Christensen P et al. (2006) A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology 131: 738–747

Injury to the spinal cord can cause neurogenic colorectal dysfunction, which is characterized by symptoms of constipation, fecal incontinence, or both. Studies have shown that transanal irrigation can improve bowel function in some patients with spinal cord injury; however, randomized, controlled trials that directly compare different bowel management options in such patients are lacking.

Christensen et al. have now reported the results of a large, multicenter trial that compared transanal irrigation with conservative bowel management (defined as 'best supportive bowel care without using irrigation') in 87 patients with spinal cord injury and neurogenic bowel dysfunction. Patients were randomly assigned to undergo either transanal irrigation (42 patients) or to receive conservative bowel management (45 patients) for 10 weeks.

Overall, transanal irrigation yielded more favorable results; the severity of incontinence and constipation symptoms markedly improved, and dependence on assistance was greatly reduced in patients who underwent transanal irrigation compared with those managed conservatively. In addition, there tended to be a greater improvement in quality-of-life measures—and, interestingly—fewer urinary-tract infections, in patients who underwent transanal irrigation, compared with the conservatively managed patients. Transanal irrigation was safe and reduced the time spent by patients on bowel management.

The authors conclude that transanal irrigation has marked benefits for patients with spinal cord injury and neurogenic bowel dysfunction, but they highlight the need for long-term follow-up data to confirm these findings.