Rectal Enema Research Articles

Protocol for faecal microbiota transplantation in ulcerative colitis (FMTUC): a randomised feasibility study

BackgroundThe interaction of the gut microbiota with the human host is implicated in the pathogenesis of inflammatory and immunological diseases including ulcerative colitis (UC). Faecal microbiota transplantation (FMT) as a...

Rectal Insulin Instillation Inhibits Inflammation and Tumor Development in Chemically Induced Colitis.

Epithelial expression of the insulin receptor in the colon has previously been reported to correlate with extent of colonic inflammation. However, the impact of insulin signalling in the intestinal mucosa is still unknown. Here, we investigated the effects of inactivating the epithelial insulin receptor in the intestinal tract, in an experimental model of inflammation-induced colorectal cancer. The mice were generated by utilizing the intestinal- and epithelial-specific villin promoter and the Cre-Lox technology. All mice included in the cohorts were generated by crossing [vil-Cre-INSR+/-] × [INSRfl/fl] to obtain [vil-Cre-INSR-/-], and their floxed littermates [INSRfl/fl] served as the control group. For the intervention study, phosphate-buffered saline with or without insulin was instilled rectally in anaesthetized wild-type mice with chemically induced colitis. We found higher endoscopic colitis scores together with potentiated colonic tumorigenesis in the knockout mice. Furthermore, we showed that topically administered insulin in inflamed colons of wild-type mice reduced inflammation-induced weight loss and improved remission in a dose-dependent manner. Mice receiving rectal insulin enemas exhibited lower colitis endoscopic scores and reduced cyclooxygenase 2 mRNA expression, and developed significantly fewer and smaller tumours compared with the control group receiving phosphate-buffered saline only. Rectal insulin therapy could potentially be a novel treatment, targeting the epithelial layer to enhance mucosal healing in ulcerated areas. Our findings open up new possibilities for combination treatments to synergize with the existing anti-inflammatory therapies.

Fecal Coliform Bacterial Detection to Assess Enema Adherence in HIV Prevention Clinical Studies.

Evaluating the efficacy of any HIV prevention strategy is dependent on ensuring and objectively monitoring adherence to the intervention. Medicated rectal enemas are a potential method for providing topical, episodic HIV prophylaxis during receptive anal intercourse. Assessing adherence to recommended enema dosing regimens is essential in evaluating the utility of this strategy. We utilized fecal coliform bacteria on used enema tips as a marker for enema use. Enema tip coliforms were tested by repurposing a microtiter plate-based water quality test designed to detect fecal contamination of water. Coliform detection occurred with 100% sensitivity and specificity when tips were assayed on day of use. The assay performed well post-7day sample storage at room temperature, yielding a sensitivity of 80% and specificity of 93%. All (n = 64) samples collected in a subset of the DREAM-01 rectal microbicide enema clinical trial tested positive, even when tips were evaluated > 7days post-reported use. The coliform-based enema tip assay allows monitoring of adherence in interventions involving rectal enemas in a sensitive, specific and inexpensive manner. The test performs well in clinical trial settings.

Development of rectal enema as microbicide (DREAM): Preclinical progressive selection of a tenofovir prodrug enema

HIV pre-exposure prophylaxis (PrEP) strategies have the potential to prevent millions of incident HIV infections each year. However, the efficacy of PrEP strategies has been plagued by issues of non-adherence, likely because of the difficulty in motivating otherwise healthy people to adhere to treatment regimens that require significant behavioral changes and daily discipline. An alternative approach to PrEP is to focus on strategies that fit in to normal, and even desirable, sexual behaviors, such as the use of cleansing enemas by men who have sex with men (MSM) prior to receptive anal intercourse (RAI). Here, we describe preclinical efforts toward optimizing a tenofovir (TFV)-based enema formulation for rectal PrEP. Using a murine model, we compared the plasma and tissue pharmacokinetics of TFV and various TFV prodrugs, including tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), and hexadecyloxypropyl tenofovir (CMX157), after dosing as enema formulations with varying osmolality and ion content. We observed that the enema vehicle composition played a more important role than the TFV prodrug properties in achieving rapid and therapeutically relevant tenofovir diphosphate (TFV-DP) concentrations in mouse colorectal tissue. Our results support the next steps, which are further preclinical (non-human primate) and clinical development of a hypo-osmolar TFV enema product for rectal PrEP.

Plantago major in Traditional Persian Medicine and modern phytotherapy: a narrative review.

Plantago major has been used widely since ancient times, to manage a wide range of diseases including constipation, coughs and wounds. The aim of this study is to review the traditional application, botanical characterization, pharmacological activities, phytochemistry effects and toxicity of Plantago major. In this review study, medicinal properties of Plantago major are collected from credible pharmacopeias, textbooks of traditional Persian medicine (TPM) belonging to the 10–18th century AD, such as “The Canon of Medicine”, “Makhzan-Al- Advia” and so on. Moreover, electronic databases including Scopus, Medline and Web of science were explored for this purpose. Plantago major has been prescribed in various forms such as roasted seeds, decoction, syrup, liniment, gargle, rectal enema, vaginal suppository, eye and nasal drop for each illness by TPM scholars. Some of its traditional properties including wound healing, antipyretic, antitussive, anti-infective, anti-hemorrhagic, anti-inflammatory, diuretic, laxative, astringent and hemostatic have been confirmed in recent researches. Phytochemical investigations showed that Plantago major contains volatile compounds, triterpenoids, phenolic acids and flavonoids. Modern pharmacological studies have proven some of the traditional applications of Plantago major. Nevertheless, more investigations are required on this plant, because it has the potential to be used to produce various natural medications.

Time-dependent dose distribution changes in prostate brachytherapy with iodine seeds.

115 Background: Prostate brachytherapy with iodine seeds has a lasting dose delivery due to a long half life of I125 (i.e. 2 months). To assess changes in dose metrics over time in low-dose rate prostate brachytherapy with iodine seeds and its relationship with rectal distension. Methods: One hundred and twenty-one post-implant CT scans performed every 2 weeks over 2 months after the treatment procedure were analyzed for dosimetry. Each CT-scan was performed without and with rectal enema. The following rectal parameters were collected to evaluate the influence of rectal distension over time: rectal volume, cross-sectional surface area (CSA) and relative CSA calculated from the first CT-scan chosen as reference (CTref). Results: Mean V150% and V200% of the prostate volume increased significantly over time (p < 0.0001) and were significantly higher on postimplant CT scan performed at day 45 (CT45) (p = 0.024 and p = 0.003, respectively) and CT scan performed at day 60 (CT60) (p = 0.0005 and p < 0.0001, respectively) compared with CTref. All dosimetric parameters for the rectum were significantly increased over time. No rectal parameters were significantly different after rectal enema and there was no difference in doses delivered to the prostate and the rectum after rectal emptying. Conclusions: Increased hot spots in the prostate and the rectum during the 2 months following the procedure with iodine seeds may be related to prostate shrinkage rather than rectal distension. We hypothesize that radioelements with shorter half-life (Pd103 or Cs131) or HDR may give less toxicity, as dose distribution is less time-dependent.

Does saline enema during the first stage of labour reduce the incidence of Clostridium difficile colonization in neonates? A randomized controlled trial

Maternal rectal enemas may reduce neonatal bacterial exposure during labour, which may reduce the risk of neonatal colonization with Clostridium difficile. The aim of this study was to determine the effectiveness of a saline enema during the first stage of labour in reducing neonatal colonization with C.difficile. This study was conducted at Cairo University Hospital, Egypt from January 2016 to July 2016. Asymptomatic mothers with uncomplicated vaginal delivery and their neonates without diarrhoea were included. The study group underwent saline enema, and the control group had no intervention. Stool samples were collected from neonates one week after delivery. The primary outcome was the detection of C.difficile in stool culture and direct detection of C.difficile Toxin A and Toxin B by enzyme-linked immunosorbent assay. The two groups were comparable (P>0.05) in terms of age, gravidity, parity, body mass index and gestational age. C.difficile was detected in 13.54% and 37.63% of stool cultures from the enema group and the control group, respectively (P<0.001). Direct detection of Toxins A and B was positive in 22.92% of cases in the enema group and 53.76% of cases in the control group (P<0.001). This study suggests that a saline enema for the mother during the first stage of labour may be useful in reducing the risk of neonatal gut colonization by C.difficile.

Hypo-osmolar Formulation of Tenofovir (TFV) Enema Promotes Uptake and Metabolism of TFV in Tissues, Leading to Prevention of SHIV/SIV Infection.

Oral preexposure prophylaxis (PrEP) has been approved for prophylaxis of HIV-1 transmission but is associated with high costs and issues of adherence. Protection from anal transmission of HIV using topical microbicides and methods congruent with sexual behavior offers the promise of improved adherence. We compared the pharmacokinetics (PK) and ex vivo efficacy of iso-osmolar (IOsm) and hypo-osmolar (HOsm) rectal enema formulations of tenofovir (TFV) in rhesus macaques. Single-dose PK of IOsm or HOsm high-dose (5.28 mg/ml) and low-dose (1.76 mg/ml) formulations of TFV enemas were evaluated for systemic uptake in blood, colorectal biopsy specimens, and rectal CD4+ T cells. Markedly higher TFV concentrations were observed in plasma and tissues after administration of the HOsm high-dose formulation than with all other formulations tested. TFV and TFV diphosphate (TFV-DP) concentrations in tissue correlated for the HOsm high-dose formulation, demonstrating rapid uptake and transformation of TFV to TFV-DP in tissues. TFV-DP amounts in tissues collected at 1 and 24 h were 7 times and 5 times higher, respectively (P < 0.01), than the ones collected in tissues with the IOsm formulation. The HOsm high-dose formulation prevented infection in ex vivo challenges of rectal tissues collected at 1, 24, and 72 h after the intrarectal dosing, whereas the same TFV dose formulated as an IOsm enema was less effective.

Bowel management and continence in adults with spina bifida: Results from the National Spina Bifida Patient Registry 2009-15.

Advances in care have allowed most children with spina bifida (SB) to live to adulthood. The majority have neuropathic bowel dysfunction (NBD), resulting in constipation, incontinence, and diminished quality of life. We sought to 1)describe contemporary NBD management and continence outcomes of adults with SB; 2) describe differences from younger patients; and 3) assess for association with socio-economic factors. We analyzed data on NBD management and continence from the National Spina Bifida Patient Registry (NSBPR). Patients were segregated into young children (5-11 years), adolescents (12-19 years), and adults (20 years and older). A strict definition of continence was utilized. Statistical analysis compared cohorts by gender, ethnicity, SB type, lesion level, insurance status, educational attainment, employment status, and continence. A total of 5209 SB patients were included, of whom 1370 (26.3%) were adults. Management and continence varied by age and SB type. Oral medication use did not differ between groups (5.2-6.6%). Suppositories and rectal enemas were used only by 11.5% of adults, which was significantly less than among school-aged children. Antegrade enemas were used by 17.7% of adults which was significantly less than among adolescents (27.2%). Adults were more likely to use digital stimulation or disimpaction or have undergone a colostomy. Bowel continence was reported by 58.3% of overall adult cohort: 55.6% of adults with myelomeningocele and 74.9% with non-myelomeningocele. Bowel continence was significantly associated with employment (p= 0.0002), private insurance (p= 0.0098), non-myelomeningocele type of SB (p= 0.0216) and educational attainment (p= 0.0324) on univariate analysis but only with employment on multivariable logistic regression (p= 0.0027). Bowel management techniques differed between adults and younger patients with SB. Bowel continence was reported by over half of SB adults and was associated with socio-economic factors.

Benefits & pitfalls of administration of rectal gel enema in MRI assessment of rectal cancer

ObjectivesTo assess diagnostic benefits of filling of the rectum with ultrasound gel during MR assessment of rectal cancer and the pitfalls that occurs due to rectal distention. Materials/methods40 patients presented with rectal cancer for either initial MR staging or for assessment after neoadjuvent chemoradiotherapy using ultrasound transmission gel as a contrast for rectal filling. ResultsMR with gel rectal filling showed better depiction in all patients with small tumors than in non filling of the rectum. The filling of rectum with gel increased the distance of the lower tumor border from the anal verge however it showed better assessment of the site of the fixed tumor lower edge in all cases of pedunculated tumor masses. Also rectal filling decreases the distance from the perirectal fascia which may affect the CRM. ConclusionsMR with rectal gel filling is useful in assessment of cases with rectal cancer and by combining empty rectum & distended rectum in the same study we can get the benefits & avoid the pitfalls by correlating the images in both techniques.Clinical Relevance/Application This study helped in assessment of patients with rectal cancer either referred for initial MR staging or for assessment after neoadjuvent chemoradiotherapy.

Microcarcinoid and Ulcerative Colitis: An Evolving Relationship

Colonic carcinoid and microcarcinoid tumors have been commonly reported amidst the backdrop of inflammatory bowel disease (IBD), suggesting an association that may be more than co-incidental. We present one case of rectal microcarcinoid in the setting of ulcerative colitis. A 54-year-old African American male with an 8-year history of ulcerative colitis (UC) and systemic lupus erythematosis presented with a three day history of abdominal pain and bloody diarrhea. Physical examination was unremarkable. Colonoscopy was performed and demonstrated edematous, friable, and severely erythematous mucosa extending from the rectum to the cecum consistent with pan-ulcerative colitis (Figure 1 and 2). Random biopsies were taken approximately every 10 cm from the cecum to the rectum with subsequent histopathology confirming moderately-active chronic colitis in every segment. Rectal biopsy was also notable for small nests of neuroendocrine cell proliferation in the mucosa, 1.5 mm in size, consistent with neuroendocrine tumor (Figure 3). The mucosal microcarcinoid tumor nests were confirmed by positive staining for CD56 and synaptophysin. Staining was negative for chromogranin. There was no ulceration or evidence of granulomas. He was subsequently discharged on a tapering dose of oral steroids, mesalamine (oral and rectal enemas). The patient showed significant improvement in symptoms and flexible sigmoidoscopy was subsequently performed demonstrating healed mucosa. Rectal biopsies showed inactive chronic proctitis with no evidence of mucosal/sub-mucosal neuroendocrine cells. Computed tomography (CT) scan of the abdomen and pelvis was unremarkable and octreotide scan showed minimal patchy uptake in the rectum with no evidence of remote metastasis. With regards to UC, various authors have suggested that local carcinoid tumors may be more likely to arise when there is enteroendocrine cell hyperplasia—as can be seen in states of chronic mucosal irritation/injury such as bronchiectasis and Type A chronic gastritis. Our case described the disappearance of mucosal neuroendocrine cells in the rectum of a UC patient who had clinical and histopathologic resolution of active disease following treatment. Despite the absence of neuroendocrine cell hyperplasia in this patient, the findings appear to support a link between chronic inflammation and the development of microcarcinoids.Figure: Proctitis.Figure: Colitis.Figure: Medium power view 100x small nests of neuroendoscrine cells.

Enhanced recovery after surgery (ERAS®) in gynecologic oncology - Practical considerations for program development.

Enhanced recovery after surgery (ERAS®) in gynecologic oncology - Practical considerations for program development.

Fresh cow metabolic diseases

Hypocalcemia, hypophosphatemia, hypomagnesemia, hyperketonemia (ketosis), and hypokalemia are important metabolic diseases of fresh dairy cows. Many dairy practitioners and dairy producers need to update their approaches to these diseases because of new findings about these disorders. Hypocalcemia in standing cows is best treated orally; intravenous calcium causes a rebound hypocalcemia and should be reserved for recumbent cases of milk fever. Glucose or additional electrolytes should not be administered intravenously to cows with hypocalcemia. The strategic use of oral calcium helps manage subclinical hypocalcemia. Hypophosphatemia is less common and is usually secondary to hypocalcemia. Mild to moderate cases of hypophosphatemia are best treated with oral phosphorus; intravenous phosphorus is best reserved for severe cases. Hypomagnesemia may be a clinical problem in grazing herds or a subclinical problem in cows fed stored feeds. Clinical cases may be treated intravenously or via rectal enema; subclinical cases are best managed by oral magnesium supplementation. Ketosis (hyperketonemia) is a very common problem in early lactation cows. Early detection and early treatment of hyperketonemia is key. Hypokalemia may follow prolonged periods of anorexia in early lactation cows. Oral potassium supplementation is the best means of treating and preventing hypokalemia.

Definition of colorectal anastomotic leakage: A consensus survey among Dutch and Chinese colorectal surgeons.

AIMTo determine the level of consensus on the definition of colorectal anastomotic leakage (CAL) among Dutch and Chinese colorectal surgeons.METHODSDutch and Chinese colorectal surgeons were asked to partake in an online questionnaire. Consensus in the online questionnaire was defined as > 80% agreement between respondents on various statements regarding a general definition of CAL, and regarding clinical and radiological diagnosis of the complication.RESULTSFifty-nine Dutch and 202 Chinese dedicated colorectal surgeons participated in the online survey. Consensus was found on only one of the proposed elements of a general definition of CAL in both countries: ‘extravasation of contrast medium after rectal enema on a CT scan’. Another two were found relevant according to Dutch surgeons: ‘necrosis of the anastomosis found during reoperation’, and ‘a radiological collection treated with percutaneous drainage’. No consensus was found for all other proposed elements that may be included in a general definition.CONCLUSIONThere is no universally accepted definition of CAL in the Netherlands and China. Diagnosis of CAL based on clinical manifestations remains a point of discussion in both countries. Dutch surgeons are more likely to report ‘subclinical’ leaks as CAL, which partly explains the higher reported Dutch CAL rates.

P30.04: Does rectal enema improve the accuracy of ultrasonography in predicting rectosigmoid infiltration in patients with ovarian cancer?

To investigate the accuracy of ultrasound with and without rectal enema in predicting rectosigmoid infiltration in patients with epithelial ovarian cancer (OC). This prospective study included 52 patients with epithelial OC who underwent primary surgery. Carcinomatosis was defined as a nodular or sheet-like hypoechoic structure, vascularised, attached to the peritoneum of the rectosigmoid or invading into the muscularis propria. Both superficial carcinomatosis and nodules invading the bowel wall were considered rectosigmoid infiltration. The depth of Infiltration of the intestinal wall was assessed. One ultrasonographer performed the exam without rectal enema. Another ultrasonographer blinded to the findings of the first investigator performed the scan only after distention of the rectosigmoid wall (200-350 ml of saline solution slowly injected inside the rectosigmoid). Surgery and histology revealed rectosigmoid infiltration in 24 patients (46.2%). The diagnostic performance of ultrasonography without rectal enema was sensitivity 75.0%, specificity 92.9%, positive likelihood ratio 10.50, negative likelihood ratio 0.27, positive predictive value 90.0%, negative predictive value 81.3%. The diagnostic performance of ultrasonography with rectal enema was sensitivity 87.5%, specificity 96.4%, positive likelihood ratio 24.50, negative likelihood ratio 0.13, positive predictive value 95.45%, negative predictive value 90.0%. The Mc Nemar's test revealed there was no significant difference between the two techniques in diagnosing rectosigmoid infiltration (p=0.134). Similarly, rectal enema did not increase the accuracy of ultrasound in discriminating superficial carcinomatosis or infiltration reaching at least the muscularis propria (p=0.578). The patients reported that ultrasonography without enema was less painful that ultrasonography with enema (p<0.001). Rectal enema does not improve the accuracy of ultrasonography in predicting rectosigmoid infiltration in patients with OC.

Intussusception in a preterm newborn

Intussusception in a preterm newborn

Mechanical bowel preparation before elective colorectal surgery in the Gaza Strip: a survey of surgical practice

BackgroundMany surgeons believe that postoperative complications and anastomotic leakage after colorectal surgery can be reduced by preoperative mechanical bowel preparation (MBP). We surveyed the practice of surgeons in the Gaza Strip, occupied Palestinian territory, and compared this with best available evidence for use of MBP. MethodsA five item questionnaire was given to the seven most senior surgeons who did almost all surgeries in the European Gaza Hospital and the Al-Shifa Hospital (the two main hospitals in the Gaza Strip). We searched the Cochrane Library for relevant evidence using the search terms “colonic” or “colon”, or “colorectal electives surgery” in combination with “mechanical bowel preparation”. FindingsAll seven surgeons stated that they routinely prescribe MBP before elective colonic or rectal surgery. Two surgeons used MBP only for left colonic surgery; the other five surveyed reported using MBP for both right and left colonic surgery. For one surgeon, MBP consisted of rectal enemas and rectal enema plus oral fluids for 48 h. Another surgeon added oral laxatives to this regimen. Two surgeons used rectal enemas plus oral MBP, and three surgeons used oral quick preparation formulae, alone. All seven surgeons used systemic antibiotics before operating. We recorded no clear evidence from the available systematic review that MBP with rectal enema reduces complications after surgery, but the confidence interval around the estimates of its effects are wide (anastomotic leakage for MBP [95% CI 0·74–1·31] vs rectal enema [95% CI 0·74–2·36]; for wound infection [95% CI 0·95–1·42]). InterpretationGenerally, surgeons in the two main hospitals in Gaza use different approaches to MBP for elective colorectal surgery because they believe that it lowers the incidence of postoperative complications and anastomotic leakage in patients. However, a wide variation in their use of many forms of MBP was noted, representing the absence of clear evidence from research. MBP is reported as unpleasant by many patients and more research is needed to provide better evidence to assess whether this procedure has the believed beneficial effects and to guide future practice. FundingNone.

Rectal Douching Among Men Who Have Sex with Men in Paris: Implications for HIV/STI Risk Behaviors and Rectal Microbicide Development

Rectal douching is a common but potentially risky practice among MSM; MSM who douche may be ideal candidates for rectal microbicides as HIV prevention. Herein we explored rectal douching and its association with condomless receptive anal intercourse (CRAI), group sex, rates of HIV and other STIs, and likelihood to use rectal microbicide gels. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France in 2016. Regression models estimated adjusted risk ratios (aRRs) for associations between rectal douche use and (1) engagement in CRAI, (2) group sex, (3) self-reported HIV and STI diagnoses, and (4) likelihood to use rectal microbicide gels for HIV prevention. 54.3% of respondents used a rectal douche or enema in the preceding 3months. Douching was significantly associated with CRAI (aRR: 1.77), participation in group sex (aRR: 1.42), HIV infection (aRR: 3.40), STI diagnosis (aRR: 1.73), and likelihood to use rectal microbicide gels (aRR: 1.78). Rectal douching is common among MSM, particularly those who practice CRAI, and rectal microbicide gels may be an acceptable mode of HIV prevention for MSM who use rectal douches.

Multicompartmental Pharmacokinetic Model of Tenofovir Delivery to the Rectal Mucosa by an Enema.

Rectal enemas that contain prophylactic levels of anti-HIV microbicides such as tenofovir have emerged as a promising dosage form to prevent sexually transmitted HIV infections. The enema vehicle is promising due to its likely ability to deliver a large amount of drug along the length of the rectal canal. Computational models of microbicide drug delivery by enemas can help their design process by determining key factors governing drug transport and, more specifically, the time history and degree of protection. They can also inform interpretations of experimental pharmacokinetic measures such as drug concentrations in biopsies. The present work begins rectal microbicide PK modeling, for enema vehicles. Results here show that a paramount factor in drug transport is the time of enema retention; direct connectivity between enema fluid and the fluid within rectal crypts is also important. Computations of the percentage of stromal volume protected by a single enema dose indicate that even with only a minute of enema retention, protection of 100% can be achieved after around 14 minutes post dose. Concentrations in biopsies are dependent on biopsy thickness; and control and/or knowledge of thickness could improve accuracy and decrease variability in biopsy measurements. Results here provide evidence that enemas are a promising dosage form for rectal microbicide delivery, and offer insights into their rational design.

A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease

ObjectiveTransanal endorectal pull-through (ERPT) is the most popular technique to treat Hirschsprung disease (HD). Still, there is limited knowledge on long-term bowel function. This cross-sectional, multicenter study assessed long-term bowel function in a large HD population and examined predictors of poor outcome. MethodsPatients older than four years or their parents filled out a validated questionnaire on bowel function. Clinical details were recorded retrospectively from medical records. Results73/200 (37%) patients reported absolutely no impaired bowel function, meaning no constipation, fecal accidents, stoma, appendicostomy or need for enemas. Seven (4%) had a stoma, and 33 (17%) used antegrade or rectal colonic enemas. Most disarrangements of fecal control and constipation were significantly less common in older age group, but abnormal defecation frequency and social problems remained unchanged. Syndromic patients (n=31) experienced frequent fecal accidents (46%) more often than nonsyndromic (14%, P<0.001). Having a syndrome (adjusted OR 5.6, 95% CI 2.1–15, P=0.001) or a complete transanal ERPT (adjusted OR 2.4, 95% CI 1.1–5.7, P=0.038) was significantly associated with poor outcome defined as having a stoma, an appendicostomy, daily fecal accidents or need of regular rectal wash outs. ConclusionA significant number of HD patients experience bowel problems many years after definite surgery. Fecal control was significantly better in older than younger HD patients, but some continued to have considerable bowel problems also as adults. A total transanal ERPT was associated with poorer outcome. Long-term follow-up of HD patients is warranted.Prognosis Study: Level II.