Methods: Between 1994 and 2007, 211 (115 female) patients with NBD (age: 7-81 years (median 49)) were introduced to TAI. One hundred and seventy-three patients had spinal cord injury and 38 had other neurological disorders. Data were obtained from hospital records and a mailed questionnaire. Treatment was considered successful in patients still using TAI, patients who had used TAI until they died and patients whose symptoms had resolved while using TAI. Results: Successful outcome was achieved in 98 (46%) patients after a mean follow-up of 19 months (range 1-114 months). A Kaplan-Meier plot showed a dropout of 20% in the first 3 months. After 3 years, the rate of success was 35% and remained almost unchanged afterwards. A regression analysis showed male gender (odds ratio (OR) 2.1), mixed symptoms (OR 2.9) and prolonged colorectal transit time (OR 2.4) to be significantly associated with successful outcome. One non-lethal bowel perforation occurred in approximately 50 000 irrigations (0.002%), whereas minor side effects were observed in 48%. Conclusion: After a mean follow-up of 19 months, 46% was successfully treated. The rate of success was 35% after 3 years and remained almost unchanged afterwards. TAI is safe and can be introduced to most patients suffering from NBD.

Aim Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. Method This international patient–provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of LARS. Results Three hundred twenty‐five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. Conclusion This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.

Objectives: To describe the prevalence and character of chronic abdominal pain in a group of patients with long-term spinal cord injury (SCI) and to assess predictors of abdominal pain. Study design: Postal survey. Setting: Members of the Danish Paraplegic Association. Methods: We mailed a questionnaire to 284 members of the Danish Paraplegic Association who met the inclusion criteria (member for at least 10 years). The questionnaire contained questions about cause and level of spinal injury, colorectal function and pain/discomfort. Results: Seventy percent returned the questionnaire (133 men and 70 women). Mean age was 47 years. Thirty-four percent reported having chronic abdominal pain or discomfort. Onset of pain was later than 5 years after their SCI in 53%. Low defecation frequency was more common in patients with abdominal pain/discomfort and constipation more often affected their quality of life compared to patients without abdominal pain/discomfort. The most common descriptors were annoying, cramping/ tightening, tender, sickening and shooting/jolting. There was no relation to age, time since injury or level of injury, but more women than men reported abdominal pain/discomfort. There was no relation of abdominal pain to other types of pain. Conclusion: Chronic pain located in the abdomen is frequent in patients with long-term SCI. The delayed onset following SCI and the relation to constipation suggest that constipation plays an important role for this type of pain in the spinal cord injured.

Background: Cross-sectional studies suggest that colorectal dysfunction after spinal cord injuries (SCI) worsens as time goes by. However, follow-up studies are needed to prove this. Study design: Prospective study. Objective: To describe long-term colorectal function in SCI patients. Results: In 1996, 25% of the respondents reported that colorectal dysfunction had some or a major impact on their quality of life. At follow-up 10 years later, it was 38% (Po0.005). In 1996 11% defecated less than every second day and 16% spent more than 30 min at each defecation; in 2006, it was 19% (Po0.01) and 25% (Po0.00001), respectively. Digital anorectal stimulation or evacuation was performed at least once every week by 48% in 1996 and by 56% in 2006 (Po0.0001). Fecal incontinence was reported at least once a month by 22% in 1996 and by 17% in 2006 (Po0.001). Conclusion: While the frequency and severity of constipation-related symptoms increase with time since SCI, there is a decrease in the frequency of fecal incontinence.

Study design: Randomized, controlled clinical trial. Objectives: Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI. Setting: Aarhus University Hospital, Denmark. Methods: Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of X30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures. Results: During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86-154) to 188 (range: 140-206) mm Hg (Po0.02), TAI from 126 (range: 91-146) to 163 (range: 130-188) mm Hg (Po0.02) and FC from 125 (range: 106-149) to 200 (range: 179-220) mm Hg (Po0.01). The sBP increase was lower during TAI than during DE (Po0.05) or FC (Po0.02). In high SCI subjects, the blood levels of norepinephrine, but not those of epinephrine, increased significantly during all three stimuli (all Po0.05). Conclusion: Bowel and bladder management caused AD in high SCI. The response is less severe during TAI than during FC or DE.