Peristeen integrated transanal irrigation system successfully treats faecal incontinence in children
Introduction
Faecal incontinence and constipation associated with myelomeningocele, anorectal malformation, and Hirschsprung disease are common, debilitating, and difficult to treat [1], [2], [3]. In the quest to achieve continence, oral and rectal medications have limited value in children with these conditions. The Malone Antegrade Continence Enema (MACE) has been used for over two decades, with measurable improvements in bowel function and quality of life. MACE requires surgery with an associated complication rate, particularly stomal stenosis [4], [5], [6], [7], [8]. There is often reluctance to commit to a surgical stoma in younger children (4–7 years), in whom compliance is unpredictable.
The Peristeen trans-anal irrigation system (TAIS) (Coloplast, Denmark) instils water or irrigation solution via a disposable balloon catheter to the colon and rectum. The instillate, along with the contents of the descending colon, sigmoid, and rectum, is then evacuated in a controlled manner [9]. We selected this system over simple rectal or conus irrigation because of the element of controlled evacuation that the system manufacturer claimed to provide. Our centre began offering this management regimen 5 years ago to families with children suffering from constipation and faecal incontinence who were responding poorly to medication. The carers (and child, if competent) are taught by a specialist nurse how to use the system. The volume and frequency of the instillations are decided on a case by case basis.
Small series of children using TAIS have been published and demonstrated improved continence but the impact on quality of life was not assessed [10], [11]. We aimed to assess any change in bowel function and quality of life of the patients and their carers following introduction of TAIS, as well as overall compliance and complications.
Section snippets
Patients and methods
Since its introduction to our centre in 2006, we have offered the Peristeen TAIS to all patients with faecal incontinence who we would previously have considered for MACE. All patients/carers to whom TAIS was offered, agreed to trial its use. We retrospectively reviewed the case notes of all children who used TAIS over the next 5 years.
We also conducted an interview with each patient's primary carer using the validated Fecal Incontinence/Constipation Quality Of Life (FICQOL) questionnaire [12].
Results
Twenty-four patients (13 male) were instructed in the use of TAIS. The goal in these patients (aged 4 years and over) was to achieve faecal continence.
Median age at commencement was 6 years (range 4–16 years). Primary diagnosis was neuropathic bowel (secondary to myelomeningocele and sacral agenesis) in 15, anorectal malformation in five (1 with additional spinal anomaly), and Hirschsprung disease in four. Eight of the children with neuropathy had reduced mobility, requiring either a wheelchair
Discussion
This study has demonstrated that there are measurable improvements in faecal incontinence and quality of life when using TAIS for children with a range of underlying disorders where soiling is the end result. A small proportion of patients (12%) were unable to cooperate with its use; unfortunately, the sample size (3 patients) was insufficient to identify any prognostic factors regarding successful use, e.g. nature of underlying condition, sex, and age. There were no significant adverse
Conclusion
The Peristeen TAIS is a safe and effective method of improving bowel management in children with intractable faecal incontinence associated with myelomeningocele, anorectal malformation, and Hirschsprung disease. There were no significant complications associated with its use and tap water appears to be safe. Peristeen may be an effective non-operative “bridge” to MACE in younger children, or even a long-term alternative to MACE, if initial compliance can be achieved.
Ethical approval
The authors obtained ethical approval from their institutional ethics committee before commencement of the study and comply with the standards set forth in the Journal of Pediatric Urology.
Conflict of interest
None.
Funding
None.
References (16)
- et al.
Somatic function, mental health, and psychosocial adjustment of adolescents with anorectal anomalies
J Pediatr Surg
(1996) - et al.
Preliminary report: the antegrade continence enema
Lancet
(1990) - et al.
The Malone antegrade continence enema
J Pediatr Surg
(1995) - et al.
Objective measurement of quality of life changes after ACE Malone using the FICQOL survey
J Pediatr Urol
(2011) - et al.
The MACE procedure: experience in the United Kingdom
J Pediatr Surg
(1999) - et al.
Management of neuropathic bowel dysfunction with transanal irrigation system
J Pediatr Urol
(2010) - et al.
Development and validation of the fecal incontinence and constipation quality of life measure in children with spina bifida
J Urol
(2008) - et al.
The enema continence catheter in spina bifida: successful bowel management
J Pediatr Surg
(1987)
Cited by (50)
Position paper on transanal irrigation in chronic non-organic constipation
2024, Digestive and Liver DiseasePediatric Neurogenic Bladder and Bowel Dysfunction: Will My Child Ever Be out of Diapers?
2020, European Urology FocusCitation Excerpt :Constipation was reported as a treatment parameter in seven studies, which found that 297/446 (67%) patients had resolution of their constipation after nonsurgical bowel therapy [9,65,69,77,78,80,83]. Corbett et al [72] did not report directly on constipation as a symptom but found that stooling frequency increased from once every 3 d to once every day after initiation of RCE. In the Choi et al’s [117] study, 88% of the patients who were taking anticholinergics for bladder management complained of constipation, while only 64% of those not taking them were constipated.