Transanal irrigation (TAI) is a bowel management therapy that assists in the evacuation of faeces by introducing water into the rectum and colon via the anus. The water is subsequently emptied from the bowel into the toilet together with the faeces from the descending colon, sigmoid and rectum.

In 2013, the first consensus review describing a 7 stepped approach to the treatment of Neurogenic Bowel Dysfunction (NBD) was published(1). The 7-step pyramid has reached widespread acknowledgement, but it has also shown not to be completely in line with the actual clinical practice. As a response to that, a group of Bowel Care experts (including 3 specialists who also took part in generating the first pyramid) suggest an updated and more simplified treatment algorithm for NBD in SCI and MS patients. In alignment with the best available evidence, the updated pyramid contains only 3 steps covering standard bowel management, TAI, and surgical intervention, while placing the remaining treatment options in a separate box as optional or experimental treatments. These updates are reflective of the existing clinical practice as well as the exploratory state and availability/eligibility of the various treatment options for the individual patient.