Case report—A 41 year old woman was referred for assessment of worsening bladder and bowel dysfunction. At the age of 17 years she had suffered a traumatic fracture-subluxation of T12–L1 following a trampoline accident in which she fell heavily on to her back. She immediately lost sensation below the waist but this returned over several days. Following eight weeks of bed rest she gradually regained the ability to walk. She subsequently had no neurological deficit in her legs.

Since the accident she had experienced bladder and bowel dysfunction. She experienced urinary frequency, urgency, urge incontinence, and episodes of spontaneous bladder emptying without warning. There had been no stress incontinence. Urodynamic studies showed a small capacity bladder of 257 ml but good voiding and minimal residual volume (30 ml). She did however have marked urgency at 150 ml.

From a gastrointestinal point of view, she developed constipation …