the barriers to irrigation so that these can be addressed for better compliance and outcome leading to a better quality of life in patients with defaecatory difficulties.
REC name
West of Scotland REC 3
REC reference
24/WS/0063
Date of REC Opinion
4 Jul 2024
REC opinion
Further Information Favourable Opinion