Transanal irrigation: Bridging the gap in treatment for chronic constipation and/or faecal incontinence—A systematic review and management guidance

TL;DR

Transanal irrigation may help people with chronic constipation or fecal incontinence, but more research is needed to confirm its effectiveness.

Contribution

This study updates evidence on transanal irrigation and proposes its role in treatment pathways while identifying key research gaps.

Findings

One randomized trial suggested high-volume transanal irrigation may be more effective than low-volume for chronic constipation.

Most observational studies showed symptom or quality of life improvements, though outcomes varied widely.

Treatment discontinuation rates ranged from 3% to 57% across studies.

Abstract

The aims of the study were to: (1) update a systematic review on the efficacy of transanal irrigation (TAI) in patients with chronic constipation (CC) and/or faecal incontinence (FI); (2) provide guidance on the position of TAI in the treatment pathway of CC and FI; and (3) discuss knowledge gaps and areas of future research.

A collaborative of 11 experts (gastroenterologists, colorectal surgeons, and clinical scientists) from eight European countries was established. The expert group was divided into three main groups, with each group leading a specific section (systematic review, treatment pathway, and knowledge gaps). A previously published systematic review on TAI was updated by conducting an additional search on 12 April 2025. Studies on TAI in specific subgroups (neurogenic bowel dysfunction, low anterior resection syndrome) were excluded.

Sixteen studies involving 1567 (range 16–507) patients were included. Only one underpowered randomised trial was performed, which demonstrated that high‐volume TAI may be more effective than low‐volume TAI in patients with CC. Most other studies (observational) showed improvement in symptoms and/or quality of life to some extent, with a large variation in outcomes used. Treatment discontinuation was reported in 3–57% of patients. The position of TAI in the treatment pathway of CC and FI was proposed, and 13 knowledge gaps were provided.

TAI may be an effective treatment in patients with CC and/or FI. There is a need for randomised controlled trials to study its efficacy and current knowledge gaps.

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