Is transanal/rectal irrigation suitable for me?

Transanal irrigation, or TAI as it is often known is a suitable management option for many people with bowel problems. However, there are some conditions that make irrigation unsuitable or unsafe to use and others where it should be used with caution and with careful consideration and monitoring.
Some situations require further investigation to exclude any underlying bowel issues prior to proceeding with TAI. These are:
• Blood in your stools
• Recent and unexplained change in bowel habit (such as a change from constipation to diarrhoea)
• Unexplained and unintentional weight loss
• Unexplained abdominal pain

Irrigation is not suitable for people with the following conditions:
• Acute inflammatory bowel disease, such as ulcerative colitis or crohn’s disease
• Obstructing rectal or colonic mass or tumour
• Rectal or colonic surgical anastamosis (join in the bowel) within the last 6 months
• Severe cognitive impairment such as dementia or learning disability (unless tolerated and a carer able to supervise/administer)

The following conditions should be identified prior to irrigation and should only be considered after careful discussion with the relevant medical practitioner.
• Pregnant or planning pregnancy
• Any bowel, pelvic or abdominal surgery within the last 6 months
• Acute diarrhoea
• Anal fissure
• Large haemorrhoids that bleed easily
• Past pelvic radiotherapy which has caused bowel problems
• Severe diverticular disease
• Rectal medications for other diseases
• Heart failure
• Anal surgery within the past 6 months

People with the following conditions may require additional supervision or monitoring:
• Spinal cord injury at or above T6 – risk of autonomic dysreflexia
• Unstable metabolic conditions – renal or liver disease
• Under 18 yrs old
• Physical or cognitive disability/mental or emotional disorder
• Anorectal conditions that cause pain or bleeding (eg: anal fissure, 3rd degree haemorrhoids)

Other considerations that you may need to take in to consideration are:
• Your ability to perform irrigation independently or the availability of someone to help you with it if not
• The time commitment required to irrigating regularly, particularly for those who require high volume irrigation

The referral process for irrigation can differ from one area to the next and your GP is usually your first point of contact if you have a bowel problem. Some examples of specialist services that use irrigation as part of bowel management options are:
• Community continence or bladder & bowel services
• Hospital continence or bladder & bowel services
• Pelvic health physiotherapy services
• Pelvic floor services (usually hospital based)
• Biofeedback services
• Colorectal services (usually hospital based)
• Stoma care services (can be community or hospital based)
• Gastrointestinal services (usually hospital based)

If you think that TAI may be useful to help with your bowel problems, speak with your GP, who can refer you to a specialist for assessment and further discussion.