Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders

Table 1 Predominant symptoms, main causes of constipation/fecal incontinence, and prior surgical procedures for constipation/fecal incontinence in the 108 patients trained in transanal irrigation n (%)

	Study group (n = 108)
Predominant symptoms
Constipation	65 (60.2)
Fecal incontinence	43 (39.8)
Type of constipation
Slow transit constipation	15 (15.3)
Obstructed defecation	47 (48)
Mixed constipation	36 (36.7)
Type of FI
Active FI	12 (21)
Passive FI	42 (73.7)
Mixed FI	3 (5.3)
Main causes of constipation/FI
Neurological disease (multiple sclerosis, spina bifida, spinal cord injury, Parkinson disease):	41 (38)
Slow transit constipation	17 (15.7)
Obstructed defecation syndrome	28 (25.9)
FI	22 (20.4)
Pudendal neuropathy	11
Sphincter lesion	5
Low rectal/reservoir compliance	5
Idiopathic	1
Prior surgical procedures	32 (29.6)
Rectal resection with colo-anal anastomosis	3
Colonic resection with colo-rectal anastomosis	3
Colonic resection with ileo-rectal anastomosis	1
Hysterectomy	1
Cystopexy	2
Rectopexy	4
Starr	1
Sacral nerve stimulation	15
Anorectal malformation	1
Rectoplasty	1

FI: Fecal incontinence.

Table 2 Comparison of background variables, baseline demographics, severity scores, anorectal physiological testing, defecography, and colonic transit times of adopters and of non-adopters who discontinued transanal irrigation during the first year n (%)

Variables	Adopters	Non-adopters	P value
	n = 46	n = 44
Age (yr)	55.9 ± 13.9	51 ± 17.8	0.29
Gender
Female	36 (78)	38 (86)	0.46
Male	10 (22)	6 (14)
BMI	25.4 ± 4.3	23.6 ± 4.9	0.05
Main symptom
Constipation	22 (48)	28 (64)	0.19
FI	24 (52)	16 (36)
Type of constipation	n = 42	n = 39
Slow transit	8 (19)	6 (15.4)	0.48
Obstructed defecation	17 (40.5)	21 (53.8)
Mixed	17 (40.5)	12 (30.8)
Type of FI	n = 28	n = 24	0.82
Urge	7 (25)	5 (21)
Passive	19 (68)	18 (75)
Mixed	2 (7)	1 (4)
Main causes of constipation/FI
Neurological disease	19 (41.3)	14 (31.8)	0.47
Slow transit constipation	6 (13)	8 (18.2)	0.70
Obstructed defaecation syndrome	8 (17.4)	11 (25)	0.53
FI	13 (28.3)	11 (25)	0.91
Prior surgical procedures	11 (24)	17 (39)	0.13
	n = 42	n = 40
Severe defecation disorders according to severity scores	32 (76)	31 (77)	0.99
Anorectal manometry:	n = 38	n = 33
Resting pressure (cmH2O)	66.6 ± 30.7	57.2 ± 27.3	0.20
Squeeze pressure (cmH2O)	57.8 ± 56.5	59.6 ± 67.7	0.81
Threshold volume (mL)	21.9 ± 15.7	15.7 ± 6.9	0.16
Maximum tolerated volume (mL)	225.1 ± 98.6	234.5 ± 145.6	0.83
Rectal compliance (mL/cmH2O)	4.1 ± 2.4	4.2 ± 4	0.51
Colonic transit time	n = 31	n = 33
Right colon (h)	28.1 ± 19.7	29.9 ± 18.4	0.54
Left colon (h)	35.5 ± 23.6	38 ± 25.4	0.60
Recto-sigmoid colon (h)	23.6 ± 21.8	29 ± 26.6	0.53
Total (h)	90.2 ± 35.4	88.4 ± 44.3	0.97
Defecography
Rectal prolapse	n = 29	n = 22
or recto-anal procidentia	9 (31)	6 (27)	0.22

Values are expressed as mean ± SD. BMI: Body mass index; FI: Fecal incontinence.

Table 3 Comparison of transanal irrigation training modalities for adopters and for non-adopters who discontinued transanal irrigation during the first year n (%)

Variables	Adopters	Non-adopters	P value
	n = 46	n = 44
Training sessions
Number of training sessions	1.2 ± 0.4	1.1 ± 1	0.30
Volume of instilled water	607.9 ± 214.8	517.4 ± 241.7	0.07
Numbers of balloon pressings	3.2 ± 1.3	3.2 ± 1.8	0.55
Auto-administration	40 (87)	42 (95.5)	0.30
Assisted administration	6 (13)	2 (4.5)
Complicated first training session	4 (9)	13 (29)	0.02
Current sessions	n = 45	n = 24
Frequency of irrigation:
2-3/wk or more	35 (78)	22 (92)	0.35
Less than 2-3 wk	10 (22)	2 (8)
Total number of side-effects	1.04 ± 1.2	1.1 ± 1	0.51
Percent of patients:
with side-effects	25 (54)	29 (66)	0.37
with constraints	13 (28)	16 (36)

Values are expressed as mean ± SD.