People with spinal cord injury (SCI) may be at risk for a serious problem called autonomic dysreflexia (AD). If you have an SCI at level T6 or higher, you should be aware of this problem and how it could affect you.
|During an AD episode, blood pressure stays high until the irritation is relieved. An AD episode that is not treated can lead to serious complications.
AD is unusual within the first
month of SCI. But it often appears within the first year. AD occurs in episodes.
Episodes are usually triggered by irritation to the body below the point of the SCI.
This is often as minor as a full bladder. But it causes an abnormal response in the
nervous system. This makes the blood vessels tighten. As a result, the blood pressure
rises quickly. This can lead to stroke and even death. So steps must be taken right away
to find and ease the irritation. You may need emergency treatment.
Symptoms of an AD episode
An AD episode can occur at any
time. It can have several symptoms. Along with high blood pressure, these include:
Severe, pounding headache
Changes in heart rate (slow pulse)
Sweating and blotchiness of the skin above the SCI, and pale, cold skin below it
Upset stomach (nausea)
Triggers of AD episodes
The most common triggers of AD
A bladder problem. This is
most often an overfull bladder. This can happen if you don't use a catheter. Or it
can happen because of a clogged or kinked indwelling catheter. A urinary tract
infection (UTI) can also be a trigger.
A bowel problem. This is often a bowel filled with stool or gas. Or it could be an infection or hemorrhoids. Stimulating your bowel with your finger (digital stimulation) as part of a bowel program is another possible trigger.
Other sources of
discomfort. These include any other type of irritation. They could be wounds,
pressure injuries, broken bones, and even ingrown nails or sunburn. Sexual
arousal, menstruation, and pregnancy and labor can also trigger an AD episode.
What to do during an AD episode
It's critical to get treatment of
an AD episode right away. You or your caregiver should take the following steps if you
have symptoms of an episode:
Sit up. This can help lower
blood pressure. Keep your head raised. Your legs should be lowered if possible.
Also loosen any tight clothing, such as a belt or bra.
Monitor the blood pressure. It should be checked every to minutes.
Find and relieve the cause of the problem. Check your bladder and bowel first. Check the catheter (if used) and empty your bladder. If your bowel is full, empty it right away. Next, check for skin problems. These could be cuts or any kind of pressure on your skin. Also look for ingrown toenails. And check for any of the other possible triggers listed above.
If the problem can't be found or relieved, call or emergency services right away. In the meantime, certain blood pressure medicines should be taken if they have been prescribed for this purpose. These can help keep the blood pressure under control until the irritation is relieved.
Preventing AD episodes
AD episodes can’t always be
prevented. But good self-care is key to reduce the number of episodes you have. These
steps can help:
Prevent your bladder from
getting too full or infected such as by urinary tract infection (UTI). If you use
a catheter, check it often for blockages.
Follow a regular bowel program as instructed by your healthcare provider.
Change positions often to
ease pressure on the skin from sitting or lying down.
Watch for sores or pressure spots on the skin.
Take all medicines as prescribed.
Choose shoes carefully. Check
that they fit well and aren’t too tight. Your healthcare provider may help with
Check that there are no
pebbles or other objects in your shoes. Also check that there are no wrinkles in
your socks. And always wear socks with your shoes.
Don't get too much sun. Wear sunscreen and protective clothing.
Check water temperatures to prevent scalding.
Be extra careful to prevent
falls, especially during transfers.
Keep a card in your wallet that describes AD, its triggers, and correct treatment. This can help healthcare providers who may not be familiar with the condition.
Form a good relationship with a healthcare provider who is familiar with AD and spinal cord injuries.
For the caregiver
You can help your loved one prevent
AD episodes. Learn AD triggers and symptoms. Help manage your loved one’s catheter and
bowel program. Watch for any skin problems or other injuries on the body below the point
of the SCI. And know how to treat an AD episode. You can also help your loved one cope
with AD. Living with the threat of an AD episode can be hard. Fear and depression are
not uncommon in people who have frequent episodes of AD. Talk with your loved one about
his or her feelings. Encourage your loved one to join a support group.