Promoting adherence with Transanal Irrigation – an electronic solution

December 14 2020

TAI is a proven therapy for managing bowel dysfunction helping thousands to find an effective relief from their bowel dysfunction symptoms. It even promotes better bladder health. But adherence to the therapy in the initial training stage can often be challenging, as the results are not immediate. It happens that some impatient users come back to less effective, but familiar strategies for managing their bowels. How to help them adhere to proven effective TAI therapy, that can truly give life changing positive results? In this case study, we look at the story of one user, who managed to overcome initial obstacles.

Navina Smart App HCP user

  • The patient started with transanal irrigation (TAI) in 2013
  • She experienced discomfort and balloon expulsion

  • On occasion, she would need to repeat the irrigation procedure between three to six times on the same visit to the toilet.

. . . the urological nurse, banged her head against a brick wall trying to help me. Transanal irrigation still seemed to be the best solution but the manually operated equipment made it difficult.

Paulene, Navina Smart user

TAI can take anywhere between 15 minutes up to an hour to complete, once the user has finished an initial training period (typically it takes 4 to 12-week period for the body to adjust to the new routine). Incidents of balloon expulsion and multiple irrigations leading to ineffective evacuation do not help the user to adhere to the therapy. Although those incidents do happen really rarely, if they do, such an experience can be more than enough to dissuade a user to persevere, when they will have already struggled with finding an effective, bowel management therapy.

So what leads to balloon expulsion and ineffective irrigations? A little knowledge about the types of TAI devices available will help us understand more.

Manual and electronically operated TAI systems

A TAI system can be either a manually operated pump system, or an electronically operated pump system. The electronically operated system can control the pressure of the balloon, as well as the speed and amount of water for irrigating the bowel. For many users, who have tried the manual pump, this is where they often run into issues, as it takes time to find the optimal amount of water, balloon size etc.
An electronic TAI system can detect the pressure and have a safe-guard cut-off measure that prevents pressure reaching a certain amount within the internal environment of the rectum. As a result with electronic systems balloon explosions are extremely rare.

Technology uptake within the Over 60s 
Paulene is 66, and as she describes herself, not particularly able or interested in technology. She also has Multiple Sclerosis, causing limited hand function. Can an electronic TAI be an optimal choice for her?

Pauline has overcome initial objections and tried TAI with an electronic pump. And although she had never used an app before, with a little help from her nurse and her family, she downloaded her first ever app and embarked upon a second attempt at TAI. This time TAI with electronic control unit.

What is a Smart Unit and a Smart App – are they the same thing?
  • An electronic system is operated by an electronic "smart unit" that controls the balloon size and pressure and also the amount and speed of water instilled for irrigation. As the irrigations are electronically controlled they are always consistent.
  • A "smart app" allows the user to track the personal satisfaction ratings after each irrigation based on used size of the balloon, amount and speed of water etc. It works as an electronic irrigation diary. It helps to identify the irrigation parameters that are optimal (and associated with highest user’s satisfaction). Crucially, this data can be sent directly to the user's health care professional so that she/he could suggest required adjustments. It is believed that app helps identify the optimal TAI regimes faster!


1246435-Navina Smart App screenshot-HCA screenshot of  "Smart App" logs and displays recorded data values over time

It’s good that I need to send reports, because it keeps me aware of how the different irrigations work out. I don’t report every time, but when it's something out the ordinary, I do. Another good thing is that I can stay in contact with the clinic, secure in the knowledge that my information has been logged – no need to call, or chase staff to ensure they have received my information. I just send a note on the app, and my nurse will get back to me when it suits her. And I get it off my mind.

 - Paulene

Did the Smart App promote adherence?

Since I started using TAI I feel much more confident. I'm able to go out without that constant anxiety about having an accident. I used to have an upset stomach and irrigation relieves the pain. This digital solution is the first treatment that works, and I’m happy to stick with it.

Why did Navina Smart work better for Paulene?

• The controls were much easier to use as only a light touch was required.
• A constant water flow was achieved as it was not dependent on hand pressure.
• The water flow could be easily adjusted.
The balloon provided a tight seal which meant that no water leaked during the procedure

wellspect-elderly-woman-using-smartphone

Paulene has been using a Smart system and app since 2016.

Read the Case Report

Topics: Navina Smart Data, Navina Smart, TAI, Transanal Irrigation