Low-volume transanal irrigation (TAI) in the treatment of functional faecal incontinence in children: a cohort study.

Purpose: Functional faecal incontinence (FFI) is a stigmatising condition for a child and parents and can be a challenge to treat even in tertiary centres. Transanal irrigation (TAI) is an emerging treatment with great success in refractory cases. We performed TAI with a substantially decreased amount of water used (low-volume TAI), yet no previous evidence exists on this treatment in children. We conducted this study to evaluate the efficacy of low-volume TAI in reducing faecal incontinence (FI) episodes and to provide associated factors for response.

Methods: Children with FFI trained in low-volume TAI in our outpatient incontinence clinic were identified. Baseline characteristics along with rectal ultrasound examination, information on weekly FI episodes and concomitant use of laxatives were noted. The continence status of patients was registered at the first outpatient clinic appointment after the commencement of TAI and after 6 months of treatment. During this period, information about side effects and changes in medication were captured.

Results: We identified 47 children (mean age 8.06 ± 2.08 years, 27 males) treated with low-volume TAI. Thirty-five (74%) were diagnosed with functional constipation and FI, while 12 (26%) suffered from non-retentive faecal incontinence. Twenty (42%) children gained full faecal continence after 6.75 ± 0.3 months. We found no differences between responders and non-responders in baseline characteristics.

Conclusions: Low-volume TAI appears safe and effective in the treatment of FFI refractory to first-line treatment in children. Low-volume TAI could be a valuable tool for the management of these children as the treatment is less invasive, low in cost and well accepted.