Spinal Cord Injury: Autonomic Dysreflexia

Overview

Autonomic dysreflexia is a syndrome in which the blood pressure of a person with a spinal cord injury (SCI) suddenly goes very high. Symptoms include:

• A pounding headache.
• A flushed face and red blotches on the skin above the level of spinal injury.
• Sweating above the level of spinal injury.
• A stuffy nose.
• Nausea.
• A slow or very fast heart rate.
• Goose bumps below the level of spinal injury.
• Cold, clammy skin below the level of spinal injury.

What causes it?

Autonomic dysreflexia occurs when your body reacts to pain or pressure below your spinal cord injury. This can be a pain or an irritant (such as tight clothing or something pinching your skin). Or it can be a normal function that your body may not notice (such as having a full bladder). These situations trigger an automatic reaction that causes your blood pressure to go up. Other things that may cause this reaction include:

• Urinary tract infections (UTIs).
• An overfull bowel or constipation.
• Gastrointestinal problems such as gallstones, stomach ulcers, or gastritis.
• Pressure injuries.
• Ingrown nails or other skin problems.
• Sexual activity.
• Broken bones or other injuries.
• Tight clothing or devices.
• Extreme temperatures or quick temperature changes.

How can you prevent it?

There are ways you may be able to prevent autonomic dysreflexia. This means doing things to avoid the things that cause it.

• To avoid an overfull bladder or urinary tract infections (UTIs), follow your bladder management program.
• To avoid an overfull bowel or constipation or gastrointestinal problems such as gallstones, stomach ulcers, or gastritis, follow your bowel management program. Eat fiber and consume fluids as your doctor suggests.
• To avoid pressure injuries, ingrown nails, or other skin problems, check your skin daily. Make sure that all clothing or devices fit right.
• Be aware that having sex can cause the condition. Discuss this with your doctor.
• Be aware of what else can cause the condition. This includes broken bones or other injuries, tight clothing or devices, and extreme temperatures or quick changes in temperature. Discuss this with your doctor. Make sure that all clothing and devices fit right.

How can you care for yourself?

There are ways you may be able to treat autonomic dysreflexia at home.

• Sit up straight, or raise your head so you are looking straight ahead. If you can lower your legs, do so. You need to be sitting upright until your blood pressure is back to normal.
• Loosen or take off any tight clothing or accessories. This includes braces, catheter tape, socks or stockings, shoes, and bandages.
• Empty your bladder by draining your Foley catheter or using your catheter.
• Use digital stimulation to empty your bowel.
• Check your skin for red spots that mean you might have a pressure injury.
• If you can, check your blood pressure every 5 minutes to see if it improves.
• Call your doctor, even if symptoms go away and your blood pressure is decreasing.
• If the symptoms return, repeat the above steps and go to the emergency room or call emergency services.

Be sure to talk to your health care team ahead of time about what to do when you have symptoms of autonomic dysreflexia. Call your doctor immediately or get emergency medical care if symptoms of autonomic dysreflexia don't get better right away. If you or a caregiver can't treat it promptly and correctly, it may lead to seizures, stroke, and even death.