Rectal irrigation is an established management option for constipation and faecal incontinence when conservative measures fail, but the patient journey through awareness, initiation, adaptation, routine and outcome use has not been explored. This study explored patients’ lived experience of the irrigation pathway to identify the practical, emotional and service-level factors that shape uptake, sustained use and quality of life.

We conducted semi-structured focused group sessions at a tertiary pelvic-floor unit with purposive sampling to capture diversity in age, gender, ethnicity and socioeconomic status; participants were current, former or declined users of rectal irrigation after failing nurse-led biofeedback. Groups of up to four met in person or virtually; sessions were audio recorded, transcribed verbatim and analysed inductively with iterative addition of newly identified domains until thematic saturation. Data were synthesised into thematic domains and illustrated with verbatim quotations drawn from transcripts.

Six interview sessions with 23 participants were conducted. Participants described a coherent, multi-stage journey beginning with low awareness and often a specialist introduction, followed by hands-on teaching and an early learning curve that determined whether irrigation became routine. Demonstration plus written materials enabled initiation for most, and supervised practice reduced fear and competence anxiety, but many emphasised that initial teaching alone was insufficient without scheduled follow-up and reliable supply pathways. Device characteristics strongly influenced everyday acceptability: low-volume systems were repeatedly described as quicker, more portable and less messy, whereas high-volume systems required more setup, cleaning and sometimes caregiver help. Practical and technical problems such as leakage, splashing, tubing disconnection, and manual pumping effort created real barriers to independence and to using irrigation outside the home. Patients reported privacy concerns and stigma that led to concealment and selective disclosure, limiting peer support and normalisation. Administrative failures such as missed prescription renewals and incorrect deliveries interrupted treatment. Patients reported a range of outcomes from irrigation, with many describing clear symptom relief and life improvements, while others experienced limited or mixed benefit. Several patients also reported better control and reduced urgency or incontinence.

From the patient perspective, the irrigation journey is shaped by four interacting domains: clinical education and follow-up, device ergonomics and technical reliability, and social-emotional context and critically by the clinical outcomes patients experience, which determine whether the intervention is sustained or abandoned. Hands-on supervised training and early follow-up consolidate competence and reduce early discontinuation. Device selection must be personalised to dexterity, mobility and lifestyle; offering low-volume options for travel or limited hand function and clearer guidance on managing leaks and cleanup would increase usability. Service redesign to provide a named contact for supplies and troubleshooting, automated prescription reminders and streamlined delivery would reduce avoidable interruptions. Normalising conversations in primary care and providing discreet packaging or storage advice would mitigate stigma and support social participation.

Patients value rectal irrigation for symptom control and restored social participation, but sustained benefit depends on coordinated clinical pathways, personalised device choice, reliable technical performance and attention to privacy. Implementing structured hands-on training with planned follow-up, a single point of contact for supplies and troubleshooting, and discreet, portable options for travel could substantially improve adherence and quality of life for people using rectal irrigation.