Rectal Irrigation Decision Guide

Patients can get their products delivered for free directly to their homes by using Qufora direct. For new patients they will get a teaching pack sent to them next day or up to 48 hours*. (Only available in the UK and Northern Ireland)

Registering them through Qufora direct also gives them access to our myqufora support service to get them off to the best start possible with irrigation. This service now also offers an automated delivery option. That way your patient can get their system delivery according to your instruction regularly. Our support team will help them with scheduled check ins and a three-month check-up – to make sure they are on track.

*Orders placed by 12pm will be delivered the next day. After that it will take up to 48 hours.

1. The PERSPECTIVE study has shown transanal irrigation (TAI) to be effective for up to 60% of patients with functional bowel problems who use long term. Since irrigation requires motivation and commitment, long term use can be considered a surrogate for effectiveness.
   
   
   • TAI can be an effective treatment for all types of functional bowel disorders (constipation and diarrhoea/faecal incontinence of any cause such as slow transit or IBS or evacuatory difficulties).
   • TAI being effective at 3 months is a good indicator that it will still be effective longer term (at 12 months and beyond).
   • TAI is effective for diarrhoea such as diarrhoea predominant IBS(IBS-D) and mixed symptoms such as IBS-M (alternating constipation & diarrhoea). This has not been shown in studies before.
     
     
2. Tamvakeras P, et al demonstrated a five-year retrospective review of patients practising TAI in a district general hospital. Patient demographics, indications, long-term compliance, adverse events, and patient reported Qufora bowel symptom bother scores were analysed in this 2023 study with some results as follows:
   
   
   • 5- year retrospective case note review, of patients using TAI, in a District General Hospital, Sutton Coldfield, UK
   • This is one of the longest follow-up studies in the literature
   • Irrigation was taught face to face
   • Patients were advised about different devices with guidance from their specialist nurse – studies usually use one device
   • Follow-up was frequent and in keeping with that in decision guide – 2, 6 ,12 weeks, 6 months, 1 year and ad hoc thereafter
   • Patients completed a bothersome score about how satisfied they were with using irrigation (0, low-10,high)
   • A high percentage of patients (14,78%) continued to use TAI long-term.
   • 12 (66%) used high volume, with Qufora IrriSedo Cone being most popular and 6 (33%) used low volume irrigation (IrriSedo Mini & Mini Go)
   • Significant improvements were observed in bowel symptom bother scores, reinforcing the positive impact of irrigation on patients’ quality of life
     
     
3. Mekhael M et al (2021) conducted a systematic review, which evaluates the effect of TAI in neurogenic bowel dysfunction (NBD), low anterior resection syndrome (LARS), faecal incontinence (FI) and chronic constipation (CC)
   
   
   • TAI is beneficial treatment for different types of bowel problems (NBD, LARS, FI and CC of heterogeneous origin)
   • Supports the use of TAI for all types of bowel problems
     
     
4. Etherson et al (2017) evaluated patient perceptions of the efficacy and safety of TAI for chronic idiopathic constipation (CIC) and whether there are predictive factors of perceived treatment response. Symptom improvement was demonstrated in patients using TAI for chronic constipation:
   
   
   • General well-being 65%
   • Rectal clearance 63%
   • Bloating 49%
   • Abdominal pain 48%
   • Bowel frequency 42%

When advising patients on the use of laxatives and/or antidiarrheals in conjunction with transanal irrigation (TAI), key opinion leaders agree that patients should continue taking these medications initially and in the usual dose. After establishing a consistent routine with TAI, it may be appropriate to consider reducing the use of laxatives and antidiarrheals. Although, some patients may prefer to continue taking these medications for a period. Henderson et al. (2022) demonstrated that transanal irrigation (TAI) is an effective treatment for functional bowel problems. The study also showed a 47% reduction in laxative use.

Reference
Henderson, Alice et al., Transanal irrigation in the treatment of functional bowel disorders: a district general hospital perspective, Gastrointestinal Nursing, vol 20 no 1, February 2022
https://www.magonlinelibrary.com/doi/abs/10.12968/gasn.2022.20.1.19

Comprehensive training is essential for the safe and efficient long-term use of TAI. Bildstein and colleagues in their 2017 study found that the first training session should be structured in order to promote more realistic expectations about treatment efficacy, side-effects and, especially, constraints in order to reduce the discontinuation rate. The symptoms of perforation must be discussed, with the advice to stop irrigating and seek emergency medical help immediately, if suspected.

During the first training session, it is advisable to teach the patient the practical aspects of irrigation through demonstrations. Additionally, it is beneficial to supplement this hands-on training with literature.

Teaching aids for the use of TAI can complement the one to one training with the patient and may include:

• Diagrams
• Chosen equipment literature
• Step by step guide
• Practical teaching with a plastic rectum

Although education and training are crucial for long-term adherence to transanal irrigation (TAI), ongoing support is also essential. To ensure the safe and effective long-term use of TAI, a designated healthcare professional can provide a structured follow-up, even when the patient is managing well.

Follow-up is crucial during the first month of using TAI to help patients establish a routine and prevent early discontinuation. Therefore, follow-up should be frequent initially and can be gradually reduced over time. Once satisfactory bowel management is established, follow-up is necessary to maintain user motivation and identify any changes in bowel function and response to TAI over time. This follow-up need not be frequent or in-person but should ideally be conducted by the same professional for each patient.