What Happens When People With Chronic Constipation Irrigate Their Bowel for Up to Two Years?

Written by

Emma Child

Manager, Trainer and Therapist

A large 2026 multicentre Italian study followed adults with functional constipation for up to two years—and its findings on satisfaction, symptoms, quality of life and safety deserve attention.

Constipation is often discussed as though it simply means not going to the toilet often enough. For people living with chronic constipation, the reality can be considerably more complex.

Difficulty emptying, straining, incomplete evacuation, abdominal discomfort and constant planning around bowel movements can affect work, relationships, travel and everyday wellbeing. For some people, conventional approaches do not provide adequate relief.

This raises an important question: what happens when water irrigation of the rectum and colon becomes part of long-term bowel management?

A national study published in Diseases of the Colon & Rectum followed adults diagnosed with functional constipation across 13 specialist gastroenterology centres in Italy. Participants were assessed at the beginning and again at 1, 6, 12 and 24 months.

First, what exactly were they doing?

The treatment studied was transanal irrigation, or TAI—introducing water through the anus into the rectum and colon to facilitate bowel emptying.

This is not simply another name for a conventional enema. An enema generally introduces a relatively small amount of fluid, primarily into the rectum and lower bowel. Modern TAI systems use specialised equipment to introduce water in a controlled manner, after which the water and bowel contents are evacuated. The goal is a more predictable and effective bowel-emptying routine.

Conceptually, this has similarities to colonic irrigation: both use rectally introduced water to support evacuation. However, TAI and Rojas Colon Hydrotherapy differ in their equipment, protocols, volume, administration and treatment setting. They should not be described as interchangeable procedures.

216 adults, 13 gastroenterology centres and two years of follow-up

One of the study’s strengths is its scale and duration relative to much of the existing irrigation research. Researchers enrolled 216 adults across 13 gastroenterology centres throughout Italy. Of those, 175 were prescribed TAI.

Participants completed validated questionnaires at baseline and at 1, 6, 12 and 24 months. Researchers assessed more than bowel frequency. Their outcomes included:

• patient satisfaction with bowel management;
• constipation-related quality of life;
• constipation severity;
• the number of constipation-related symptoms;
• safety and technical difficulties; and
• treatment discontinuation and reasons for stopping.

This is important because successful bowel management is about considerably more than asking, “Did you open your bowels?” Improvements in comfort, predictability, evacuation, symptoms and quality of life may all be meaningful to a person with chronic constipation.

Patient satisfaction more than doubled

At baseline, participants’ average satisfaction with their bowel management was only 2.9 out of 10. After one month, it had increased to 6.5 out of 10.

The improvement was statistically significant and remained higher through 24 months. That early change is noteworthy: participants did not need to wait a year to report a difference. Improvement was already evident at the first follow-up.

At the same time, 6.5 out of 10 is not perfect satisfaction. The results suggest meaningful improvement for the group on average, not complete symptom resolution for every individual.

Bowel-related quality of life improved

The study used a validated constipation-related quality-of-life questionnaire, where a lower score indicates less negative impact. The mean total score improved from 2.7 at baseline to 2.0 after one month, then remained at approximately 1.9 during later follow-up.

For chronic constipation, this matters. The burden can extend beyond physical symptoms into anxiety about access to bathrooms, lengthy bowel routines, disruption of social activities and diminished confidence. A treatment that changes how manageable bowel care feels may be important even if it does not create a “perfect” bowel habit.

Constipation severity decreased

Constipation severity was measured using the Wexner Constipation Score, a validated tool assessing features such as frequency, difficulty, incomplete evacuation, pain, time spent attempting to empty and use of assistance.

The average score decreased from 17.9 at baseline to 12.5 after one month. That improvement was maintained through 24 months and was statistically significant.

Constipation-related symptoms fell from 3.3 to 1.0

Researchers also counted the average number of constipation-related symptoms reported by each participant. This decreased from 3.3 symptoms at baseline to 1.0 at 24 months.

This broader symptom result supports the changes seen in the formal Wexner score. It suggests that people continuing in the study were not merely reporting greater satisfaction while experiencing the same symptom burden; the number of reported constipation symptoms also fell.

What happened to treatment use over time?

Long-term bowel-management interventions must be both effective and practical enough for people to continue. The researchers therefore recorded discontinuation at each follow-up.

Among the 175 people prescribed irrigation, reported discontinuation was 10.3% at six months, 9.1% at 12 months and 6.3% at 24 months. Technical difficulties were uncommon and were not reported at the 24-month assessment.

People discontinue treatment for many possible reasons, including inadequate benefit, burden of the routine, discomfort, technical challenges or changing health circumstances. Without full individual follow-up data, the headline results should not be read as meaning every participant used irrigation continuously for two years.

What did the study find about safety?

No serious adverse events were reported. This is reassuring, particularly because the research included repeated use and extended follow-up rather than only a single treatment.

However, “no serious adverse events were reported” does not mean “the procedure is risk-free”. Observational research depends on how adverse events are identified, reported and retained in follow-up. It also cannot guarantee safety for people with contraindications or those using different equipment and protocols.

Appropriate assessment, instruction, hygiene, technique and follow-up remain essential. TAI and colon hydrotherapy are not suitable for everyone, and new or worsening constipation may require medical investigation.

Why the study is important

Much bowel-irrigation research has focused on neurogenic bowel dysfunction—for example, bowel problems associated with spinal cord injury, spina bifida or multiple sclerosis. This study instead examined adults with functional constipation, broadening the population in which longer-term irrigation has been formally evaluated.

It also assessed outcomes repeatedly over two years and involved multiple specialist centres. That makes the findings more informative than a small case series from a single clinic.

The pattern was consistent across several outcomes: satisfaction increased, quality of life improved, constipation severity decreased and symptom count fell. The improvements were evident early and remained present at group level during longer follow-up.

What this study does—and does not—show

What it supports

• TAI can be followed prospectively across multiple specialist centres for up to 24 months.
• Participants reported significant early improvements in bowel-management satisfaction, quality of life and constipation severity.
• These improvements were maintained at the study’s later follow-up points.
• The average number of constipation-related symptoms was lower at 24 months.
• No serious adverse events were reported in the study.

What it cannot establish

• It does not prove that TAI was responsible for all improvement because participants were not randomised and there was no control group.
• It does not show that all 216 enrolled participants received or continued irrigation; 175 were prescribed the treatment.
• It does not prove that every person with chronic constipation will benefit.
• It does not compare TAI directly with medication, pelvic-floor therapy, dietary treatment, surgery or professional colon hydrotherapy.
• It does not establish the same results for Rojas Colon Hydrotherapy.

Important limitations for medical professionals

This was a prospective observational study rather than a randomised controlled trial. Participants and clinicians knew which treatment was being used, and there was no untreated or alternative-treatment group against which changes could be compared.

The main outcomes came from validated but subjective self-reported questionnaires. These measures are highly relevant because constipation symptoms and quality of life are experienced by the patient, but they remain susceptible to expectation, response and attrition bias.

The study population was unbalanced for sex and comorbidities. The researchers reported that these factors did not significantly affect the primary findings, but they may still limit generalisability. People treated at specialist gastroenterology centres may also differ from the broader population managing constipation in primary care or wellness settings.

Long-term studies are particularly vulnerable to survivorship bias: people who find a treatment useful and manageable may be more likely to continue and complete later assessments than those who stop early.

What does this mean for Rojas Colon Hydrotherapy?

The study does not test Rojas Colon Hydrotherapy, so it cannot be used as direct evidence that the Rojas approach produces the same results. The treatment systems, delivery models and clinical contexts are different.

What the study does contribute is evidence that the underlying concept—using controlled water irrigation to facilitate recto-colonic evacuation—can be incorporated into longer-term bowel management and studied through recognised clinical outcomes.

For the colon hydrotherapy profession, this is relevant without needing to overstate it. It supports continued research into water-assisted evacuation while reinforcing the importance of treatment-specific trials, careful screening, practitioner training and transparent evidence communication.

For a wider review of the available evidence, visit our colon hydrotherapy scientific review. If you are unfamiliar with the treatment, see what colon hydrotherapy involves.

The bottom line

This 2026 national Italian study provides valuable long-term observational evidence about transanal irrigation for functional constipation. Across follow-up, participants reported better bowel-management satisfaction, improved quality of life, lower constipation severity and fewer constipation-related symptoms. No serious adverse events were reported.

The study’s multicentre design, 216 enrolled participants and two-year follow-up make it an important contribution to the field. Its nonrandomised design and reliance on self-reported outcomes mean it should not be treated as definitive proof or directly generalised to professional colon hydrotherapy.

The honest conclusion is encouraging and appropriately measured: for selected adults with functional constipation, prescribed transanal irrigation was associated with meaningful improvements that remained evident during long-term follow-up—and it deserves further controlled research.

Frequently asked questions

Reference

Falletto E, Martellucci J, Rossitti P, et al. Transanal Irrigation in Functional Constipation: Long-term Results From an Italian National Study. Diseases of the Colon & Rectum. 2026;69(7):1901–1910. doi:10.1097/DCR.0000000000004224.