Transanal Irrigation (TAI) is a new and growing method of emptying the bowels. There are two primary systems, Peristeen and Navina.

The Peristeen anal irrigation system from Coloplast is fairly new to the United States and is now FDA approved, but it has been used with success by people with spinal cord injuries and Spina Bifida in Europe for many years.

How it Works
This Peristeen Video by Coloplast explains how to use it. Also, Coloplast has ensured that healthcare professionals scattered all across the country are available to train individuals and parents on how it works. In fact, a formal training is required before one can use the product.

Benefits and Challenges
Peristeen was designed to allow a person to administer their own enema independently. Unlike the cone enema, the Peristeen is designed to inflate inside the rectum and stay put until deflated, reducing the need for help from a caregiver. Unlike the balloon enema, which is long and floppy and must be inflated with a syringe, the Peristeen’s short and stiff catheter is easier to insert and inflate independently. Further, the system does not require gravity to work, so a user can place the bag on the floor or a counter instead of hanging it up high. Many people try the Peristeen as a last-ditch effort toward independent bowel management before trying surgeries such as the MACE. If an older child, teen, or adult can administer the Peristeen independently, that prevents the need for a sometimes difficult surgery!

Many people say they prefer the Peristeen over other enema programs because they spend less time on the toilet each night. Unlike the cone or balloon enema programs, once the water from the Peristeen is pumped in, the balloon can be deflated immediately or after one minute instead of waiting 10 minutes.

Studies show that more stool is cleaned out from the rectum and descending colon with the Peristeen compared with traditional enemas. Although the Peristeen is designed to use plain tap water only, some people do have to try adding irritants such as glycerin or castile soap to get a better clean out.

Ideally the inflated catheter stays in place without being manually held, which is why the system works so well in the spinal cord injury population. However, low anal tone and patulous (wide open) anus are more common in the Spina Bifida population, and the catheter sometimes must be manually held in place. Unlike the balloon enema, for which the solution is to inflate the balloon more, the solution to this problem with the Peristeen is often to inflate the balloon less so that it can more naturally mold to fit the rectum. Even then it may just not work depending on the person’s anal sphincter tone. That can limit independence with the program, but some still prefer the device even with its limitations.

The biggest obstacle in starting a Peristeen program is actually getting the equipment supplied by a medical supply company and paid for by insurance. There are precious few supply companies in the U.S. that will provide this product, and it can take months or in some cases years to get it approved by insurance and supplies delivered. It is wise to have another bowel management program in place while you wait.

Navina (information provided by Wellspect)

Navina Systems for transanal irrigation (TAI) includes Navina Smart and Navina Classic and gives you the opportunity to choose an electronic system or a manually controlled system.

• The Navina Systems are indicated for use for children (2 – 12 years old), adolescents (12 – 18 years old), and transitional adolescents (18 – 21 years old) patients with neurogenic bowel dysfunction, congenital disorders such as Hirschsprung disease or anorectal malformations, fecal incontinence or chronic constipation where less invasive therapies are not successful, as well as, for adults who suffer from fecal incontinence, chronic constipation, and/or time consuming bowel management.
• The only solution which offers an electronic system with digital follow-up.
• An interchangeable system. All the consumables can be used together with both Navina Smart and Navina Classic.
• Available in two different sizes of rectal catheters and a rectal cone.

Navina Classic – Intuitive and convenient
With Navina Classic, you use a manual control unit, which means the balloon inflation and water instillation is controlled by manual pumping. Navina Classic has been designed with the user in mind and to make TAI easier. The color coding, symbols and two pumps are easy to use and handle.

Navina Smart – intelligent and precise
Navina Smart has software-controlled pumps that inflate a balloon and instill water into the bowel. Pushing the buttons allows for total control over the procedure. Your irrigations can be transferred to the Navina Smart app. This stores and displays information related to the procedure and serves as an irrigation diary that can be shared with your nurse or doctor. The information can be used to assist a review/evaluation of the procedure. Navina Smart and the accompanying app are designed with the user in mind. The intelligent solution for giving you control over the procedure.
Please see our Website for more information: www.wellspect.us

How does that work?
A rectal catheter with a balloon or a cone catheter (without balloon) is inserted into the rectum. The balloon is inflated in the rectum and holds the catheter in place while the water is instilled. This initiates the bowel movements (peristalsis) towards the rectum. When the water is instilled and the catheter is removed, the bowel can be emptied. The procedure is carried out on the toilet. Performing this procedure regularly will empty the bowel effectively, and the bowel will remain empty until the next irrigation. This will allow you to choose time and place to empty your bowel. You regain control and the independence to live the life you prefer and without being afraid of having a bowel accident.

Succeed with TAI. The factors in succeeding with TAI are:

• Motivation
• Realistic expectations
• Allowing time for learning and adapting (the initiation period)

Be prepared and give yourself time to adapt to the new routines. Set a realistic time frame. It may take up to 12 weeks to find the optimal irrigation routine and have a satisfying outcome for you. When the initiation period is over and you have found a routine that works for you, it may suffice to irrigate every other day, but this is highly individual. Your body will have to adapt to the treatment. Have patience, and it will be worth it.

Clinical Support at Wellspect
Wellspect has a clinical support team to answer any questions you may have about Navina and to support you and your family throughout TAI. They can be reached at 877.456.3742.

Next: Phosphate Enemas