How Do Continence Management Systems Work?

Continence or colorectal irrigation systems work by introducing a gentle flow of water or normal saline into the lower bowel to trigger natural peristalsis and controlled evacuation. This process helps clear stool from the rectum and colon, preventing unplanned bowel leakage and relieving constipation for up to 24–48 hours.

Depending on patient needs, condition, anatomy, or surgical history, washing out can be performed via retrograde or antegrade incontinence management.

Retrograde Irrigation (Transanal Irrigation or TAI)

A transanal irrigation system (TAI), or rectal irrigation, is the most common non-surgical, or conservative, bowel management method. Water is gently introduced into the rectum and lower colon via insertion of a specialized anal irrigation kit consisting of a rectal catheter and an inflatable balloon. This helps clear stool and provides up to 48 hours of predictable continence.

This conservative bowel management system is often recommended for individuals who have not experienced improvement after changes in their diet and lifestyle and use of laxatives, stool softeners, and suppositories. These include patients who have:

• Neurogenic bowel dysfunction (NBD)
• Low anterior resection syndrome (LARS)
• Faecal incontinence
• Spinal cord shock
• Long-term spinal cord injuries
• Multiple sclerosis
• Chronic constipation

However, due to the pump mechanism of the device, TAI is not recommended for those at risk of bowel perforation. These include patients who are known or suspected to have colorectal cancer, acute diverticulitis, active inflammatory bowel disease (Crohn's disease or ulcerative colitis), ischaemic colitis, recent rectal or colonic surgery, endoscopic polypectomy, or severe cognitive impairment.

It is also not recommended for patients who have severe cognitive impairment, and they do not have a trained carer who can administer it safely.

Antegrade Irrigation (Stomal)

When TAI is ineffective or impractical, an ostomy surgery is done, specifically the Malone Antegrade Continence Enema (MACE) procedure, to create a stoma. It allows for antegrade irrigation, in which water or saline is flushed from the beginning of the large intestine to the rectum via an access or fluid-delivery device. This follows the natural flow of waste evacuation, resulting in a much cleaner colon, reduced risk of stool leakage or soiling, and decreased risk of stool impaction.

This system is typically a long-term solution when other conservative treatments have failed. It is a common procedure for those who have:

• Severe constipation that oral medications or traditional enemas fail to address
• High risk for rectal impaction
• Anorectal malformations
• Fecal incontinence due to neurological disorders or spinal cord defects (like Spina Bifida), Hirschsprung's disease, and other underlying conditions.

Additionally, this system provides independence and convenience, allowing young and adult patients to manage their fecal incontinence with little to no help from a caregiver and reduce the need for full-size colostomy pouches or constant use of oral laxatives.

Find the Right Continence Management System for Your Needs

ATC Medical carries a complete selection of FDA-tested continence management products and ostomy accessories for safety and effectiveness, including:

• Peristeen transanal irrigation systems
• Bowel management kits
• Replacement catheters
• Water bags
• TAI refill Cones
• Sleeves
• Tubing sets

Whether for at-home bowel management or post-surgical care, our product range supports safety, hygiene, ease of use, and improved quality of life for patients, healthcare professionals, and caregivers alike.