Int J Colorectal Dis (2008) 32:195–200 DOI 10.1007/s00384-007-0375-y ORIGINAL ARTICLE Colonic irrigation for defecation disorders after dynamic graciloplasty Sacha M. Koch & Özenç Uludağ & Kadri El Naggar & Wim G. van Gemert & Cor G. Baeten Accepted: 26 July 2007 / Published online: 21 September 2007 # Springer-Verlag 2007 Abstract Background and aims Dynamic graciloplasty (DGP) improves anal continence and quality of life for most patients. However, in some patients, DGP fails and fecal incontinence is unsolved or only partially improved. Constipation is also a significant problem after DGP, occurring in 13–90%. Colonic irrigation can be considered as an additional or salvage treatment for defecation disorders after unsuccessful or partially successful DGP. In this study, the effectiveness of colonic irrigation for the treatment of persistent fecal incontinence and/or constipa- tion after DGP is investigated. Materials and methods Patients with defecation disorders after DGP visiting the outpatient clinic of the University Hospital Maastricht were selected for colonic irrigation as additional therapy or salvage therapy in the period between January 1999 and June 2003. The Biotrol® Irrimatic pump or the irrigation bag was used for colonic irrigation. Relevant physical and medical history was collected. The patients were asked to fill out a detailed questionnaire about colonic irrigation. Results Forty-six patients were included in the study with a mean age of 59.3±12.4 years (80% female). On average, the patients started the irrigation 21.39 ±38.77 months after the DGP. Eight patients started irrigation before the DGP. Fifty-two percent of the patients used the irrigation as additional therapy for fecal incontinence, 24% for consti- pation, and 24% for both. Irrigation was usually performed S. M. Koch : Ö. Uludağ : K. El Naggar : W. G. van Gemert : C. G. Baeten (*) Department of Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands e-mail: c.baeten@surgery.azm.nl in the morning. The mean frequency of irrigation was 0.90 ± 0.40 times per day. The mean amount of water used for the irrigation was 2.27 ±1.75 l with a mean duration of 39 ± 23 min. Four patients performed antegrade irrigation through a colostomy or appendicostomy, with good results. Overall, 81% of the patients were satisfied with the irrigation. Thirty- seven percent of the patients with fecal incontinence reached (pseudo-)continence, and in 30% of the patients, the constipation completely resolved. Side effects of the irriga- tion were reported in 61% of the patients: leakage of water after irrigation, abdominal cramps, and distended abdomen. Seven (16%) patients stopped the rectal irrigation. Conclusion Colonic irrigation is an effective alternative for the treatment of persistent fecal incontinence after DGP and/or recurrent or onset constipation additional to unsuc- cessful or (partially) successful DGP. Keywords Colonic irrigation . Fecal incontinence . Constipation . Dynamic graciloplasty Introduction Dynamic graciloplasty (DGP) is a proven effective treat- ment for fecal incontinence. Success rates vary from 42– 92% [1–5]. Comparison of results is difficult because the outcome of this method seems to be influenced by the etiology of fecal incontinence, pre-existing stoma, length of follow-up, method of stimulation, and the surgeon’s experience [1, 6]. DGP significantly improves quality of life and anal continence for most patients [2]. Quality of life and patient satisfaction scores correlate significantly with continence scores [7, 8]. However, in some patients, fecal incontinence is unsolved or only partially improved after DGP.