Int J Colorectal Dis (2008) 32:195–200 197 Fig. 2 Irrigation bag (Braun®) pump works on a storage battery, and the speed of water ejection can be regulated. The working mechanism of the irrigation bag is similar, except for the water ejection, which is induced by gravity. Data analysis was performed by using SPSS 14.0 (SPSS release 14.0, SPSS, Chicago, USA), with the Mann– Whitney U test. P ≤ 0.05 was considered statistically significant. Data are given as the mean values with the standard deviation. Results The questionnaire was sent to 74 patients. Fourteen patients did not wish to participate in the study for various reasons, and 14 patients did not return the questionnaire. Forty-six patients (62%) could be included for analysis of which 37 were female (80%), and these patients had an overall mean age of 59.3±12.4 years. Complications of the DGP occurred in 23 (50%) patients of which 10 patients had two or more complications. Twenty-two patients suffered from constipa- tion, 35 patients were still incontinent for feces, and seven patients had pain in the IPG pocket, leg, or anus. The medical history besides the DGP is mentioned in Table 1. On average, the patients started the irrigation 21.39± 38.77 months after the DGP. Eight patients already used irrigation before DGP. Twenty-four (52%) patients used irrigation as an additional therapy for fecal incontinence in partially failing DGP. Eleven (24%) patients used irrigation for constipation and 11 (24%) patients for both. Most patients (91%) used the irrigation pump. Three patients added soap and one patient an enema to the water to achieve a better result. These were patients with constipation or a combination of fecal incontinence and constipation. Irrigation was usually performed in the morning (70%) and sometimes in the evening (16%). The frequency of irrigation was 0.90 ±0.40 times per day. The amount of water used for irrigation was 2.27±1.75 l with duration of 39 ±23 min. Seventy-four percent of the patients with fecal incontinence irrigated in the morning, 17% in the evening, and 9% twice a day. For the patients with constipation, these numbers are, respectively, 45, 18, and 36%. Ninety percent of the patients with a combination of defecation disorders used the colonic irrigation in the morning. There was no significant difference in the frequency of irrigation between patients with fecal incontinence and patients with constipation (0.92 vs 0.98/day; P= 0.108). The amount of water used for irrigation was higher in patients with fecal incontinence compared to patients with consti- pation, but this difference was not significant (2.31 vs 1.91 l; P=0.484). There was no significant difference in the time needed for irrigation between patients with fecal incontinence and those with constipation (40.8 vs 32.9 min; P=0.154). Overall, 81% of the patients were satisfied with the irrigation, 80% of the patients with fecal incontinence, 90% of the patients with constipation, and 72% of the patients with a combined defecation disorder. Thirty-seven percent of the patients with fecal incontinence reached (pseudo-) continence, and in 30% of the patients, the constipation completely resolved (Fig. 3). In 29% of the patients with a combined defecation disorder, the constipation resolved and they were (pseudo-) continent. Overall, satisfaction was related with symptomatic improvement. Only one patient with good symptomatic improvement was not satisfied because he felt that the irrigation was time-consuming and not practical. Four patients, two with fecal incontinence, one with constipation, and one with both, performed antegrade irrigation through a (3) colostomy or an (1) appendico- cecostomy with good results, and all indicated that the irrigation improved their quality of life. The patients could be divided in six groups according to the underlying cause of fecal incontinence before DGP (Table 2). When the different etiologies before DGP were compared with the result during irrigation, the patients with Table 1 Medical history Medical history Anal rupture during delivery Anal repair Prolapse operation Hysterectomy Abdomino-perineal resection for rectum carcinoma Sigmoid resection for sigmoiditis Cholecystectomy Anus atresia Number of patients (percentage of total) 13 (28%) 14 (30%) 19 (41%) 17 (37%) 8 (17%) 2 (9%) 8 (17%) 1 (2%)