Study design: A controlled, descriptive and comparative, questionnaire based study. Objectives: To describe the bowel function of spinal cord injured (SCI) patients and compare this with a general community control group. Setting: Christchurch, New Zealand. Methodology: A postal questionnaire was sent out to past SCI patients of the Burwood Spinal Injuries Unit, Christchurch, New Zealand, and age/gender matched with controls randomly selected from the electoral roll. Permission was obtained from SCI participants to retrieve data relating to their injury from hospital case notes. The questionnaire detailed general bowel function, in¯uence of bowel problems on everyday life, incidence of incontinence and methods of defecation. A Faecal Incontinence Score was generated according to an established incontinence grading scheme. Results: Questionnaires were sent out to 1200 SCI patients and 1200 control subjects. Of these, 467 completed questionnaires were returned from SCI patients and age/gender matched from the 668 returned control questionnaires. Mean Faecal Incontinence Score was higher for SCI patients than controls (P50.0001), and for complete compared with incomplete injury (P=0.0023). Age or time from injury did not aect Faecal Incontinence Score. Incontinence aected quality of life for 62% of SCI patients, compared with 8% of controls. Faecal urgency and time spent at the toilet were also signi®cantly higher for the SCI group (39% of SCI patients use laxatives, compared with 4% of controls (P50.0001)). Haemorrhoidectomy was more common (P50.001) in the SCI population (9% vs 1.5%), particularly among those requiring manual evacuations. Conclusion: SCI has a signi®cant eect on bowel function in terms of faecal incontinence, urgency, and toileting methods. This results in a marked impact on quality of life. While bowel function may deteriorate with time, most patients with poor function can be identi®ed early implying a role for early intervention in those with potential bowel problems, such as colostomy or ACE procedure.

Purpose: Spinal cord injured (SCI) patients have delayed colonic motility and anorectal dysfunction resulting in functional obstruction and constipation. This may be caused by changes in descending modulation from the central or sympathetic nervous systems. Anorectal dyssynergy may demonstrate similarities to that seen in the bladder following SCI. Methodology: Anorectal manometry was performed on 37 SCI volunteers. Patterns of rectal and sphincter function were identi®ed. These patterns were then compared with questionnaire answers on bowel function and cystometrograms to identify a relationship between detrusor dyssynergy and anal sphincter tone. Results: Rectal compliance and basal resting sphincter pressures were lower than normal values. Ramp rectal in¯ation demonstrated patterns of sphincter activity similar to that recorded in the patients' cystometrograms. There is no de®nite relationship of bowel function to the ®ndings on manometry in SCI patients. Conclusions: SCI patients have abnormal anorectal function. Anorectal manometry results were able to be classi®ed into four patterns on the basis of rectal pressure and sphincter tone in response to rectal distention. The patterns of anorectal manometry seen were similar to those in cystometrograms, however there is no de®nite relationship to bowel dysfunction. Spinal Cord (2000) 38, 573 ± 580

Study Design: Prospective controlled comparative analysis. Objective: To determine whether a colostomy changes quality of life in patients with a spinal cord injury. Method: A previously validated questionnaire designed to assess quality of life in spinal injured patients (Burwood Questionnaire) was sent to 26 spinal cord injured patients with colostomies and 26 spinal cord injured patients without colostomy. The two groups were matched for level of injury, completeness of injury, length of time since injury, age (+5 years) and gender. Results: There was 100% completion of the questionnaire. There was no signi®cant di erence (P40.05) in the two groups of patients in regard to their general well being, emotional, social, or work functioning. Conclusions: Patients with colostomy following spinal injury are no worse o in regard to quality of life, than those without. The inference is that perhaps a colostomy should be considered earlier in patients with major bowel dysfunction following spinal cord injury.

Objective To assess the sensitivity of serum creatinine level in detecting clinically important and early deterioration of renal function in patients with spinal cord injury (SCI), and to evaluate the optimal method of determining creatinine clearance in these patients. Patients and methods

Study design: Case controlled study. Objective: To compare nutritional status and immune response in a group of spinal cord injured (SCI) patients with age and gender matched non SCI control subjects. Method: Thirty past patients of the Burwood Hospital Spinal Injuries Unit living locally were enrolled in the study. Age and gender matched non SCI control subjects were selected volunteers from hospital sta . Nutritional status was assessed by generating a Nutritional Risk Score (NRS, Appendix 1) and drawing blood for full blood count, iron studies, red blood cell folate, vitamin B12, ferritin, magnesium, and zinc. Immune status was assessed by vaccination response index (VRI) to Pneumovax 23 vaccine. Results: Full blood count, iron studies, and testing for red blood cell folate, albumin, prealbumin, vitamin B12, ferritin, magnesium and zinc were normal range for both groups. The SCI group had signi®cantly di erent median values than controls (P50.01) for haemoglobin concentration, white blood cell count, albumin, prealbumin, serum iron and % saturation. Body Mass Index (weight kg/(height cm 2 ) was 22.2 (range 15 ± 30) for the SCI group, signi®cantly less than the paired control group index of 26 (range 20 ± 32, P=0.0004). Median NRS for SCI patients was 2 (range 0 ± 6), compared to 0 (range 2 ± 4) for paired controls (P50.0001). Scores ranged from 0 to 2 for each of the ®ve NRS components for the SCI patients and 0 to 3 for the control group. There was no signi®cant di erence in the preand post-vaccination ratio for IgG, IgA, and IgM response to Pneumovax 23 vaccine. Conclusion: We have not identi®ed any nutritional or immune status abnormality in SCI patients, however the SCI patients have a lower value for certain nutritional parameters and BMI. SCI patients however are at only slight risk of nutritional problems given their NRS and their lower normal values for certain nutritional factors.