Michelle Henderson
How do the key findings impact on clinical practice?
The PERSPECTIVE* study used an online questionnaire to explore how people with different functional bowel disorders use transanal irrigation. Yan Yiannakou and Michelle Henderson led the study whilst working together in Durham.
*PERSPECTIVE: Patient pERSPective of functional bowel disorders: Effects on lifestyle, experienCe of Transanal Irrigation and effects of the COVID-19 pandEmic.
Here, Michelle discusses how the key findings might impact on clinical practice.
PERSPECTIVE has explored how people use rectal irrigation (RI) to manage a range of functional bowel disorders (FBDs). The results offer a snapshot of irrigation use and perceived effectiveness for a mixed population of people across primary and secondary care.
The first key finding was that where irrigation is effective at 3 months, it is a reasonable indicator of effectiveness at 6 months, with a trend for this effectiveness to continue up to 12 months and beyond. In fact, results showed that 58 (53%) respondents had been irrigating for a long time, 3 -12 years. This supports the notion of long-term effectiveness since irrigation is time-consuming and requires motivation, so it is reasonable to expect that people will only irrigate if it is helping them.
This is reassuring for patients, who might worry about RI becoming less beneficial as time goes on, particularly since we know this can happen with other forms of treatment such as laxatives.
This also reassures health care professionals (HCPs) that treatment strategies are helping, and they can confidently discharge patients back to their GP, freeing up valuable clinical time to help more patients.
Conversely, if patients are not experiencing an improvement in their symptoms by 3 months, HCPs might consider referring their patient back to the multi-disciplinary team for further advice. This is in keeping with follow-up recommendations suggested by Emmanuel et al (2019)1.
Awareness of this key finding can strengthen the treatment pathway with patients having opportunity to explore all treatment options in a timelier fashion. This is important since PERSPECTIVE showed 48 (44%) of respondents had bowel symptoms for 10+ years before starting irrigation. This may be due to the length of time it takes people to get to specialist services, typically 10-15 years after onset of symptoms. Perhaps because they do not present to healthcare early on, have convoluted journeys to get to specialist services or irrigation is seen as a treatment of last resort.
The second key finding was that RI can benefit diarrhoea-type symptoms (diarrhoea predominant irritable bowel syndrome (IBS-D), functional diarrhoea and faecal incontinence), with 74% continuing irrigation long term, suggesting good efficacy for this group. A high proportion of these (20, 77%) also had faecal incontinence. Perhaps the high burden of faecal incontinence makes irrigation more worthwhile.
FBDs are complex and can be difficult to treat. Irrigation is a safe and effective treatment, with 60% of respondents in PERSPECTIVE finding it beneficial.
Greater awareness of this efficacy for a wide range of FBDs, including diarrhoea-type symptoms, means more patients might get started sooner and benefit from this treatment.
