Transanal Irrigation in Functional Constipation: Long-term Results From an Italian National Study

BACKGROUND: – Functional constipation is a chronic gastrointestinal disorder that significantly impairs quality of life. OBJECTIVE: – To evaluate the beneficial effects of transanal irrigation after 12 and 24 months of treatment in patients with functional constipation. DESIGN: – Multicenter, prospective, observational study. SETTINGS: – Thirteen gastroenterology centers across Italy. PATIENTS: – A total of 216 adults diagnosed with functional constipation were enrolled. INTERVENTION: – A transanal irrigation system was used to perform bowel irrigation. Patients completed validated questionnaires at baseline and at 1, 6, 12, and 24 months. MAIN OUTCOME MEASURES: – The primary endpoints were to assess improvement in patient satisfaction and quality of life related to bowel function, as well as the safety of the procedure. Secondary outcomes included constipation severity, symptom occurrence, treatment discontinuation rates, and reasons for dropout. RESULTS: – Satisfaction score increased from 2.9 ± 2.4 at baseline to 6.5 ± 2.0 at 1 month and remained higher through 24 months (p < 0.001). The quality of life total score improved from 2.7 ± 0.6 to 2.0 ± 0.7 at 1 month and about 1.9 thereafter (p < 0.001). Constipation score severity decreased (Wexner score 17.9 ± 5.8 to 12.5 ± 5.2 at 1 month; maintained to 24 months; p < 0.001), and mean constipation-related symptoms declined from 3.3 to 1.0 per patient at 24 months. Of 175 patients prescribed irrigation, discontinuation occurred in 10.3% at 6 months, 9.1% at 12, and 6.3% at 24; technical difficulties were uncommon and absent at 24 months, and no serious adverse events were reported. LIMITATIONS: – The non-randomized design may have introduced bias. Outcomes were assessed through validated but subjective self-reported questionnaires, and the study population was unbalanced for sex and comorbidities, although these factors did not significantly affect primary results. CONCLUSIONS: – This study provides the first evidence to support the effectiveness and safety of long-term transanal irrigation in improving bowel function, symptoms and quality of life in patients with functional constipation over the long term. See Video Abstract.