By Brigitte Collins, Head of Clinical Education
A recent article published in Gastrointestinal Nursing by Hasan Alsararatee, Advanced Clinical Practitioner, Northampton General Hospital, Acute Medicine, provides an excellent review titled “Transanal Irrigation: A Review of Indications, Key Assessments, Benefits, Contraindications, Complications, Efficacy, and Safety.” This insightful piece serves as an up-to-date resource for healthcare professionals, offering a broad overview of this bowel management technique.
One section of particular interest is the discussion on “When to Stop Transanal Irrigation (TAI).” The article highlights that while TAI is an effective long-term management option for patients with bowel dysfunction (Rodriguez et al 2024), it may need to be discontinued if its therapeutic effect reduces over time (Tamkaveras et al 2023). Upon further research, I could not find evidence indicating that the therapeutic effect of TAI naturally diminishes over time for all patients. However, there is evidence supporting the long-term effectiveness of TAI.
For example, the Perspective study found that patients who continue using TAI at three months are likely to maintain its use at six months, twelve months, and beyond, demonstrating its potential for sustained benefit over time. It is important to acknowledge that this is not universally observed, and as Alsararatee points out some individuals may find that TAI does not work as effectively for them over time as it initially did. In such cases, it is worth considering whether various factors may contribute to this change, such as progression or changes in the underlying condition, variations in technique, or challenges with maintaining routine and adherence. In my opinion, the key is to ensure long-term follow-up, allowing for adjustments that can help restore the effectiveness of TAI. However, this may not always be achievable, and in some cases, discontinuation may ultimately be unavoidable.
Alsararatee also emphasises that there are certain circumstances where pausing TAI may be advisable. These include during pregnancy, active inflammatory bowel disease, colorectal cancer, or when there is a significant change in bowel habits until cancer is ruled out (Henderson et al., 2022). Additional conditions that may warrant discontinuation include undergoing chemotherapy, the presence of anal or colorectal stenosis, active diverticulitis, ischemic colitis, and specific surgical recovery periods, such as three months following colorectal surgery, four weeks after a polypectomy, or twelve months post-radical prostatectomy (Norton and Coggrave, 2016).
One of the points raised by the author is that discontinuation of TAI does not necessarily need to be permanent. They go on to suggest that, in many cases, TAI can be safely reintroduced once the underlying issue has been resolved or adequately managed.
To ensure safety and effectiveness, long-term follow-up is essential, as is consultation with a specialist or multidisciplinary team in guiding the decision on whether it involves stopping, pausing, or reintroducing TAI.
This is where we can assist. Our complete patient care programme provides ongoing follow-up, reassuring healthcare professionals that patients are never discharged. This approach supports the continuity of TAI while prioritising safety and maintaining routine for the continued improved quality of life.
