Andrea Jordan, Lead Clinical Nurse Specialist: Paediatric Surgery, and Georgina Malakounides, Consultant Paediatric Surgeon, Addenbrookes Hospital, Cambridge
In our centre we have found low volume transanal irrigation (LV TAI) to have revolutionised the management of children with faecal incontinence. In our surgical colorectal clinic, we see children with chronic idiopathic constipation, neuropathic bowel or with ongoing constipation after surgery for Hirschsprung’s disease and anorectal malformations. These children often have a distal evacuation disorder and can have a secondary megarectum.
This is an in-demand clinic in our East of England network with 136 children seen since its introduction in 2019. These children have not responded to treatments beneath the transanal irrigation approach on the ERIC ladder including laxatives and suppositories. Even in young children aged between 3-5 years we find a proactive TAI approach to be very useful. We currently have 85 children on our active caseload on transanal irrigation.
On review of our centre’s experience of TAI between 2015-19 we found almost all children (80%) were managed on low volume TAI in the first instance rather than requiring the cone toilet or balloon irrigation device with good success rates. We would only step up the treatment ladder if effective emptying was not achieved.
Since the introduction of the upgraded version ‘MiniGo’ and ‘MiniGoFlex’ in 2021 the proportion of children we can successfully manage with low volume has increased to near 100%. We have found the ability to add laxatives in the LV TAI devices also reduces the need to step up the treatment ladder. Our provision of close follow up, early input with play therapy as needed and emphasis on getting the fundamentals right (drinking enough, pre-emptive, and active toileting) along with TAI has proven to be a success.
Parents and carers quote the use of LV TAI as ‘life changing’ and ‘amazing’ with one noting it ‘brought my happy and healthy child back to me after years of being sad and withdrawn because of previous soiling’ and as professionals these words give us increasing confidence in the LV TAI device.