Latest / Numotion Ally Program Podcast / The CathCast With Leah: Bowel Management and Transanal Irrigation
Transcript
- Amber: Good afternoon. Welcome, Allied Podcast members and friends. Today is the Cathcast, and we are doing a Cathcast takeover with Leah Holderbaum, our normal facilitator, is going to be in the hot seat today answering some questions. Hello, Leah. Leah: Hello, I am pumped to be here. I'm excited for this takeover. Should be fun. Amber: It's a fun topic, a topic that nobody probably woke up and thought they were gonna want to listen to about today, but we we're gonna get into it. The topic today, our discussion is around transanal irrigation. My words for it always an enema on steroids. but there are definitely some more clinical terms behind it. So we're gonna have a quick discussion today around what it is, who it's good for, whatever we think the future of it is, and really specifically geared toward any clinician who's watching this. So, Leah, would you tell our guest what transanal irrigation or for the purposes of this podcast will be TAI? What is it, and talk to us like we're in middle school. Leah: Yeah, absolutely. So transgenal irrigation is a method for bow management and it is an alternative solution for individuals whenever conservative measures have failed. Conservative measures means, you know, diet and medication modification or using digital stimulation and suppositories. So whenever someone is not having an effective bow management program, transgenal irrigation or TAI is another option for them. And so what they would do is they would get the unit and using either Amber: Yeah. Leah: a rectal catheter or a rectal cone, it is inserted into that rectal vault Amber: Yeah. Leah: and that allows for irrigation. So water is going to go up into the intestine. it is a kind of like a manual pump system. And it goes further up into the intestine than say a standard enema. So it's actually going to pull out more stool than what a regular enema or a standard bow program would do. So it allows for more full evacuation. And again, it's just a different alternative for a bow management strategy. Amber: Yes. Great explanation. So for the viewers, this particular device has been around for quite some time. When did it come out, Leah? Like in the eighties? Leah: Mm-hmm. I mean, it was many, many, many, many, many moons ago, but it wasn't Amber: Yeah. Leah: until the nineties that it was actually accepted by by people. So it hasn't been that long ago. Amber: And there's a s certain patient demographic it was created for. And will you share what that is? Yes. Leah: Yes. Yes. So transital irrigation was originally designed for individuals that have spina bifida. And the intent was that it would help them have better control over their incontinence and or manage their constipation and ultimately give them a better quality Amber: Yeah. Leah: of life. So it was specifically designed for individuals with spina bifida. Amber: So there's a lot of talk about it recently, just because in 2025 the device was finally given a hic code. So that means it's going to be reimbursed by more insurance and the access is open. So there's a lot of chatter. There's a lot of resources being put into the manufacturing side, into the distribution side, to the teaching side. So there's a lot of chatter around it, but it has been around for a while. I would love for you to share with our audience how you felt about transanal irrigation a year ago. Leah: A year ago. so I was I will be the first to hesitantly admit that I was not a fan of transental irrigation. with my background as an occupational therapist, I was of the belief that conservative measures worked. I came from a model rehab for spinal cord injury, Amber: We have trying to Leah: and I had convinced myself that suppository digital stimulation was going to work perfectly fine, and we didn't really need another alternative. And it wasn't until very recently just the Start of this year, probably when I started doing more research on bowel management and transital irrigation, that I really started to understand the significant impact that it can make for individuals. And it's not for everybody, but for the people that have success with transgenital irrigation, it is Amber: Yeah, Leah: ultimately life-changing. Whether someone has, let's say, a high-level cervical injury and they're struggling with constipation. Transanal irrigation is going to soften and help to remove the stool that is within that colon. So it's going to help them feel better, ultimately Amber: You'll get a bad. Leah: eliminate, you know, the potential for autonomic dysreflexia, allow them to Amber: Yeah, I know. Leah: participate in more daily life. Whereas on the other side of things, someone with, let's say, spina bifida or a lower motor neuron injury, if they have a lower spinal cord injury, they might have lower motor neuron. where they are going to be more prone to accidents. And if someone is more prone to accidents, they are not going to participate in daily life. They're not going to go out in the community. That's going to take Amber: Yeah. Leah: up time for you know cleaning the accident and having to get you know back onto their schedule. So for these individuals that have these issues of chronic incontinence, chronic constipation, that is going to be the primary target that can benefit from trans anal irrigation. So Again, I'm a firm believer in there is something out there for everybody. TAI is not for everybody, but for individuals that have trialed it and have success with it, it is a ultimate solution long term. Amber: So paint a picture for us what success would look like for someone else. Leah: What success looks like. Yes. so what success looks like when it comes to bowel management is it needs to be consistent Amber: It's Leah: so the person can anticipate around the same time every day when they need to evacuate their bowels. They're not having accidents, they know when it's going to happen and they have some some sense of control over it. The idea also we want to make sure that they Amber: Yeah, yeah, so gonna make sure. Leah: aren't you know, we don't want to have a ton of medications, a ton of equipment, a ton of gadgets. So let's make this as simple as possible. Amber: I wish. Leah: and what's gonna be the most conducive for that person's lifestyle? And then lastly, we wanna make sure that their bowels are managed, that they are staying healthy, they're not having accidents, they aren't constipated, they aren't at risk for autonomic dysriflexia, skin breakdown, UTIs. so ultimately that's the realm of what success Amber: Yeah. Leah: looks like. Someone has control, no accidents. No constipation, no A D and they're just healthy and able to participate in daily Amber: So how many manufacturers are on the market today? Leah: Currently there are three. There are three units that are available on the market right now. Amber: And what without disclosing their names, like can you say like what one unit has maybe different from another unit or if is that Leah: Yeah, I think so again, much like with catheters, all of the units are very, very similar. They're all just a little bit different when it comes to features and benefits. Some of the considerations are looking at if the units come with rectal catheters, rectal cones, or can you choose? there are different clinical indications for a rectal catheter versus a rectal cone. and that could have to do with, you know, the clinical presentation or it could Amber: shit. Leah: have to do with the individual sensation, their dexterity, their functional skill set. But ultimately it's going to come down to does the person want a cone or a rectal catheter? And also, you know, just looking at their their functionality, their, for example, let's look at their dexterity. Do they have the dexterity to potentially you know, pump the manual pump for the air or for the irrigation? Do they have dexterity to, you know, turn the dial for air or water? So again, they're all very, very similar, just a little bit different when it comes to features and benefits. Amber: So if there are clinicians out there watching this and their interest has been piqued by what you've shared, what would the lift look like to be if I'm a clinician and I have a population that might benefit from it? Like am I signing up for a bunch of training? Who trains these customers and these patients on it? Is it gonna be a time like you know basically it's not gonna be billable hours if if if Leah: Mm-hmm. Mm-hmm. Amber: I'm putting someone on it? So unfortunately I know they're all everyone's thinking about that, so kind of describe what that like onboarding of a c patient customer for us looks like. Leah: Yeah, ideally when it comes to clinicians, you know, PTs, OTs, nursing, case manager, whoever it is, the Amber: Right. Leah: the bowel program just needs to be identified. It just needs to be recognized that whatever the person is currently doing is not working for them. They are still constipated, they are still having accidents, they are having episodes of AD, so on and so forth. So once that person is recognized, all that needs to happen is The individual can contact their local new motion medical supply account manager, and we can get in contact with the manufacturers. So we'll do all of the stuff behind the scenes, but the lift for the clinician is just Amber: Right. Leah: to recognize that there is a need there. With these manufacturers, many of them do provide their own. you know, clinical training and they're onboarding with these individuals because this is a minimally invasive bowel regimen. And so we want to make sure that they have ongoing clinical support. And you know, that's something that we unfortunately cannot provide. So we make sure that that is set up with those manufacturer partners. Other than that, there are some one manufacturer specifically works directly with the clinic and that clinic would provide the training. So in summary, the lift for clinicians is just to recognize that hey, this bow pro Program isn't working for whatever reason, would TAI potentially be beneficial and then contact their new motion counterpart? Amber: So it sounds pretty easy outside of my mind. Yeah. Leah: Super easy. Mm-hmm. Amber: So with you being an OT in the space before, I am interested in in how you think an OT's role kind of plays and partners in with like a doctor, with a patient, or with a nurse in the in the realm, all the different Leah: Mm-hmm. Amber: disciplines that are interactive. Like what would an OT's role be in the group for T. Leah: Yeah, so anytime you're addressing anything, you know, bowel and bladder management, it has to be interdisciplinary, it has to be collaborative. And I'll speak just from the OT side. but as an occupational therapist, some of the things I'm looking at are initially dexterity. Can they manage their suppository? Do we need to look at adaptive equipment? I'm also looking at, you know, what type of bathroom equipment they're on. Amber: I don't know. Leah: looking at their ability to transfer onto that equipment, but also considering the potential wet bare bottom exhausted transfer at the end of the bow program in the shower. I'm also working on, you know, clothing management. I'm trying to determine their home modifications for their bathroom setup. And that being said, it it really has to be collaborative. I'm working with my PT partner on balance and transfers and determining the appropriate equipment. And when it comes to specifically TAI, I might be looking at you know, potential modifications for the device. Where's the person going to hold or position the device when they're doing their their bow regimen? does the equipment that they're on, does it need to be modified, Amber: I understand. Leah: potentially looking on a different seat cutout, looking at if it's on, you know, if it's a front cutout, do we need to look at a cutout on the right so that they can be independent? there's a lot of different things that we're looking at, the environmental setup there, cognition. So it really is a very holistic approach. And as an OT, if I didn't have the support of my doctors working on prescriptions and medications and managing the clinical piece or my nurses to help carry it over, my PT counterparts. it would not be effective whatsoever. So it has to be every individual working together for the outcome for the person. Amber: Have you do you have any success stories? Have you had read of any patients or know of anybody in this brief time we've been engaged that have had these like basically something that could be relatively life-changing for them? Leah: Yes. So I actually had a friend and they've been injured for quite a long time. It's been over ten years, but this individual has struggled with chronic constipation forever. this individual has female anatomy and so having constipation, having female anatomy, she was also having increased UTIs. there were a lot of things, a lot of health risks that were going on with her. She was also having increased episodes of autonomic dysriflexia. Because she was constipated, having UTIs. It was just this vicious cycle. And it was, it wasn't that long ago. I will probably maybe six or seven months ago, I believe, she started trialing trans anal irrigation. And Amber: I'm gonna make sure that Leah: she has lost weight. She has had decreased episodes of autonomic dysriplexia. She is back in the gym. She is traveling all over. It actually allowed her to get a brand new job because she didn't have to be so overly focused on her bowel program. So now she has this brand new career. Amber: Yeah. Leah: and it made a significant change in her in her life is is just the short of that. Amber: We love a good success story. Leah: Yes. Amber: Okay, so what c what what misconceptions are out there about TAI that you wish people more understood? Leah: And I'll I'll speak to my own misconceptions. one of them was that a rectal catheter andor potential, you know, rectal cone could cause significant trauma andor injury. And I have since learned that that is not fully true. It really comes down to the technique, the lubrication. and ultimately someone is going to be at a as much of a risk for injury if they're inserting a finger into their rectum or using a digital stimulator or a suppository inserter. Amber: It's Leah: So that is one misconception. Amber: like Leah: Another one that I've Amber: Yeah. Leah: heard a few times is that, and I also believed this, that autonomic dysriflexia would be a prime result of using transanal irrigation. And I actually had a friend of mine share some research with me, and it completely changed my eyes, and it's been something that I've shared with anyone who will listen. But when it comes to autonomic dysriflexia, TAI has been shown that if someone does go into an episode of AD, Amber: Someone definitely. Leah: That episode is less severe and it lasts a significantly shorter amount of time compared to standard bowel treatment programs. So if you think about, Amber: Celebration. Leah: you know, bowel and bladder are typically the primary causes for autonomic dysriflexia. Whereas if someone does go into an episode, if they aren't using transinal irrigation, but it takes, you know, an hour to an hour and a half or longer for their bowel program to take effect, that is that hour and a half that they are going to be enduring. Symptoms and they are going to be feeling not well at all. Whereas if they use transal irrigation, they can be done in 30 minutes. Symptoms will start to subside and they'll be able to start recovering once that has concluded. So I would say those are probably the two biggest misconceptions. And I can say that because I was absolutely guilty of Amber: Yeah. Leah: both of those. It's the injury, the trauma, as well Amber: Yeah. Leah: as autonomic dysriflexia. Amber: What about the the one we've we've heard a few times of the thought that it weakens the colon? even though Leah: I I have heard that talking about how it weakens the colon. And I think it's important that at the end of the day we're looking at the the type of person and the clinical presentation for them. For example, if someone has lower motor neuron, they are not going to have any pelvic floor reactivity whatsoever. There is not going to be Any reflex, there's not Amber: Right. Leah: going to be any ability to tighten those muscles, clench those muscles, no sensation. And so that colon is basically already weakened in and of itself. so it's it's not necessarily the same concept. a lot of times, you know, we Amber: Yeah. Leah: would compare it to a foley or an indwelling catheter where you have that balloon in place and it's just allowing for continuous drainage. Transcendal irrigation isn't like that, it goes in. you would irrigate the bow and then you would remove it. So it's not something that is consistently staying in. but what's great about it is it re it removes the stool from that descending colon. And so someone, you know, they're typically free for about 30 hours. So it does that give them a significantly longer time that they're going to be able to participate. But yeah, that would be my thought. Amber: Cool. Kinda one final question here. What what do we think the future's gonna be for TAI? Like no idea. Leah: You know, I have no idea. I would love to be able to try to compare it with catheters. you know, right now there's only three units on the market. Amber: And Leah: I would not be remotely surprised if down the road if there are more units. I also wouldn't be surprised if there are more options compared to you know, like I mentioned Amber: I'm just gonna kill the same thing. Leah: right now, some units come with cones, some come with catheters. there's only one that has both that are available. So I wouldn't be surprised down the road if All of these units offer cones and rectal catheters. Amber: My Leah: definitely I see a lot of change for the features and benefits. As this is becoming more utilized, I see some functionality being tested behind it and making it more conducive for individuals that have different whether it's dexterity concerns or you know, visual impairments, I see some other things happening with that in regard to features and benefits. Hopefully. Hopefully. Amber: I'm sure it will evolve, you know, from what it's been in the past forty years already out there. So Yeah. Leah: yeah, yeah, it's just gonna continue to change. Amber: I mean, the first thing that would change is the color, you know. I want a pink one, I want a green one. So Leah: And I wouldn't be surprised too, like if you know, down the road if they come up with something that's a bit more compact. Like they're already, you know, fairly small units anyway, but just thinking for like travel or you know, who Amber: No. Leah: knows? I'm just I'm here for the journey. I'm excited for it. I think it's gonna be great. Amber: Put it put in the suggestion box for all the manufacturers. Travel size TAI, please. Yeah. Leah: Absolutely. Absolutely. Mm-hmm. Amber: Well, Leah, thank you for letting me take over your podcast for this really Leah: Absolutely. Amber: exciting new topic. And I I think we'll have more discussions around this in the future. Is there anything you want to Leah: Yeah, I'm very excited. Amber: share with the audience before we before we release you back your podcast to you? Leah: No, I would just, you know, encourage anyone out there who's listening, explore all options and do research and know that you know, just like with, you know, therapy and medications and home exercise programs, BAO program is not one size fits all. TAI is not destined for everybody, but for the person that can benefit from it, it can be significantly life-changing. So be open, learn what you can and It took me convincing, but go Amber: We can then Leah: in with an open mind and I think you'll be excited what you can learn about it. Amber: Thank you again for sharing. And thank you again, Allied friends, Leah: Absolutely. Absolutely. Amber: and community for joining us today. Leah: Absolutely. Thank you all so much.