Clinical, social, and motility factors influencing transanal irrigation response in pediatric patients

OBJECTIVES: Chronic constipation (CC) and fecal incontinence (FI) are significant problems for pediatric patients. Transanal irrigation (TAI) is a therapy that effectively relieves symptoms in patients with disorders of gut-brain interactions (DGBI) or organic CC/FI. This mixed-methods study aimed to identify predictive factors for TAI adherence and outcomes in pediatric patients. METHODS: Out of 151 screened patients, 63 were eligible for enrollment, with a 60.3% response rate and 97.3% survey completion. We analyzed adherence, symptom severity, quality of life (QOL), and manometry data from 38 patients who initiated TAI at Nemours Children's Hospital (2017-2023). Additionally, seven parents of noninitiating patients were interviewed to assess barriers. RESULTS: No significant differences were found in TAI-related difficulties (pain, independence, and technical issues), though patients with DGBI etiologies reported slightly more psychological difficulties with TAI (p = 0.077). Adherent patients showed fewer CC symptoms and higher QOL compared to nonadherent patients (p = 0.002) at the time of interview. Attention-deficit/hyperactivity disorder (ADHD), diagnosed in 42.1% of patients, was a significant predictor of nonadherence, with these patients reporting more severe symptoms and lower psychosocial scores. Manometry results did not predict outcomes, indicating a need for improved diagnostics. Barriers to TAI initiation included insurance challenges, fear of trauma, and logistical obstacles. CONCLUSIONS: Patients with organic and DGBI CC/FI experienced similar challenges using TAI. Adherence was associated with improved symptoms and QOL. ADHD was a significant predictor of nonadherence, underscoring the need for tailored interventions. Future research should focus on long-term outcomes and strategies to enhance adherence, particularly for children with ADHD.