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269 Transanal irrigation 13 kg of water and the frequency of irrigations depends on the patient's response. 10,11 Transanal irrigation has been shown to be effective in the management of fecal incontinence in children with spina bifida, Hirschsprung’s disease, and defecation disorders due to anorectal malformations. 11–16 Data on the effectiveness of transanal irrigation in children with FC are, however, scarce. 10,17 Therefore, the aim of this survey study was to explore the treatment efficacy and parental satisfaction in children with FC who are treated with Peristeen®. METHODS Patients and materials This cross-sectional survey study was performed in the Emma Children's Hospital/Academic Medical Center (Amsterdam, the Netherlands), a tertiary referral center for pediatric defecation disorders. Parents of children who were treated with transanal irrigation for intractable FC (with or without fecal incontinence) at the time of the study were invited to participate via mail between March 2014 and October 2014. Children with FC fulfilled the Rome III criteria, based on clinical assessment. In all children, transanal irrigation was initiated when they were no older than 18 years of age. Patients with intractable FC had been referred to a specialized pediatric gastroenterology nurse (HV) for transanal irrigation by their pediatric gastroenterologist. Transanal irrigation was only considered as a treatment option if intensive conventional pharmacological treatment had failed. In addition, children with intractable FC are usually referred for psychological evaluation at our center. Transanal irrigation was performed with Peristeen® Anal Irrigation System (FDA K103254). Children and their parents received information about Peristeen® and were instructed on how to use this irrigation system conform the instructions of the manufacturing company. This included patient-tailored instructions on how to insert and inflate the balloon (e.g., maximum amount of air inflations based on age). During the first time of irrigation, the balloon was inflated until there was no more water leakage from the anus, this indicates that the balloon seals the anal canal. The patients (and their parents) were then supported during outpatient clinic visits until they were able to use Peristeen® at home, from then on follow-up by the pediatric gastroenterology nurse consisted mainly of telephone contacts. Questionnaires A questionnaire was sent out to the parents by mail, they were asked to fill out the questionnaire together with their children. The questionnaires were developed by the department of pediatric gastroenterology in collaboration with the department of psychology of the Emma Children's Hospital/Academic Medical Center. The questionnaire involved 25 questions and consisted of multiple choice questions regarding gastrointestinal