Authors (including presenting author) :
Liu LW (1), Lam CP (2), Ng YHG (1), Lam YY (3), Cheung YF (3), Futaba K (1)(4)
Affiliation :
(1) Department of Surgery, Prince of Wales Hospital, (2) Colorectal Surgery, NTEC, (3) Department of Surgery, North District Hospital, (4) Colorectal Surgery, The CUHK University
Keyword 1: :
Transanal Irrigation
Keyword 2: :
Bowel Dysfunction
Keyword 3: :
Self-management
Keyword 4: :
Patient empowerment
Keyword 5: :
Nurse-led Clinic
Introduction :
Bowel dysfunction, encompassing constipation, fecal incontinence (FI), low anterior resection syndrome (LARS) and obstructive defecation syndrome (ODS), significantly impairs patients’ quality of life, negatively affects their social life and daily activities and lowers their self-confidence. Between 2021 and 2024, 1150 patients with bowel dysfunction were identified in the New Territories East Cluster (NTEC) and referred to the functional nurse clinic. While the majority were effectively managed with standard treatments including dietary advice, behavioral modification, medications and pelvic floor exercise, a proportion remained refractory to conservative management. For these intractable cases, transanal irrigation (TAI) was introduced as a minimally invasive adjuvant therapy to avoid surgical interventions. Traditionally, TAI was performed by healthcare professionals in hospital settings, limiting accessibility and patient autonomy. Recent technological advancements have led to the development of user-friendly irrigation system designs and electric pumps, enabling TAI to be self-administered or performed by caregivers at home following structured training provided by qualified healthcare professionals.
Objectives :
1. To improve bowel function symptoms in patients with bowel dysfunction unresponsive to conservative management 2. To ensure safe and competent administration of TAI at home by patients or caregivers
Methodology :
Patients with bowel dysfunction who did not respond to conservative management and had no contraindications of TAI such as severe cognitive impairment, ongoing chemotherapy and recent colorectal surgery or polypectomy etc. were offered TAI. Informed consent with indications and possible risks of TAI was obtained before initiating TAI. Specialty nursing practice guideline on the care of patients with TAI was adhered for patient care. Selection of TAI devices (cone or rectal catheter with low or high -volume irrigation system) depended on patients’ or caregivers’ dexterity, ability to use the device and volume of irrigation required. Training comprised explanation of the mechanism of TAI, demonstration of TAI procedure, education on signs of colonic perforation and the actions to take. A checklist was used to ensure competency for independent home administration. To monitor the effectiveness and safety, patients received weekly phone follow-ups for two weeks and a nurse clinic follow-up one month after the programme commenced.
Result & Outcome :
A total of 51 patients participated in the home-based TAI programme. The cohort was predominantly characterized by constipation (49%), followed by fecal incontinence (21%), refractory LARS (20%), and ODS (10%). For patients with LARS, the mean LARS score decreased from 37 (classified as major LARS) to 29 (minor LARS) after using TAI. In the group of constipation, 60% reported symptoms improvement including increased frequency of bowel movement, less painful evacuation and reduced sense of incomplete emptying. For patients with FI, 75% experienced fewer episodes of FI and reduced use of incontinent products. 75% of patients with ODS reported reduced straining and less sense of incomplete rectal emptying. Crucially, no major complications such as bowel perforation were reported during the study period. To conclude, this study validates that a nurse-led home-based transanal irrigation programme represents a safe, effective, and patient-empowering non-surgical intervention for intractable bowel dysfunction. Beyond achieving significant clinical symptom improvement, this innovative care model successfully transitions therapeutic responsibility from the hospital to the patient's home environment, embodying a truly patient-centered approach to healthcare delivery. The programme demonstrates that with proper assessment, structured education, and ongoing professional support, patients can confidently and safely self-manage complex bowel conditions in their own homes.
