Trans-Anal Irrigation Systems- Neurogenic Bowel Dysfunction

Background

Treatment should be initiated and stabilised by specialist service providers for a period of 3 months. Prescribing responsibilities may then be transferred to primary care after the initial 3 month period only where there has been a demonstrable improvement in validated measures of bowel function such as the Cleveland Clinic constipation scoring system, St Mark’s faecal incontinence score or neurogenic bowel dysfunction score.

The Choice of product should be made by an appropriately trained specialist, in conjunction with the patient. Where possible the least invasive device, which meets the patients’ needs should be used in preference. It is recognised that there are differences in the levels of service provision across Lancashire and that use of TAI in non-neurogenic bowel dysfunction may result in a significant increase of use.

Existing primary care services cannot be expected to provide support for this. Therefore, TAI is only supported by the LMMG in the context of an agreed commissioning pathway. Specialist services are expected to retain responsibility for on-going patient follow-up and review (until such time that treatment is stopped).

Please see the link to the NICE technology guidance above. NICE advises the following:

“A number of different transanal irrigation systems, including Peristeen, are available. Clinicians and patients should discuss the options available and may try a number of devices before settling on a preferred system…”