Early transanal irrigation in spinal cord injury-related neurogenic bowel dysfunction: preliminary insights.

Clinical Snapshot

Key Findings

• P Value: p = 0.02 for constipation improvement, p = 0.02 for SCIM total score, p = 0.006 for self-care activities

• Effect Size: 5.88-point reduction in constipation score at 4 weeks (44% improvement from baseline)

• Primary Outcome: Wexner constipation score reduction from 13.43 ± 4.24 to 7.55 ± 2.38 at 4 weeks and 8.80 ± 4.16 at 6 months in TAI group

• Nnt Or Sensitivity: Not calculable from available data due to lack of control group outcomes and confidence intervals

• Confidence Interval: Not reported

Clinical Application

TAI systems readily available in Australian spinal units; requires specialized training for patients and caregivers; cost considerations for ongoing supplies Relevant to Australian spinal injury units; TAI devices available through medical suppliers; potential PBS consideration for consumables; aligns with RACGP chronic disease management principles Adult SCI patients with neurogenic bowel dysfunction during acute rehabilitation phase, particularly those with significant constipation

Abstract

STUDY DESIGN: Prospective, randomized, open-label, multicenter, parallel group study. OBJECTIVES: Neurogenic bowel dysfunction (NBD) is a common complication in spinal cord injury (SCI) patients, severely affecting quality of life. While transanal irrigation (TAI) has shown superior efficacy over conservative treatments (CT), its early adoption during the first hospitalization post-injury remains unexplored. This study aimed to compare early TAI initiation versus CT in managing NBD in SCI patients. SETTING: This study involved four spinal units across Italy. METHODS: SCI patients were randomized to receive TAI or CT during a four-week hospital stay, followed by continued treatment at home for 6 months. Bowel function, constipation, and continence were assessed using the Wexner scales, while quality of life was measured using the EQ-5D-5L and Spinal Cord Independence Measure (SCIM) questionnaires. Stool transit time and patient independence were also monitored. RESULTS: Twenty-two patients were enrolled, with the TAI group showing significant improvements in constipation (Wexner score reduction from 13.43 ± 4.24 at baseline to 7.55 ± 2.38 and 8.80 ± 4.16 at 4 weeks and 6 months, p = 0.02) and a trend toward continence improvement. A significant increase in the total SCIM score was observed in the TAI group (p = 0.02), particularly in respiratory and sphincter management. Quality of life improved in both groups, with a notable enhancement in self-care activities for the TAI group (p = 0.006). CONCLUSIONS: These preliminary results suggest early TAI adoption improves bowel management, especially constipation, and enhances patient independence. Larger studies are needed to validate these findings and assess long-term benefits.

References

1. 1.Frasca, G., De Palma, L., Megna, M., Rosso, I., Cocchini, L., Medina, G., Righi, G., Baroni, A., Del Popolo, G., Bonaccorsi, A., Savoca, F., & Costa, A. (2026). Early transanal irrigation in spinal cord injury-related neurogenic bowel dysfunction: preliminary insights. Spinal Cord Series and Cases. https://doi.org/10.1016/j.urology.2023.12.012