Pulsed Irrigation Evacuation (PIE) for Neurogenic Bowel - Transanal Irrigation (TAI)

Neurogenic Bowel and Fecal Impaction Treatment - A system for relief with PIEMED

Alternative to Colostomy Bag

Provides Transanal Irrigation also termed retrograde irrigation while laying on one's side in bed. All other solutions such as Peristeen® Plus Transanal Irrigation System require sitting on a toilet. Coloplast® Care at 1-855-605-7594 peristeen@coloplast.com

Aging

Bowel programs may function well for years without any issues when, for no apparent reason,that changes. Part of the issue can be the effects of long-term neurological issues and aging. As individuals age, the bowel can slow. Combined with the bowel challenges of neurological issues this can be a compounding complication.

Starting from the beginning might help in creating an improvement. Review your diet, fluid intake, medications, and activity level. Talk with your healthcare professional to review your techniques and medications. Sometimes people get caught in a cycle of adding things to make the bowels move and adding other things to stop it. Let the bowel do its natural processing with minimal intervention if possible.

Bowel nerve function

Individuals with neurological issues have difficulty with their bowels because of slowing of the bowel function by the nerves of the Autonomic Nervous System (ANS). This nerve system slowing combined with decreased body movement affects bowel function.

Many people think that because the bowels are slow, the problem is constipation. This is not the source of the problem. Treatment for constipation will not assist a neurogenic bowel to work more efficiently. Individuals with or without neurogenic bowel can become constipated. Neurogenic bowel does put you at higher risk for constipation. A bowel program will result in controlled bowel movements with a neurogenic bowel.

Gas

Bloating and gas can be an issue for individuals with neurogenic bowel. Slowing of the bowel can lead to a buildup of gas which appears as bloating. Movement can help resolve some of the issue because it pushes gas along in the bowel. Eating foods that produce little gas can help. Adding movement through range of motion exercises, pressure reduction techniques and activity assist with gas movement in the bowel.

Gas reducing tablet medication (simethicone) is available. Take gas reduction medication when needed, not as a routine, if possible. Gas in the bowel is one of the ways waste is propelled through the bowel. It is a necessary action. Eliminating gas can reduce bowel propulsion.

Neurogenic Bowel Management Using Transanal Irrigation by Persons with Spinal Cord Injury - Claes Hultling, MD, PhD - paraplegic Director of Swedish Spinalis Foundation that provides inpatient and outpatient rehabilitation for 25% of all Swedes with spinal cord injury.

11.3 Treatment for hemorrhoids is conservative; if bleeding is refractory, non-excisional techniques are warranted. Excisional hemorrhoidectomy should be avoided.

Individuals with SCI develop common benign anorectal conditions similar to those in neurologically intact individuals. These conditions may include hemorrhoids, anorectal abscesses and fistulae, rectal prolapse, and pilonidal disease, as well as other entities. If there is any uncertainty in diagnosis or if symptoms cannot be explained, flexible sigmoidoscopy and pelvic magnetic resonance imaging should be used. Chronic constipation, straining, pelvic and perineal pressure, stasis, hygiene, and poor blood flow often contribute to the development of these entities. Hemorrhoids are best managed conservatively except for chronic blood loss, in which case rubber band ligation, infrared coagulation, and sclerotherapy are options.235,236 Excisional hemorrhoidectomy should be avoided unless the pedicle has evidence of a necrotizing infection. Perirectal and perianal abscesses should be adequately drained. Anal fistulae are best managed with non-cutting setons and these setons may be required long term.

Transanal Irrigation for Refractory Chronic Idiopathic Constipation: Patients Perceive a Safe and Effective Therapy 2017

Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury
Clinical Practice Guideline for Health Care Providers 2021

Bowel Management by Christopher & Dana Reeve Foundation (very comprehensive)

Trans-anal irrigation therapy to treat adult chronic functional constipation: systematic review and meta-analysis 2015

Malone antegrade continence enema Surgery often done with Mitrofanoff procedure

Aetna Policy

Aetna considers manual pump enema systems (e.g., Peristeen Anal Irrigation System, Coloplast, Minneapolis, MN) medically necessary for the management of chronic neurogenic bowel when initial management involving diet, bowel habit, laxatives or constipating mediations has failed. Aetna considers manual pump enema systems experimental and investigational for the treatment of idiopathic constipation and treatment of fecal incontinence, because their effectiveness for these indications has not been established.

Aetna considers pulsed irrigation and evacuation systems (e.g., Pulsed Irrigation Evacuation (PIE), P.I.E. Medical Inc., Buford, GA) experimental and investigational because its clinical value for persons with chronic constipation has not been established. Note: Consistent with Medicare policy, pulsed irrigation evacuation systems are not covered because they are considered institutional equipment.

Aetna considers gravity-administered enema systems medically necessary for the treatment of constipation, fecal incontinence, and bowel management protocols.

Aetna considers rectal inserts and related accessories experimental and investigational because of inadequate evidence of their effectiveness.

Aetna considers the use of a stent for bowel obstruction due to colorectal malignancy medically necessary for palliation and as a bridge to surgery.