Introduction to Autonomic Dysreflexia
Autonomic dysreflexia is a serious condition that occurs when, as a result of a spinal cord injury, nerve signals are blocked from reaching the brain. This condition can happen with spinal cord injuries at T6 or above. Dysreflexia is an emergency situation.
When the bladder, bowels or skin are irritated, they send signals to the spinal cord and a reflex begins. This reflex causes the blood vessels below the injury level to tighten. This makes it harder for the blood to pump through the blood vessels and causes the blood pressure to rise.
The brain tries to send a message to the blood vessels to open up. These messages cannot get past the spinal cord injury. Therefore, blood pressure continues to rise. Very high, uncontrolled blood pressure can cause a stroke, heart attack or death. The blood vessels above the injury level open up and enlarge to try to balance what is happening below the level of injury.
What Causes Autonomic Dysreflexia?
| Full bladder (Number 1 Cause!) | During bowel program (Dil) |
| Full bowel | Tight fitting clothing |
| Bladder infections | Ingrown toenails |
| Skin pressure/sores |
How do you know if you have Autonomic Dysreflexia?
- Severe, pounding headache
- High blood pressure
- Sweating above the level of injury
- Goose bumps above the level of injury
- Red blotches above the level of injury (face, neck, arms)
- Stuffy nose
You should know your normal blood pressure. Dysreflexia may be present with a 30-40 point rise in blood pressure. For example, if your pressure normally runs 100/60, dysreflexia may be present if your pressure rises to 140/70. It is very important to tell this to other health care providers because they may not understand that 140/70 is life threatening for you when it may not be for people who do not have spinal cord injuries.
What should you do if you have Autonomic Dysreflexia?
Take these steps in the order they are listed:
- If you are alone, get help.
- Sit up if you are not already doing so.
- Check your bladder. Do an I.C. If you already have a Foley or a condom catheter, check the tubing for kinks. Change the catheter if it is blocking the flow of urine.
- Do your bowel program. You may need to use a numbing ointment (like Nupercainal) to lubricate the rectum instead of your usual lubricating jelly.
- Do the dil gently or remove the bowel movement.
- Check your skin for sores or irritated areas.
- Check for ingrown toenails.
- Remove tight clothing like socks, shoes, hose, pants.
Prevention is key!
How can Autonomic Dysreflexia be prevented?
- Empty bladder on schedule and keep urine amounts less than 500 cc each time
- Empty bowel on schedule
- Keep bladder free of infection. Know the signs of bladder infection so you can notice it early and seek treatment.
- Stay free of constipation or impactions
- Keep pressure off of the skin. Prevent skin sores.
- Do regular foot care to prevent ingrown toenails.
- Stay as free from other infections as possible.
Common Questions
What if I am doing a dil and dysreflexia happens in the middle of my bowel program?
- Stop the dil
- Sit up if not already doing so. Sit up in the bed or in the chair depending on your location.
- Insert a local numbing agent like Nupercainal Ointment into the rectum
- Check your bladder (IC); check catheter for kinks
