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268 Chapter 13 children with intractable FC, surgery is sometimes required; however, surgery always carries the risk of complications and does not provide a guarantee of success. Transanal irrigation is a nonsurgical treatment modality and, if treatment is successful, transanal irrigation could prevent children from having to undergo surgery. FIGURE 1. Peristeen® Anal Irrigation System, figure provided by Coloplast. The system consists of a control unit with a pump, a water bag, and a rectal catheter through which water can be infused into the colon. Peristeen® Anal Irrigation System (Coloplast A/S, Kokkedal, Denmark or Mallinckrodt, St. Louis, MO) is a relatively novel rectal irrigation system that can be used at home in children with constipation and fecal incontinence (Figure 1). After inserting the rectal catheter, a balloon attached to the catheter is inflated with air to secure the position of the catheter in the rectum. Then, after infusion of the irrigation fluids into the colon, the balloon is deflated and both stools and irrigation water are evacuated from the rectum. By irrigating the colon, accumulation of large quantities of stools is prevented, which consequently results in a decrease in the number of fecal incontinence episodes, thereby improving the quality of life in these children. Transanal irrigations are usually performed with a volume of 10 to 20 mL/