Marco Di Mitri et al., Pediatric Surgery International, 2026
Severe bowel dysfunction—including fecal incontinence and refractory constipation—can significantly impact daily life for children and their families. Even after surgical correction or optimized medical therapy, many patients require intensive bowel management routines that are time-consuming and burdensome.
In this prospective observational study, Di Mitri et al. evaluated the impact of transanal irrigation (TAI) using the Navina Smart® system on bowel function, medication use, and quality of life in children with chronic bowel dysfunction over a 60-day treatment period.
The findings suggest that TAI can significantly improve continence, reduce dependence on medications, and support greater social participation for pediatric patients.
Pediatric Bowel Dysfunction and the Need for Effective Management Strategies
Bowel dysfunction is frequently seen in children with conditions such as:
- Anorectal malformations
- Hirschsprung’s disease
- Neurogenic bowel dysfunction
- Idiopathic megarectum
These patients often experience persistent constipation, fecal incontinence, or both, despite standard therapies including dietary modifications, laxatives, stool softeners, or rectal enemas. In some cases, surgical options such as antegrade continence enemas or colostomy may be considered.
Because these approaches can be invasive or burdensome, there is growing interest in therapies that can help establish predictable bowel routines while supporting independence and quality of life.
How Transanal Irrigation Supports Bowel Control
Transanal irrigation involves introducing a controlled volume of water into the rectum via a catheter to stimulate bowel emptying and facilitate regular evacuation.
The therapy aims to:
- Reduce fecal incontinence
- Improve bowel regularity
- Prevent stool retention
- Create a predictable bowel routine
While TAI is widely used in adults with neurogenic bowel dysfunction, its role in pediatric bowel management has only recently been studied in greater depth.
Study Design: Evaluating TAI in Children With Severe Bowel Dysfunction
The study included 20 pediatric patients with fecal incontinence who initiated transanal irrigation using the Navina Smart® system as part of routine clinical care.
Patient characteristics included:
- Mean age: 12.5 years
- Sex: 70% male
- Underlying diagnoses: anorectal malformations (60%), megarectum (15%), neurogenic bowel dysfunction (15%), and Hirschsprung’s disease (10%).
Patients and caregivers completed a structured questionnaire assessing bowel function, medication use, and quality of life before starting TAI and again after 60 days of treatment.
Significant Improvements in Continence and Bowel Function
After 60 days of transanal irrigation, several key clinical outcomes improved significantly.
Fecal incontinence episodes decreased substantially.
Before treatment, many patients experienced frequent incontinence, with 13 reporting two or more episodes per week. After treatment, most patients reported fewer than one episode per week.
Daily soiling episodes were markedly reduced.
Prior to treatment, 10 patients reported three or more soiling episodes per day. Following TAI, none reported more than two daily episodes.
Bowel routines became more predictable.
More patients achieved a single regular daily evacuation following treatment, reflecting improved bowel regulation.
Time spent on bowel care decreased.
The number of patients requiring more than 10 minutes per day for bowel management fell significantly after TAI initiation.
Reduced Reliance on Laxatives and Enemas
One of the most notable findings was the reduction in medication use.
Before starting TAI:
- all patients used oral laxatives
- all patients required rectal enemas
After initiating transanal irrigation with Navina Smart:
- only six patients continued using laxatives
- none required enemas
These changes were statistically significant and suggest that TAI may reduce reliance on pharmacological and rectal interventions in pediatric bowel management.
Improvements in Quality of Life and Social Participation
The study also demonstrated meaningful improvements in daily life.
After initiating transanal irrigation, patients reported:
- fewer limitations when leaving the house
- reduced fear of accidents or odor
- improved participation in school and leisure activities
The impact of fecal incontinence on school attendance and free-time activities decreased significantly, highlighting the broader psychosocial benefits of improved bowel control.
Key Takeaways for Pediatric Bowel Management
This prospective study adds to the growing evidence supporting transanal irrigation as an effective therapy for children with refractory bowel dysfunction.
The findings suggest that TAI—including treatment delivered using systems such as Navina Smart—can:
- improve fecal continence
- reduce reliance on laxatives and enemas
- shorten bowel care routines
- support greater independence and participation in daily life
Although larger studies with longer follow-up are needed, these results reinforce the role of transanal irrigation as a valuable component of modern pediatric bowel management.
Clinical Practice Perspective
For clinicians managing pediatric bowel dysfunction, these findings highlight several practical considerations:
- Consider TAI earlier in the treatment pathway for patients with persistent fecal incontinence or refractory constipation despite conservative management.
- Structured training for caregivers and patients is essential, particularly for younger children who rely on caregiver-performed irrigation.
- TAI may reduce reliance on enemas and laxatives, simplifying bowel care routines and potentially improving long-term adherence.
- Quality-of-life outcomes are clinically meaningful, with improvements in school participation, social activities, and daily confidence.
Together, these findings reinforce the importance of a multidisciplinary, patient-centered approach to pediatric bowel management, where effective bowel control can support both physical health and psychosocial development.