198 Fig. 3 Success of rectal irriga- tion for defecation disorders Int J Colorectal Dis (2008) 32:195–200 incontinence constipation 5% 21% 37% 37% 10% 30% 10% 50% continent sometimes incontinent often incontinent no change no constipation sometimes constipation often constipation no change a rupture or anal surgery had the worst results of irrigation. The patients with a spinal cord lesion seemed to have the best results. Side effects of the irrigation were reported in 61% of the patients: leakage of water after irrigation (43%), abdominal cramps (17%), and distended abdomen (17%). Twenty-four (53%) patients changed the irrigation method during their course to improve the results. Seven (16%) patients stopped the rectal irrigation: in five patients, the result was unsatisfactory; two other patients did not need the irrigation anymore because the complaints resolved completely. Finally, two patients received a permanent stoma. Discussion Colonic irrigation can be used effectively to treat defecation disorders when other conservative treatments fail or in addition to unsuccessful or partially successful surgical treatment [18]. Colonic irrigation is usually forgotten as an alternative conservative treatment for defecation disorders, although many health care takers are familiar with colonic irrigation, particularly, for its use as perioperative colonic cleansing [19, 20]. Retrograde colonic irrigation is performed through the anorectum or via a colostomy. Only a few publications addressed to retrograde colonic irrigation are found in literature. Briel et al. [13] found a success rate of 38% of retrograde colonic irrigation for fecal incontinence and a significant improvement in quality of life. Recently, another study reported a success rate of 41% in patients with fecal incontinence and 65% in patients with constipation [18]. The success rate is based on patient satisfaction. Although patient satisfaction is the primary goal of treatment, it is a subjective measure. In future research, this should be combined with objective measures such as validated quality of life questionnaires in a prospective study design. Antegrade colonic irrigation is especially known for the treatment of evacuation disorders in small children and can be performed through an appendico-cecostomy (MACE) or a cecostomy button [16, 21–23]. Alternative enteral access is a sigmoid tube or transverse colonic conduit for patients with a left colonic evacuation disorder [24–26]. The most Table 2 Success of rectal irrigation in different etiologies for fecal incontinence before DGP Number of cases Success (%) during irrigation Etiology Congenital Trauma Pudendopathy Spinal cord lesion Abdomino-perineal resection for rectum carcinoma Prolapse Total 1 14 15 5 8 2 45 1 (100%) 3 (21%) 5 (33%) 3 (60%) 3 (37%) 0 (0%) 15 (33%)