Clinical, social, and motility factors influencing transanal irrigation response in pediatric patients

Objectives Chronic constipation (CC) and fecal incontinence (FI) are significant problems for pediatric patients. Transanal irrigation (TAI) is a therapy that effectively relieves symptoms in patients with disorders of gut–brain interactions (DGBI) or organic CC/FI. This mixed‐methods study aimed to identify predictive factors for TAI adherence and outcomes in pediatric patients. Methods Out of 151 screened patients, 63 were eligible for enrollment, with a 60.3% response rate and 97.3% survey completion. We analyzed adherence, symptom severity, quality of life (QOL), and manometry data from 38 patients who initiated TAI at Nemours Children's Hospital (2017–2023). Additionally, seven parents of noninitiating patients were interviewed to assess barriers. Results No significant differences were found in TAI‐related difficulties (pain, independence, and technical issues), though patients with DGBI etiologies reported slightly more psychological difficulties with TAI ( p = 0.077). Adherent patients showed fewer CC symptoms and higher QOL compared to nonadherent patients ( p = 0.002) at the time of interview. Attention‐deficit/hyperactivity disorder (ADHD), diagnosed in 42.1% of patients, was a significant predictor of nonadherence, with these patients reporting more severe symptoms and lower psychosocial scores. Manometry results did not predict outcomes, indicating a need for improved diagnostics. Barriers to TAI initiation included insurance challenges, fear of trauma, and logistical obstacles. Conclusions Patients with organic and DGBI CC/FI experienced similar challenges using TAI. Adherence was associated with improved symptoms and QOL. ADHD was a significant predictor of nonadherence, underscoring the need for tailored interventions. Future research should focus on long‐term outcomes and strategies to enhance adherence, particularly for children with ADHD.