Patient education: Autonomic dysreflexia (The Basics)

What is autonomic dysreflexia? — This is when the "autonomic" nervous system reacts abnormally to pain, discomfort, or pressure. It is a serious medical problem.

The abnormal reaction involves a sudden and severe increase in blood pressure. This can be very dangerous. Autonomic dysreflexia usually happens in people who have had an injury to the upper part of their spinal cord.

The autonomic nervous system controls body functions that are automatic, meaning you do not have to think about them. These include things like your heartbeat, breathing, digestion, and blood pressure. After a spinal cord injury, some of the nerves that make up the autonomic nervous system do not work the way they should.

What causes autonomic dysreflexia? — It is normal for your blood pressure and heart rate to increase when something painful or uncomfortable happens. Normally, your autonomic nervous system corrects this reaction and brings your blood pressure and heart rate back down. But if you have a spinal cord injury, your nerves no longer send the right signals to the parts of your body below where your injury is. Because of this, your body does not fully correct the first reaction. Your blood pressure can get very high and stay that way.

Autonomic dysreflexia can happen when something "stimulates" or bothers a part of the body below where your injury is. This often involves the:

●Bladder – Having a very full bladder is the most common cause, or "trigger," of autonomic dysreflexia. This can happen if you have a urinary catheter that gets blocked or kinked so urine cannot flow through. It can also happen if you get a urinary tract infection ("UTI").

●Bowels – Another common trigger is "fecal impaction." This is when a person is constipated for a long time, and hardened bowel movements build up inside the rectum.

●Skin – Skin injury or irritation can trigger autonomic dysreflexia. An example is pressure sores. These are areas of damage to your skin caused by sitting or lying in 1 position for a long time.

Other things can trigger autonomic dysreflexia, too. These include:

●Sexual activity

●Injury

●Surgery or another medical procedure

●Labor and childbirth

What are the symptoms of autonomic dysreflexia? — Symptoms can include:

●Headache

●Sweating

●Blurry vision

●Stuffy nose

●Anxiety

●Nausea and vomiting

●Changes in heart rate

Symptoms can be mild to severe. In very bad cases, a person can have a stroke or seizures, or their heart can even stop. People with a more severe spinal cord injury are more likely to have severe symptoms of autonomic dysreflexia.

Will I need tests? — Maybe. After an episode or "attack" of autonomic dysreflexia, your doctor or nurse will monitor your blood pressure. They will also make sure that they know what triggered the attack. This usually involves asking questions and doing a physical exam.

If your doctor or nurse needs to learn more about your condition, they might order tests. These might include blood or urine tests.

How are autonomic dysreflexia attacks treated? — Treatment involves:

●Lowering your blood pressure – It can help to sit upright and remove any tight clothing.

●Fixing the problem that caused the attack – It's important to do this as soon as possible. For example, if it was related to a full bladder, there could be a blockage in your urinary catheter. If it was related to a buildup of bowel movements, you might need treatment to clear out your rectum and prevent constipation.

●Giving medicines – If the above things don't help, or the cause can't be fixed right away, doctors might give medicine to lower your blood pressure.

Talk to your doctor and make a plan for dealing with future attacks. Your doctor might prescribe a blood pressure medicine to take if you have another attack. They might also recommend that you measure your blood pressure during attacks, and as you recover.

Can autonomic dysreflexia attacks be prevented? — Sometimes. If you have a spinal cord injury or have had autonomic dysreflexia before, there are things you can do to help prevent attacks. You can:

●Empty your bladder regularly – If you use a catheter, know how to take care of it and what to do if it gets blocked. Make sure that it does not kink or bend.

●Practice good bowel care – This includes trying to avoid getting constipated. Drink plenty of water. Eat lots of fruits, vegetables, and other foods with a lot of fiber.

●Take care of your skin – This includes changing positions often to prevent pressure sores. Checking your skin regularly can also help you find any issues before they cause problems.

●Take medicines, if your doctor prescribes them – These might include medicines to keep your blood pressure under control. If you often have bladder problems, your doctor might recommend other treatment.

●Avoid activities that trigger autonomic dysreflexia – Sometimes, certain types of sexual activity or positions are more likely to cause autonomic dysreflexia. You might be able to find other ways to have sex that work for you. Stop what you are doing if you start to have symptoms.

Even if you can't always prevent attacks, it's important to be prepared to deal with them.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if you think that you might be having a heart attack or stroke. While you are waiting for help, sit upright and remove any tight clothing. This can help bring your blood pressure down.

Symptoms of a heart attack might include:

●Severe chest pain, pressure, or discomfort with:

•Trouble breathing, sweating, upset stomach, or cold and clammy skin

•Pain in your arms, back, or jaw

•Worse pain with activity like walking up stairs

●Fast or irregular heartbeat

●Feeling dizzy, faint, or weak

Symptoms of a stroke might include:

●Numbness or weakness of the face, arm, or leg, especially on 1 side of the body

●Confusion, or trouble speaking or understanding

●Trouble seeing in 1 or both eyes

●Trouble walking, dizziness, or loss of balance or coordination

●Persistent severe headache

Call your doctor for advice if:

●You continue to have symptoms of autonomic dysreflexia, even after treating the problem that caused it.

●You have symptoms of infection – Examples include fever, chills, pain when urinating, or a wound that will not heal.

More on this topic

Patient education: Paraplegia and quadriplegia (The Basics)
Patient education: Neurogenic bladder in adults (The Basics)
Patient education: Bladder spasm (The Basics)
Patient education: How to care for a urinary catheter (The Basics)
Patient education: Urinary tract infections in adults (The Basics)
Patient education: Constipation in adults (The Basics)
Patient education: High-fiber diet (The Basics)
Patient education: Pressure sores (The Basics)
Patient education: Blood pressure measurement (The Basics)

Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics)
Patient education: Constipation in adults (Beyond the Basics)
Patient education: High-fiber diet (Beyond the Basics)