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Nurses welcome NICE support for irrigation device for constipation and faecal incontinence

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A medical device for treating constipation and faecal incontinence has been recommended for health service use by the National Institute for Health and Care Excellence.

Specialist stoma care nurses working with both children and adults affected by faecal continence problems welcomed the decision by NICE to back the use of the Peristeen transanal irrigation system.

“This is good news for children and young people with continence problems, who are sometimes sadly forgotten”

June Rogers

In new medical technology guidance published today, NICE said the “case for adopting” the Peristeen for managing bowel dysfunction was “supported by the evidence”.

According to NICE, the system can “reduce the severity of constipation and incontinence, improve quality of life and promote dignity and independence”.

However, the institute cautioned that Peristeen may not be suitable for all people with bowel dysfunction. It may take several weeks before a person is comfortable with using Peristeen, and some people may choose to stop using it, noted NICE.

It said the system was, therefore, most effective when it was offered with specialist training for users, carers and NHS staff, and structured patient support.

“Transanal irrigation is well tolerated by children and young people; we should not shy away from its use”

Brenda Cheer

Meanwhile, NICE described cost modelling for the system as “uncertain”, but said it was “likely that Peristeen provides additional clinical benefits without costing more than standard bowel care”.

According to its manufacturer Coloplast, Peristeen should be used every other day to empty the rectum and distal sigmoid colon to prevent faecal incontinence or relieve and prevent constipation.

It is usually self-administered while sitting on a toilet, commode or shower chair, noted the NICE guidance. The device comprises a rectal catheter with inflatable balloon, a manual control unit with pump, leg straps and a bag to hold water.

It uses a constant-flow pump that does not rely on gravity so the user does not need to hang the bag up for the water to flow. However, Peristeen needs a new catheter each time it is used.

It costs £76.28 per system – comprising a Peristeen pump, two catheters, two straps and a water bag – and £132.95 per consumable pack of 15 catheters and replacement water bag (excluding VAT).

Coloplast highlighted that NICE had acknowledged that the firm had a range of community-based and non-clinical services for Peristeen users and prescribers, including a team of specialist nurses.

“We’re very happy that NICE has acknowledged the role that Peristeen plays in supporting good bowel function”

Carol Adcock

The publication of this NICE appraisal offers a solution to some of the estimated one in seven adults and one in three children who suffer from constipation at any one time, it said.

June Rogers, a paediatric continence specialist and nurse at Bladder and Bowel UK, said the NICE guidance was “good news” for children and young people with continence problems.

“Children with chronic constipation resulting in soiling, those born with anorectal malformations and those with a disability, or other problems resulting in no or poor bowel control have had limited treatment options until now,” she said.

“This new NICE guidance means that these young patients will now have another form of treatment available from the NHS,” she said. “Hopefully this will also reduce the need for them to undergo surgery.”

She added: “It is important now to ensure that all paediatricians, GPs and nurses who work with children and young people are made aware of this promising therapy.”

Coloplast

Peristeen transanal irrigation system

Peristeen transanal irrigation system

Brenda Cheer, a paediatric specialist continence nurse from ERIC, the children’s bowel and bladder charity, said transanal irrigation systems offered “enormous benefits” to children and young people.

“No child should have to suffer from ongoing faecal soiling; if laxatives and regular, effective toileting do not prevent it then they should be offered a rectal intervention,” she said.

“This new NICE guidance will help to spread that message more widely,” she said. “It will add credibility to the prescription of Peristeen both for long term conditions and for those that require it temporarily to enable the bowel to rehabilitate.”

She added: “Transanal irrigation is well tolerated by children and young people; we should not shy away from its use.”

Carol Adcock, a spinal cord injury nurse specialist with the Spinal Injuries Association, said: “Effective bowel care is crucial in helping spinal cord injured people lead a fulfilled life.

“Transanal irrigation products like Peristeen are known to be both very effective and popular with spinal cord injured people as they reduce the severity of constipation and incontinence, improve quality of life and promote independence,” she said.

“We’re very happy that NICE has acknowledged the role that Peristeen plays in supporting good bowel function,” said Ms Adcock.

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