Autonomic dysreflexia can occur in some people with a spinal cord injury, resulting in medical emergencies such as a stroke, seizure or cardiac arrest. It can happen when there is a hyperactive reflex in your body’s autonomic nervous system – a control centre for key functions like breathing and digestion – to something happening below the point of damage in the spine.
What is autonomic dysreflexia?
Autonomic dysreflexia is an overreaction of your body that can lead to a dangerous scenario if not quickly resolved. Although it’s not as common as other post-spinal cord injury medical issues, it’s vital that you and your carers understand how autonomic dysreflexia works and are aware of the warning signs, especially if your injury is located at T6 or above.
Autonomic dysreflexia symptoms
Initially, the most typical signs of autonomic dysreflexia are subtle. They include a flushed feeling and an intense headache. Other more innocuous warning signs are heavy sweating, a stuffy nose or chills (without a fever).
Additional symptoms of autonomic dysreflexia may include:
- Slowed heart rate
- Fuzzy vision
- Difficulty breathing
- Muscle spasticity
- Bowel impaction
- Blotchy skin
- Cold, clammy skin below the level of injury
You may also experience mental warning signs that mimic the body’s response to stress. These include a feeling of anxiety, apprehension, or restlessness. You may experience some confusion as well.
Autonomic dysreflexia causes
The causes of autonomic dysreflexia can range from a blocked catheter or sexual activity to an ingrown toenail. The commonality is that something new is happening below the level of your spinal cord injury that your body’s autonomic system or “control centre” overreacts to by raising your blood pressure and lowering your heart rate.
Let’s explore three common areas of autonomic system stimuli that might be the culprit.
Bladder problems are the most common cause of autonomic dysreflexia. Several potential bladder issues can cause this condition. If you think you are experiencing autonomic dysreflexia, you and your carer should check for bladder problems that can be quickly resolved.
For example, it may simply be an issue with your catheter. Examine your catheter bag to see if it may be at or near capacity. If that’s not the problem, look for other issues with your catheter. Is it connected properly? Are there any kinks or is anything blocking urine flow?
Another common cause of autonomic dysreflexia is incomplete emptying of your bladder if you use an intermittent catheter. It’s vital to stick to your optimum routine and ensure complete emptying to avoid the onset of this serious condition.
Other more serious bladder issues that may require a trip to the doctors include infections and bladder or kidney stones. Certain medical tests may also cause autonomic dysreflexia, so check with your doctor about the risks before proceeding.
Other common autonomic dysreflexia causes fall under the bowel category. For instance, constipation, hard stools or digital stimulation done too roughly (or without enough lubricant) can cause this condition’s onset. Haemorrhoids, gas, flatulence and bloating may also bring it on. Although it is possible to resolve these bowel issues at home, medical assistance may be required, especially if you continue to experience the symptoms of autonomic dysreflexia.
A bowel infection is another possibility that warrants a trip to the doctors or A&E.
Many minor skin-related issues can trigger your autonomic system to go into overdrive. They include:
- Tight-fitting clothing, belts, braces or shoes.
- Pinched or constricted genitalia.
- Hard or sharp object pressing against your body.
- Ingrown toenails.
- Insect bites.
- Sunburns or burns.
More serious skin issues, such as pressure sores, severe burns or lacerations, may not be remedied at home. If you suspect that these might be the root cause, visit your doctor or go to A&E.
Other causes of autonomic dysreflexia
The three categories mentioned above constitute the most common autonomic dysreflexia causes. Nevertheless, there is a long list of potential stimuli that warrant quick action. The one thing that all these autonomic system stimuli have in common is that they all constitute activities or events that would usually cause pain, discomfort, or in the case of sexual activity, intense sensations below your level of injury.
Autonomic dysreflexia treatment
The following treatment for autonomic dysreflexia should be carried out if you or your carer suspect that it is occurring.
- Change your body position: Sit up or raise the head to 90 degrees and lower your legs, if possible.
- Loosen or remove anything tight: Check for any clothing or items that may be too tight or constrictive, including the area around your genitalia.
- Check blood pressure every five minutes: If your spinal cord injury is above T6, often, your normal systolic blood pressure is in the 90–110 mm Hg range.
- Adults: a reading of 20-40 mm Hg above baseline may be a sign of AD.
- Adolescents: a reading of 15- mm Hg above baseline signals possible AD.
- Children: a reading of 15 mm Hg above baseline potentially indicates AD.
- Focus on the three main stimuli areas: bladder, bowel and skin-related issues are the most common causes in people with a spinal cord injury. Check these areas for specific stimuli to try to pinpoint the cause.
- Be aware that symptoms may not resolve immediately: once you find the cause and fix it, if possible, symptoms like a pounding headache, a flushed feeling and profuse sweating may not subside immediately and may even get worse.
When autonomic dysreflexia warrants a trip to the A&E
If you cannot find the cause or something more serious below your spinal cord injury location is causing the problem – such as a bladder infection, broken bones or fractures, severe burns or other trauma – go to your nearest A&E immediately.
The doctor may not be familiar with spinal cord injury ailments and this lesser-known condition. It’s a good idea to carry an AD wallet card with life-saving information for emergency medical teams. The Christopher and Dana Reeve Foundation offers an autonomic dysreflexia wallet card for at-risk people with a spinal cord injury that you should download, print and carry with you at all times in case of an emergency.
For more help and support with autonomic dysreflexia visit Navigator, our dedicated spinal cord injury support service. Once registered with Navigator you’ll receive one-to-one support from our SCI experts via live chat, telephone, or email. Plus, free and discreet worldwide delivery of bowel and bladder management medical supplies, from Fittleworth.