Transanal irrigation in clinical practice: a scoping review

As the aim of this study was to map the use of TAI in clinical practice across heterogeneous patient populations and outcome measures, a scoping review was chosen as the most appropriate study design [ 14 ]. This scoping review was inspired by the JBI methodology for scoping reviews [ 15 ] and reported in accordance with the PRISMA-ScR guideline (Supplementary Fig.  1 ) [ 16 ]. The protocol was preregistered on the Open Science Framework ( https://doi.org/10.17605/OSF.IO/QV854 ) [ 17 ]. Participants included in this review were adults aged 18 years or older with any condition leading to treatment with TAI. Studies were excluded if TAI was used for treating bleeding, infections, or poisoning. The concept and context were self-administered TAI in an outpatient setting. The review included irrigation performed transanally. Excluded irrigation types were antegrade irrigation, stoma irrigation, irrigation used for preparation before procedures such as colonoscopy or surgery, intraoperative irrigations, and hydrotherapy or bowel cleansing in wellness settings. The phenomena of interest included: irrigation protocols (timing of treatment, frequency, duration, volume, and type of fluid), equipment (device name, usage, and other technical aspects), patient selection (conditions and indications for treatment), outcome measures (assessment tools), and reported harms. This scoping review considered all original studies for inclusion, including case reports and case series. The following were excluded: not original data, conference abstracts, editorials, commentaries, expert opinions, surveys of healthcare professionals, protocols, and letters to the editor. The year span for included studies was 1995 to 2025, and studies in all languages were considered. The search strategy began with a consensus discussion on the topic and its various synonyms, leading to a thorough exploration of the subject. This led to including and excluding search terms, gradually developing the final search string for PubMed. An information specialist reviewed, modified, and approved the final version. A backward citation search was performed by searching the reference lists of included studies. For studies that could not be retrieved for full-text screening, corresponding authors or the publication journal were contacted for retrieval. The final search string for PubMed was: ("transanal" OR “anal” OR "bowel" OR "rectal" OR "fecal" OR "faecal" OR "colon") AND "irrigation". The search was restricted to studies published between 1995 and 2025. The search was conducted on February 27, 2025. The search string was adapted for Embase, CINAHL, and Cochrane CENTRAL. The full search strings are presented in the protocol [ 17 ]. Grey literature sources, including theses, registries, and unpublished reports, were not systematically searched. Search results were uploaded to Covidence (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia), and duplicate entries were removed both automatically and manually. Title/abstract screening and full-text screening were conducted independently by two authors, with disagreements resolved through discussion until consensus was reached. Data extraction was done by one reviewer. A Microsoft Excel sheet was used to extract data as described in the protocol [ 17 ]. The extracted variables included author, publication year, study design, and country. Patient-related variables covered age, sex, and indication for TAI. Additional variables included irrigation protocol, equipment used, outcome measures, and reported harms. When relevant, variables were grouped into categories to ensure consistency in analysis. No formal critical appraisal of methodological quality was performed, as the objective of this scoping review was to characterize and map the available literature on TAI in outpatient clinical practice rather than to evaluate treatment effectiveness or synthesize comparative outcomes. Data were limited to descriptive statistics and were summarized using counts and percentages to illustrate study characteristics and outcomes.

The literature search identified 4,255 records for title and abstract screening, of which 323 were assessed in full text. A total of 92 studies [ 8 – 12 , 18 – 104 ] were included, covering a total of 4,821 patients (age range 18–91 years; 45% female). The study selection process is depicted in Fig.  1 . Fig. 1 PRISMA flow diagram of study selection process PRISMA flow diagram of study selection process Most studies were observational studies and accounted for 51% (47 of 92) [ 9 , 12 , 20 – 23 , 26 – 28 , 31 , 37 , 39 , 40 , 42 – 45 , 47 , 49 , 50 , 52 , 55 – 57 , 59 , 61 , 62 , 66 , 67 , 72 , 74 , 75 , 78 , 81 , 83 , 85 , 89 , 90 , 94 – 96 , 98 – 101 , 103 , 104 ]. Interventional studies accounted for 27% (25 of 92) [ 8 , 10 , 11 , 29 , 35 , 36 , 38 , 51 , 54 , 58 , 60 , 63 , 65 , 68 , 69 , 73 , 79 , 80 , 82 , 84 , 86 , 87 , 93 , 94 , 102 ]. There was a trend toward more recent publications, with 58% (53 of 92) [ 9 , 10 , 19 – 22 , 24 – 26 , 28 , 31 , 32 , 36 – 38 , 40 , 42 , 44 , 47 – 60 , 63 , 66 – 68 , 71 , 72 , 75 , 78 , 82 , 84 , 85 , 88 – 90 , 93 , 95 – 99 , 103 ] published in the past decade. Only seven studies were published before 2005 [ 30 , 41 , 62 , 64 , 74 , 83 , 104 ]. In terms of geographic distribution, most studies were from Europe. The United Kingdom was the largest contributor with 27% of the studies (25 of 92) [ 19 – 23 , 25 , 27 , 32 , 34 , 36 , 39 , 41 , 42 , 46 , 65 , 70 , 73 , 75 – 77 , 82 , 83 , 88 , 96 , 99 ]. The Netherlands contributed with 14% of the studies (13 of 92) [ 9 , 30 , 33 , 43 , 62 , 74 , 79 , 80 , 87 , 89 , 91 , 94 , 95 ] and France with 13% (12 of 92) [ 28 , 31 , 38 , 56 , 57 , 60 , 61 , 66 , 78 , 90 , 97 , 101 ]. A summary of study characteristics is presented in Table  1 . See Supplementary Table  1 for detailed study characteristics. Table 1 Summarized study characteristics. Data are reported as number (percentage) Studies (n = 92) Patients (n = 4821) Sex   Female 2173 (45) Study design   Observational 47 (51) 3221 (67)   Interventional 25 (27) 1075 (22)   Case report/case series 17 (18) 491 (10)   Mixed methods 3 (3) 34 (< 1) Publication year   2020–2025 28 (30) 885 (18)   2015–2019 25 (27) 1972 (41)   2010–2014 18 (20) 674 (14)   2005–2009 14 (15) 922 (19)   2000–2004 4 (4) 308 (6)   1995–1999 3 (3) 60 (1) Country   United Kingdom 25 (27) 1514 (31)   The Netherlands 13 (14) 700 (15)   France 12 (13) 363 (8)   Denmark 9 (10) 1142 (24)   Italy 8 (9) 422 (9)   Spain 5 (5) 68 (1)   Sweden 3 (3) 37 (< 1)   Germany 2 (2) 40 (< 1)   Multinational 6 (7) 206 (4)   Other a 9 (10) 329 (7) a Australia (n = 1), Belgium (n = 1), Canada (n = 1), Israel (n = 1), Japan (n = 1), New Zealand (n = 1), South Korea (n = 1), Taiwan (n = 1), USA (n = 1). Summarized study characteristics. Data are reported as number (percentage) a Australia (n = 1), Belgium (n = 1), Canada (n = 1), Israel (n = 1), Japan (n = 1), New Zealand (n = 1), South Korea (n = 1), Taiwan (n = 1), USA (n = 1). Overall, daily or alternate-day irrigation with tap water using a rectal catheter-based system, most commonly Peristeen®, represented the most frequently reported irrigation practice across studies. The frequency of irrigation was often individualized and ranged from more than once a day to less than once a week. Most studies reported either daily irrigation (40% [37of 92]) [ 8 – 12 , 21 , 32 , 33 , 35 , 36 , 38 , 41 , 43 , 51 , 52 , 55 , 56 , 61 , 67 – 70 , 72 – 74 , 79 , 81 – 84 , 86 , 89 , 91 , 93 , 94 , 97 , 100 ], or irrigation every other day (39% [36 of 92]) [ 8 – 12 , 21 , 33 – 36 , 40 , 42 – 46 , 50 – 52 , 55 , 56 , 61 , 68 , 69 , 73 , 74 , 76 , 81 , 83 , 86 , 90 , 92 , 99 , 100 , 102 , 104 ] (Supplementary Table  2 ). Not all studies reported irrigation volume and time spent on irrigation. Those who reported it used different summary measures, including means and medians. Among studies reporting mean irrigation volumes (16% [15 of 92]), the mean volume ranged from 400 to 2400 ml [ 12 , 33 , 44 , 50 , 52 , 56 , 60 , 79 , 86 , 91 , 94 , 97 , 100 – 102 ]. In studies reporting median irrigation volumes (10% [9 of 92]), the reported range was 400 to 1000 ml [ 8 , 9 , 11 , 35 , 54 , 55 , 68 , 81 , 89 ]. For studies reporting time spent on irrigation, mean values ranged from 25 to 70 min (13% [12 of 92]) [ 8 , 12 , 38 , 58 , 60 , 79 , 91 , 94 , 97 , 100 – 102 ] and median values ranged from 20 to 45 min (4% [4 of 92]) [ 12 , 55 , 62 , 93 ] (Supplementary Table  1 ). Irrigation protocols were often adapted to patient preference and tolerance, and the included studies rarely reported on the timing of TAI, i.e., when TAI was first introduced as a treatment for bowel dysfunction. Two studies [ 68 , 93 ], both based on the same cohort, reported that 18 out of 37 patients received TAI as a first-line treatment. In contrast, 36% [33 of 92] of studies [ 9 , 11 , 12 , 18 , 19 , 21 – 23 , 32 , 33 , 43 , 45 – 47 , 49 – 51 , 55 – 57 , 61 , 65 , 70 , 72 , 74 , 79 , 80 , 82 , 83 , 88 – 90 , 100 ] reported that TAI was initiated after conservative treatments such as dietary modifications, biofeedback, and the use of laxatives or antidiarrheal agents, without further specification of the exact treatment algorithm. Different mechanisms for the delivery of irrigation fluid were reported across the studies. A manual pump was the most common method (23% [21 of 92]) [ 8 , 9 , 11 , 33 , 35 , 36 , 38 , 43 , 46 , 51 , 61 , 65 , 70 , 73 , 77 , 79 , 85 , 86 , 90 , 94 , 100 ], while gravity (13% [12 of 92]) [ 18 , 32 , 33 , 43 , 55 , 62 , 74 , 77 , 79 , 83 , 91 , 100 ] and electrical pump (5% [5 of 92]) [ 9 , 45 , 60 , 63 , 91 ] were less frequent. Tap water was the most commonly used irrigation fluid (57% [52 of 92]) [8, 9, 11, 12, 18, 19, 23, 32, 33, 35, 38, 40, 43, 45, 46, 51, 52, 54–58, 60–63, 65, 68–72, 74, 75, 77, 80–82, 84–92, 94, 95, 98, 101, 102, 106]. Three studies reported that they added table salt [ 12 ], sodium phosphate [ 12 , 102 ], or iodine-free salt [ 45 ]. The remaining studies did not report on the type of fluid. Various irrigation systems were used, and all but two were commercially available at the time of data analysis for this study. These included Peristeen® (Coloplast), Navina® (Wellspect HealthCare), IryPump® and Iryflex® (Braun), Qufora® (MBH-International), Reprop® (Practomed GmbH), and the Cone Irrigator Kit® (Hollister). Non-commercially available were Astra irrigation set and ACIA (Ashong colonic irrigation apparatus). Peristeen® was the most used system (50% [46 of 92]) [ 8 , 10 , 11 , 18 , 19 , 23 , 24 , 26 , 35 , 36 , 38 – 40 , 42 – 44 , 46 , 48 , 51 , 52 , 54 – 57 , 61 , 65 , 68 , 69 , 71 – 73 , 76 , 82 – 86 , 89 , 90 , 92 , 93 , 96 , 97 , 99 – 101 ] (Supplementary Table  1 ). The most commonly used rectal insertion device was a rectal catheter (38% [35 of 92]) [ 8 – 12 , 19 , 24 , 26 , 35 , 36 , 41 , 44 , 46 , 50 , 51 , 53 – 58 , 60 , 61 , 63 , 65 , 69 , 73 , 81 , 84 , 86 , 90 , 99 , 100 , 102 , 104 ], and less frequently a cone (21% [19 of 92]) [ 8 , 12 , 18 , 21 , 33 , 43 , 45 , 50 , 55 , 62 , 70 , 74 , 79 , 81 , 83 , 91 , 94 , 99 , 100 ]. Studies were categorized based on the reported indications for TAI. Most studies applied TAI exclusively for neurological conditions (35% [32 of 92]; 1229 patients) [ 8 , 12 , 20 , 24 , 28 , 31 , 32 , 34 – 36 , 38 – 40 , 46 , 51 , 57 – 59 , 61 , 67 , 69 , 73 , 75 , 76 , 78 , 86 , 90 , 92 , 95 , 96 , 101 , 102 ], followed by abdominal surgery (27% [25 of 92]; 601 patients) [ 10 , 11 , 19 , 25 – 27 , 30 , 33 , 48 , 49 , 53 , 54 , 66 , 68 , 71 , 72 , 74 , 82 – 84 , 88 , 93 , 94 , 97 , 103 ]. Furthermore, some studies applied TAI for mixed populations with various conditions (18% [17 of 92]; 1847 patients) [ 9 , 18 , 41 , 43 , 44 , 55 , 56 , 60 , 62 , 79 , 80 , 87 , 89 , 91 , 99 , 100 , 104 ], while one study exclusively applied TAI for patients with endometriosis (1% [1 of 92]; 60 patients) [ 52 ]. See Fig.  2 for an overview of all reported indications for TAI. Fig. 2 Reported indications for transanal irrigation. Indications were grouped into four categories: neurological, abdominal surgery, obstetric and gynecological (Ob-Gyn), and other. Within each category, specific indications reported in the included studies are displayed. Bubble size reflects the relative frequency with which each category was represented across the included studies, whereas text size reflects the relative frequency of individual indications within each category. Larger bubbles and larger text indicate more frequently reported indications Reported indications for transanal irrigation. Indications were grouped into four categories: neurological, abdominal surgery, obstetric and gynecological (Ob-Gyn), and other. Within each category, specific indications reported in the included studies are displayed. Bubble size reflects the relative frequency with which each category was represented across the included studies, whereas text size reflects the relative frequency of individual indications within each category. Larger bubbles and larger text indicate more frequently reported indications In total, 40 individual tools were used for measuring outcomes after TAI across all studies. Most outcome measures assessed bowel dysfunction (Fig.  3 a). The most frequently used tools for assessing bowel dysfunction were the Cleveland Clinic Florida Fecal Incontinence (CCF-FI) score (21% [19 of 92]) [ 21 , 27 , 29 , 31 , 38 , 40 , 44 , 48 , 55 , 56 , 66 , 68 , 72 , 78 , 84 , 86 , 87 , 93 , 97 ], Neurogenic Bowel Dysfunction (NBD) score (20% [18 of 92]) [ 8 , 20 , 35 , 36 , 40 , 46 , 51 , 56 – 58 , 60 , 61 , 66 , 78 , 84 , 90 , 95 , 101 ], and the Low Anterior Resection Syndrome (LARS) score (15% [14 of 92]) [ 10 , 44 , 48 , 49 , 52 – 54 , 66 , 68 , 72 , 82 , 84 , 93 , 103 ]. The tools were used either independently or in combination with other bowel-related assessment tools (Fig.  3 b). Thirty-eight studies reported the use of additional study-specific outcome measure tools. The most common of these were custom-designed non-validated questions or questionnaires (32% [29 of 92]) [ 8 , 12 , 20 , 27 , 39 , 40 , 42 , 44 , 46 , 48 , 50 , 52 , 55 , 58 , 59 , 61 , 62 , 67 , 70 , 74 , 75 , 79 , 84 , 86 , 89 , 95 , 96 , 100 , 102 ]. Some studies (23% [21 of 92]) [ 8 , 10 , 20 , 21 , 27 , 40 , 42 , 44 , 46 , 48 , 50 , 52 , 54 , 55 , 58 , 61 , 84 , 86 , 89 , 95 , 96 ] combined a validated bowel dysfunction score with custom-designed questions or questionnaires, and other studies (13% [12 of 92]) [ 12 , 23 , 39 , 59 , 62 , 67 , 70 , 74 , 75 , 79 , 100 , 102 ] relied entirely on custom-designed questions or questionnaires (Fig.  3 a). Only two studies (2% [2 of 92]) [ 11 , 94 ] used quality of life as the sole outcome measure. Sixteen studies (17% [16 of 92]) [ 9 , 24 , 28 , 31 , 36 , 37 , 44 , 50 , 54 , 66 , 68 , 86 , 87 , 93 , 96 , 97 ] included both a bowel dysfunction tool and a quality of life measure. The most frequently used quality of life tools were the SF-36 (9% [8 of 92]) [ 11 , 44 , 54 , 68 , 73 , 89 , 93 , 94 ] and EQ-5D (8% [6 of 92]) [ 36 , 37 , 50 , 66 , 96 , 97 ]. One study [ 89 ] used both the SF-36 and the Fecal Incontinence Quality of Life (FIQL) tool, and one study [ 97 ] combined the FIQL and the EQ-5D tool (Fig.  3 c). See Supplementary Table  1 for further details. Fig. 3 Tools for measuring outcomes. An UpSet plot of the distribution of outcome measurement tools used across the studies. a ) Overlap of outcome measurement tools used across the categories: bowel dysfunction , quality of life , and other . The category other consists of custom designed questions or questionnaires, visual analogue scores, and numeric rating scales. b ) Overlap of outcome measurement tools for the bowel dysfunction category. c ) Overlap of outcome measurement tools for the quality of life category. BD = bowel dysfunction. QoL = quality of life. NBD = Neurogenic Bowel Dysfunction score. LARS = Low Anterior Resection Syndrome score. CCF-FI = Cleveland Clinic Florida Fecal Incontinence score. CCF-C = Cleveland Clinic Florida Constipation score. Rome = Rome criteria. KESS = Knowles Eccersly Scott Incontinence score. SF-36 = Short Form (36) Health Survey. EQ-5D = EuroQol-5 dimensions. FIQL = Fecal Incontinence Quality of Life score Tools for measuring outcomes. An UpSet plot of the distribution of outcome measurement tools used across the studies. a ) Overlap of outcome measurement tools used across the categories: bowel dysfunction , quality of life , and other . The category other consists of custom designed questions or questionnaires, visual analogue scores, and numeric rating scales. b ) Overlap of outcome measurement tools for the bowel dysfunction category. c ) Overlap of outcome measurement tools for the quality of life category. BD = bowel dysfunction. QoL = quality of life. NBD = Neurogenic Bowel Dysfunction score. LARS = Low Anterior Resection Syndrome score. CCF-FI = Cleveland Clinic Florida Fecal Incontinence score. CCF-C = Cleveland Clinic Florida Constipation score. Rome = Rome criteria. KESS = Knowles Eccersly Scott Incontinence score. SF-36 = Short Form (36) Health Survey. EQ-5D = EuroQol-5 dimensions. FIQL = Fecal Incontinence Quality of Life score Across 86 studies, minor harms were more common than major harms. Anal or abdominal pain were most frequent (28% [26 of 92]) [ 8 , 9 , 11 , 12 , 36 , 42 , 48 , 50 , 52 , 55 – 57 , 61 – 63 , 68 , 69 , 74 , 81 , 84 , 86 , 91 , 95 , 97 , 100 , 102 ], followed by minor bleeding (16% [15 of 92]) [ 12 , 27 , 36 , 42 , 56 , 57 , 61 , 69 , 72 , 84 , 92 , 99 , 101 , 102 , 104 ] and cramps (12% [11 of 92]) [ 9 , 36 , 43 , 51 , 63 , 74 , 79 , 81 , 91 , 94 , 97 ]. General discomfort, including symptoms like chills, nausea, dizziness, and fatigue, was reported in 13 studies (14% [13 of 92]) [ 8 , 12 , 38 , 55 , 58 , 69 , 79 , 91 , 94 , 100 – 102 , 104 ]. Major harms were reported in six studies: rectal perforation (4% [4 of 92; 6 patients]) [ 26 , 57 , 64 , 92 ], bowel perforation (1% [1 of 92; 1 patient]) [ 12 ], and pan-colonic ischemia (1% [1 of 92; 1 patient]) [ 71 ]. Technical difficulties were commonly reported, with leakage, meaning that the water enema leaks out during the irrigation, being the most common (23% [21 of 92]) [ 8 , 12 , 18 , 38 , 46 , 50 , 51 , 55 , 56 , 60 , 61 , 77 , 79 , 81 , 86 , 91 , 94 , 97 , 100 , 102 , 104 ]. Expulsion of the rectal catheter was reported in 13 studies (14% [13 of 92]) [ 9 , 12 , 35 , 50 , 51 , 55 , 56 , 69 , 84 , 86 , 100 , 102 , 104 ], and bursting of the catheter balloon in six studies (7% [6 of 92]) [ 9 , 42 , 46 , 56 , 61 , 101 ]. Other challenges included the procedure being time-consuming (11% [10 of 92]) [ 21 , 55 , 56 , 62 , 68 , 79 , 88 , 91 , 101 , 104 ].

This scoping review found that transanal irrigation was primarily used for managing neurogenic and post-surgical bowel dysfunction. Irrigation was most often performed daily or every other day. Irrigation time typically lasted 20 to 70 min, and volume ranged from 400 to 2400 ml of tap water. The Peristeen® system, used with a catheter and manual pump, was the most commonly used equipment. Outcome measures varied with 40 different tools used, of which the Neurogenic Bowel Dysfunction score and the Low Anterior Resection Syndrome score were the most frequently used tools. Despite heterogeneity in study designs and populations, the included studies demonstrated several recurring practical patterns in the application of transanal irrigation, particularly regarding irrigation frequency, use of tap water, and rectal catheter systems. Most irrigation protocols involved daily or every-other-day use of transanal irrigation with tap water and a rectal catheter, highlighting the established role of this approach in outpatient bowel management. TAI was often introduced after the failure of conservative treatment. These recurring patterns suggest that certain practical aspects of TAI use, such as irrigation frequency and use of tap water and rectal catheter systems, are commonly applied across indications and clinical settings, which may help inform future standardization efforts. We found a wide variability in outcome measures, with 40 different measurement tools used across the included studies. While over half of these tools assessed bowel function, only a small number were used repeatedly across multiple studies. This lack of standardization limits meaningful comparison and evidence synthesis, making it difficult for clinicians to evaluate treatment effectiveness or guide patient selection. The heterogeneity in outcome measures highlights the need for greater standardization in future TAI research. A core outcome set for TAI should be considered and should ideally include both symptom-based and patient-centered domains, such as bowel function, fecal incontinence, constipation, quality of life, treatment burden, adherence, patient satisfaction, and harms. Existing validated tools may provide a useful starting point. The NBD score appears particularly relevant for patients with neurogenic bowel dysfunction, while the LARS score is clinically meaningful for patients treated with TAI after rectal surgery. The CCF-FI score may be useful when fecal incontinence is the dominant symptom. Generic quality-of-life tools such as the SF-36 and EQ-5D may allow comparison across populations and interventions, but should be supplemented by condition-specific measures when possible. Future studies should clearly justify the choice of outcome measures and use validated tools that capture both bowel function and patient-important outcomes. Among post-surgical indications, LARS was one of the most frequently reported conditions treated with TAI. The increasing recognition of LARS as a distinct syndrome and its impact on quality of life are reflected in the frequent use of patient-reported outcome measures in this field. This is reflected in the frequent use of the LARS score among the included studies. The frequent reporting of TAI within the LARS literature suggests that it has become an increasingly recognized management option for selected patients with persistent bowel dysfunction following rectal surgery. Although TAI was used across a wide range of indications, relatively few studies explored factors associated with long-term continuation or discontinuation of treatment. Interpretation of outcomes across TAI studies should also be considered in the context of the substantial heterogeneity of the underlying patient populations and treatment indications. Treatment goals and determinants of treatment success may differ considerably between indications. For example, patients with neurogenic bowel dysfunction may place greater emphasis on independence and reduction of bowel-related symptoms, whereas patients with post-surgical bowel dysfunction may primarily focus on symptom control and quality of life. In addition, factors such as functional dependency may influence how treatment success and quality of life are perceived and reported. Consequently, comparisons of outcomes across indications should be interpreted with caution. Future research should therefore focus not only on treatment outcomes, but also on identifying patient and disease characteristics associated with sustained use, treatment burden, discontinuation, and indication-specific treatment success, particularly in commonly studied conditions such as LARS and neurogenic bowel dysfunction. This review has several strengths. A comprehensive literature search was conducted across four major databases, and the search string was developed in collaboration with an information specialist. A backward citation search was performed to identify additional relevant studies. The screening process was carried out by two independent authors, and no language restrictions were applied. The protocol was preregistered on Open Science Framework [ 17 ] before data extraction, and the study was reported in accordance with the PRISMA-ScR guideline [ 16 ]. The study also has limitations. Although the search strategy covered multiple large databases, region-specific databases, such as the China National Knowledge Infrastructure, were not systematically searched; consequently, some relevant studies may have been missed. This may have contributed to an underrepresentation of non-Western studies, and the findings may therefore primarily reflect TAI practices reported in Western healthcare settings. In addition, data extraction was performed by a single reviewer, which may have increased the risk of extraction errors or subjective interpretation. Dual independent extraction was not feasible due to the large number of included studies and the extensive data-charting required across multiple domains, including indications, irrigation protocols, equipment, outcome measures, and harms. The 30-year publication period was chosen to exclude studies using outdated equipment that is not relevant in modern settings; however, it may have led to the exclusion of some relevant studies. TAI is generally considered safe and represents a minimally invasive treatment option [ 7 ]. It may therefore be considered earlier in the management of fecal incontinence and severe constipation, rather than being reserved as a last resort before more invasive interventions such as nerve stimulation, appendicostomy, or stoma formation. Indeed, some studies have proposed TAI as a first-line treatment in selected patients [ 84 , 93 ]. Earlier introduction of TAI may provide patients with an additional therapeutic option alongside other conservative strategies. Although serious complications such as rectal perforation and bowel perforation were rarely reported in the included studies, adverse event reporting was inconsistent across studies and likely subject to underreporting. Consequently, this scoping review was not designed to estimate the incidence of complications associated with TAI. Nevertheless, the available findings are broadly consistent with previous literature describing serious complications of TAI, particularly bowel perforation, as rare but clinically important adverse events requiring awareness during patient selection, training, and follow-up [ 13 ]. In conclusion, this scoping review provides a comprehensive overview of self-administered transanal irrigation in adult outpatient settings. TAI was used across diverse indications, most commonly neurogenic and post-surgical bowel dysfunction, with some recurring patterns in irrigation practices. However, substantial heterogeneity in outcome reporting limits comparability across studies. Future research should prioritize standardized outcome measures, clearer treatment algorithms, and patient-centered implementation strategies.

Bowel dysfunction is a common condition with great global impact. Worldwide, it is estimated that 8% of adults experience fecal incontinence, while 16% are affected by constipation. Both conditions are most commonly reported among women and older adults [ 1 , 2 ]. Transanal irrigation (TAI) can treat bowel disorders involving fecal incontinence and constipation. The technique involves introducing water via the anus into the rectum, sigmoid colon, and descending colon using a catheter or cone [ 3 , 4 ]. It functions as a water-based enema, facilitating bowel emptying optimally up to the left colonic flexure [ 5 , 6 ]. TAI helps individuals regain control of time and place of bowel movements, reducing unpredictability [ 6 ] and relieving symptoms of chronic constipation and incontinence [ 7 ]. Between irrigations, many experience fewer or no episodes of bowel movements [ 6 ], and TAI may improve quality of life and patient satisfaction [ 7 , 8 ]. TAI is used across a range of conditions, including neurological disorders such as multiple sclerosis and spinal cord injury, surgical conditions like postoperative bowel dysfunction and low anterior resection syndrome, and obstetric conditions such as anal sphincter rupture after birth trauma [ 9 ]. TAI is also used in a wide range of other diseases, such as idiopathic bowel disorder, irritable bowel syndrome, and slow transit constipation [ 7 , 10 , 11 ]. Many strategies exist for managing bowel dysfunction. First line treatment involves dietary modifications, lifestyle changes, and the use of laxatives or antidiarrheal agents. If symptoms persist, second line treatment includes small-volume enemas, biofeedback, or suppository laxatives. Third line treatment is transanal irrigation. If these conservative strategies fail, treatment can escalate to invasive interventions such as nerve stimulation, appendicostomy, or stoma formation [ 4 ]. TAI is considered safe and with few harms [ 3 , 11 , 12 ]. Although very rare, serious harms like rectal perforation have been reported [ 13 ]. While TAI is an established treatment for constipation and incontinence, there is no comprehensive overview of its use in clinical practice. Therefore, this scoping review aimed to map the use of self-administered TAI in outpatient settings.

Below is the link to the electronic supplementary material. Supplementary file1 (DOCX 107 KB) Supplementary file1 (DOCX 107 KB)