European Journal of Pediatrics

, Volume 176, Issue 6, pp 731–736 | Cite as

Transanal irrigation is effective in functional fecal incontinence

  • Cecilie Siggaard JørgensenEmail author
  • Konstantinos Kamperis
  • Line Modin
  • Charlotte Siggaard Rittig
  • Søren Rittig
Original Article


Functional fecal incontinence (FFI) is divided into cases related to functional constipation (FC) and cases without concomitant constipation termed functional non-retentive fecal incontinence (FNRFI). Transanal irrigation (TAI) is widely used in children with neurogenic fecal incontinence but is less studied in children with functional defecation disorders. The aim was to evaluate the feasibility and efficacy of TAI in the treatment of FFI. A retrospective study in 72 children (mean age 9.2 ± 2.2 years, 47 males) with treatment-resistant FFI was performed. All children accepted treatment and 35% (n = 25) were titrated to daily sessions. Of the 63 children who fulfilled the Rome III criteria of constipation, 46 (73%) showed full response with complete remission of incontinence episodes. Eleven (17%) showed partial response (≥50% reduction). Of nine children with FNRFI, four (44%) showed full response whereas two (22%) showed partial response. We found no significant difference in the reduction of incontinence episodes between the children with FC (87%) and children with FNRFI (68%) (p = 0.11).

Conclusion: TAI is an effective, well-tolerated, and safe choice in children with FC. No clinical parameters seemed to predict response to treatment. The number of children with FNRFI was low, but TAI seemed effective in this group of children.

What is Known:

Functional fecal incontinence (FFI) is a frequent, chronic condition with significant impact on children’s quality of life.

Transanal irrigation (TAI) is used in children with neurogenic bowel dysfunction but less studied in children with functional defecation disorders.

What is New:

TAI seems an effective, well-tolerated, and safe choice in children with FFI due to functional constipation.

Albeit the number of children with functional non-retentive fecal incontinence was low in our study, TAI seems effective also in this group of children.


Functional fecal incontinence Functional constipation Functional non-retentive fecal incontinence Transanal irrigation Children 



Antegrade continence enema


The International Children’s Continence Society


Functional constipation


Functional non-retentive fecal incontinence


Functional fecal incontinence


Transanal irrigation


Authors’ Contributions

Cecilie Siggaard Jørgensen—contribution: study design, data collection, data analysis, and writing the first draft. Konstantinos Kamperis—contribution: study design, data analysis, and critical revision of manuscript. Line Modin—contribution: study design, and critical revision of manuscript. Charlotte Siggaard Rittig—contribution: study design, and critical revision of manuscript. Søren Rittig—contribution: study design, data analysis, and critical revision of manuscript.

Compliance with ethical standards

The project was preformed according to the regulations of The Central Denmark Region Committees on Health Research Ethics. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


No grants or financial support has been received.


  1. 1.
    Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Vande Walle J, von Gontard A, Wright A, Yang SS, Neveus T (2014) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society. J Urol 191(6):1863–1865 . doi: 10.1016/j.juro.2014.01.110 e1813CrossRefPubMedGoogle Scholar
  2. 2.
    Benninga MA, Voskuijl WP, Taminiau JA (2004) Childhood constipation: is there new light in the tunnel? J Pediatr Gastroenterol Nutr 39(5):448–464CrossRefPubMedGoogle Scholar
  3. 3.
    Bray L, Sanders C (2013) An evidence-based review of the use of transanal irrigation in children and young people with neurogenic bowel. Spinal Cord 51(2):88–93. doi: 10.1038/sc.2012.146 CrossRefPubMedGoogle Scholar
  4. 4.
    Christensen P, Krogh K (2010) Transanal irrigation for disordered defecation: a systematic review. Scand J Gastroenterol 45(5):517–527. doi: 10.3109/00365520903583855 CrossRefPubMedGoogle Scholar
  5. 5.
    Joensson IM, Siggaard C, Rittig S, Hagstroem S, Djurhuus JC (2008) Transabdominal ultrasound of rectum as a diagnostic tool in childhood constipation. J Urol 179(5):1997–2002. doi: 10.1016/j.juro.2008.01.055 CrossRefPubMedGoogle Scholar
  6. 6.
    King SK, Sutcliffe JR, Southwell BR, Chait PG, Hutson JM (2005) The antegrade continence enema successfully treats idiopathic slow-transit constipation. J Pediatr Surg 40(12):1935–1940. doi: 10.1016/j.jpedsurg.2005.08.011 CrossRefPubMedGoogle Scholar
  7. 7.
    Koppen IJ, Kuizenga-Wessel S, Voogt HW, Voskeuil ME, Benninga MA (2016) Transanal irrigation in the treatment of children with intractable functional constipation. J Pediatr Gastroenterol Nutr. doi: 10.1097/mpg.0000000000001236 Google Scholar
  8. 8.
    Mosiello G, Marshall D, Rolle U, Cretolle C, Santacruz BG, Frischer J, Benninga MA (2017) Consensus review of best practice of transanal irrigation in children. J Pediatr Gastroenterol Nutr 64(3):343–352. doi: 10.1097/mpg.0000000000001483 CrossRefPubMedGoogle Scholar
  9. 9.
    Mugie SM, Benninga MA, Di Lorenzo C (2011) Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol 25(1):3–18. doi: 10.1016/j.bpg.2010.12.010 CrossRefPubMedGoogle Scholar
  10. 10.
    Mugie SM, Machado RS, Mousa HM, Punati JB, Hogan M, Benninga MA, Di Lorenzo C (2012) Ten-year experience using antegrade enemas in children. J Pediatr 161(4):700–704. doi: 10.1016/j.jpeds.2012.04.042 CrossRefPubMedGoogle Scholar
  11. 11.
    Nasher O, Hill RE, Peeraully R, Wright A, Singh SJ (2014) Peristeen© transanal irrigation system for paediatric faecal incontinence: a single centre experience. Int J Pediatr 2014:954315. doi: 10.1155/2014/954315 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ng J, Ford K, Dalton S, McDowell S, Charlesworth P, Cleeve S (2015) Transanal irrigation for intractable faecal incontinence and constipation: outcomes, quality of life and predicting non-adopters. Pediatr Surg Int 31(8):729–734. doi: 10.1007/s00383-015-3735-7 CrossRefPubMedGoogle Scholar
  13. 13.
    Pacilli M, Pallot D, Andrews A, Downer A, Dale L, Willetts I (2014) Use of Peristeen(R) transanal colonic irrigation for bowel management in children: a single-center experience. J Pediatr Surg 49(2):269–272 . doi: 10.1016/j.jpedsurg.2013.11.036 discussion 272CrossRefPubMedGoogle Scholar
  14. 14.
    Pijpers MA, Bongers ME, Benninga MA, Berger MY (2010) Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr 50(3):256–268. doi: 10.1097/MPG.0b013e3181afcdc3 CrossRefPubMedGoogle Scholar
  15. 15.
    Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130(5):1527–1537. doi: 10.1053/j.gastro.2005.08.063 CrossRefPubMedGoogle Scholar
  16. 16.
    Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, Staiano A (1999) Childhood functional gastrointestinal disorders. Gut 45(Suppl 2):Ii60–Ii68PubMedPubMedCentralGoogle Scholar
  17. 17.
    Shandling B, Gilmour RF (1987) The enema continence catheter in spina bifida: successful bowel management. J Pediatr Surg 22(3):271–273CrossRefPubMedGoogle Scholar
  18. 18.
    Tabbers MM, Boluyt N, Berger MY, Benninga MA (2011) Clinical practice : diagnosis and treatment of functional constipation. Eur J Pediatr 170(8):955–963. doi: 10.1007/s00431-011-1515-5 CrossRefPubMedGoogle Scholar
  19. 19.
    Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, Staiano A, Vandenplas Y, Benninga MA (2014) Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 58(2):258–274. doi: 10.1097/mpg.0000000000000266 CrossRefPubMedGoogle Scholar
  20. 20.
    von Gontard A, Niemczyk J, Weber M, Equit M (2015) Specific behavioral comorbidity in a large sample of children with functional incontinence: report of 1,001 cases. Neurourol Urodyn 34(8):763–768. doi: 10.1002/nau.22651 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Cecilie Siggaard Jørgensen
    • 1
    Email author
  • Konstantinos Kamperis
    • 1
  • Line Modin
    • 2
  • Charlotte Siggaard Rittig
    • 1
  • Søren Rittig
    • 1
  1. 1.Center for Child Incontinence, Department of PaediatricsAarhus University HospitalAarhus NDenmark
  2. 2.HC Andersen Children HospitalOdense University HospitalOdenseDenmark

Personalised recommendations