Autonomic dysreflexia (AD) is a dangerous rise in blood pressure that can happen after spinal cord injury. It affects people who have a spinal injury at level T6 or above. AD happens when you have pain or discomfort in the areas of your body that have no feeling. The most common cause of AD is a full bowel or bladder. When you have AD, you have other signs and symptoms at the same time. If you have these symptoms, you need to fix the problem right away. AD is a medical emergency. If not treated, it can cause stroke, heart attack, seizure, and death.
AD is a sudden rise in blood pressure by 20-40mmHg that happens with other symptoms. Since you cannot feel your blood pressure rising, you need to know the signs and symptoms of AD. If you have any of these symptoms, check your blood pressure right away. Symptoms of AD start suddenly. If you can’t check your blood pressure, see a doctor right away.
|Symptoms of Autonomic Dysreflexia|
|*Blood pressure increase by 20-40mmhg*|
|Pounding Head||Nasal congestion|
|Sweating and flushing of the face||Blurred vision|
|Increased Muscle Spasms||Nausea|
|Metallic taste in your mouth||Difficulty breathing|
|feeling of anxiety||Slow heart rate|
To know if your blood pressure has increased, you need to know your usual blood pressure. After spinal cord injury, blood pressure is often lower. Many people with an injury level of T6 and above can have systolic blood pressure of 90 to 110 (upper number). For some people it can be even lower. For these people, blood pressure above 130 can be a sign of AD.
AD is a serious condition that must be treated right away. Once the cause has been treated, your blood pressure should go down. The symptoms should also go away. If your blood pressure stays high, go to the nearest emergency department.
Sit up and lower your legs if you are lying down. This will help lower your blood pressure. Check your blood pressure to see if it is high (20-40mmHg increase). If it’s high, it’s an emergency. Check your blood pressure every 5 minutes to see if it comes down. Keep a blood pressure monitor at home. They can be purchased at most drug stores.
- Blocked or kinked urine drainage tubes (Foley catheter or condom catheters).
- A condom catheter that is set too tight.
- Urinary tract infections or bladder/kidney stones.
- Bladder tests (urodynamics, cystoscopy). Numbing gel can help.
- Anal fissures
- Ingrown toenail
- bent toe in your shoe
- tight or bunched up clothing
- cuts and burns
- Insect bites
- trauma (e.g. broken bone)
- Pressure on Scrotum
- Pressure Sore
Sexual activity can lead to AD. Causes can include intercourse, vibrators, pinched genitalia, orgasm, and ejaculation. Other causes can come from menstrual cramps, and child birth.
Medical conditions can also cause AD. These include stomach ulcers, heart attack, asthma, lung infections, and blood clots in your legs. If you cannot find the source of AD, get medical attention right away.
If your blood pressure does not go back to normal, go to the nearest emergency department. Do not drive. Inform hospital staff that you have AD and that it is a serious condition. Emergency room workers are not always aware of the special needs of people with spinal cord injuries. Carrying an AD card can be helpful.
Keeping a wallet sized card with you at all times can help in an emergency. It explains the warning signs and describes what to do. Write your normal blood pressure on your AD card. Give hospital staff your AD card and ask them to check your blood pressure right away. You may need medicine to bring your blood pressure down.
- Paralyzed Veterans of America
- Christopher and Dana Reeve Foundation
- Wear loose clothing
- Follow a regular bladder schedule.
- Follow a regular bowel schedule.
- Make sure that tubing is draining well (Foley and condom catheters).
- Check your skin regularly.
- Keep clothing and bedsheets free of wrinkles.
- Perform regular foot care to prevent ingrown toenails.
- Treat infections early (e.g. bladder infections).