Transanal irrigation with Peristeen in neurogenic bowel dysfunction: audit of impact on symptoms and quality of life

Background: Spinal cord injury often results in neurogenic bowel dysfunction (NBD). NBD is associated with constipation and faecal incontinence, as well as loss of sensation, faecal loading and faecal leakage, and it has a severe impact on healthcare resources and patient quality of life. NBD is treated conservatively with medication, suppositories, physiotherapy, digital rectal stimulation and digital removal of faeces. Conservative options are not always effective and long-term may lead to haemorrhoids, rectal bleeding, mucosal prolapse and faecal soiling. The National Institute for Health and Care Excellence recommends the use of the Peristeen transanal irrigation system, which instills lukewarm water into the colon via a balloon catheter to stimulate regular and complete bowel movements. Aim: To assess the impact of transanal irrigation with Peristeen on the symptoms and treatments of NBD, as well as patient quality of life and satisfaction, in a regional spinal injury centre. Method: Patients were asked to complete an adapted NBD assessment at consultation when they were prescribed Peristeen and at 8-week follow up. Answers to 10 questions on symptoms and treatment were individually weighted to provide a bowel dysfunction score, excluding two Likert-type questions on quality of life. Results: Patient numbers undergoing digital evacuations once or more a week decreased by more than 50%, and medication use decreased slightly. Patients reported a decrease in the following symptoms: peri-anal skin problems (9%); uneasiness, sweating or headaches (20%); uncontrollable flatus (27%); rectal bleeding (30%); faecal soiling (37%) and involuntary defecation (46%). Mean total bowel dysfunction score decreased by 11.6 from 20.4 to 8.8, and those with dysfunction categorised as severe decreased by 64% from 80% to 16%. Average negative emotional wellbeing improved from 4.0 to 1.2, and mean satisfaction increased from 3.2 to 7.3. Conclusion: According to the study findings, Peristeen is observed to improve quality of life in spinal NBD, and it is effective at reducing both associated symptoms and the need for digital rectal stimulation and digital removal of faeces.