Overview

Autonomic dysreflexia is a syndrome in which the blood pressure of a person with a spinal cord injury (SCI) suddenly goes very high, (20 to 40 mmHg) above your normal blood pressure. After a spinal cord injury, your blood pressure may be lower than it was before the injury. A rise in your blood pressure may be dangerous, but the same rise in blood pressure may still be within a normal range for someone who doesn’t have a spinal cord injury. Symptoms include:

• Increase (rise) in blood pressure 20 to 40 mmHg above your normal blood pressure.
• May have a slow heart rate (fast heart rate is possible, may be irregular).
• A pounding headache.
• A flushed face and red blotches on the skin above the level of spinal cord injury.
• Sweating above the level of spinal cord injury.
• Nausea.
• Pale and/or coolness below the level of spinal cord injury.
• Goose bumps below the level of spinal cord injury.
• Cold, clammy skin below the level of spinal cord injury.
• Blurred vision and/or nasal congestion.
• Feelings of apprehension or anxiety.

What causes it?

Autonomic dysreflexia occurs when your body reacts to pain or pressure below your spinal cord injury. This can be a pain or an irritant (such as tight clothing or something pinching your skin). Or it can be a normal function that your body may not notice (such as having a full bladder). These situations trigger an automatic reaction that causes your blood pressure to go up. Other things that may cause this reaction include:

• Urinary tract infections (UTIs).
• Kinked or blocked indwelling catheter, delayed intermittent catheterization, or increased urine volume.
• An overfull bowel or constipation.
• Gas or bloating.
• Gastrointestinal problems such as gallstones, stomach ulcers, or gastritis.
• Sitting or lying on something hard.
• Tight clothing or shoes.
• Skin or body hair zipped into zippers.
• Sitting on scrotum.
• Wound or burn.
• Pressure injuries.
• Ingrown nails or other skin problems.
• Sexual activity.
• Pain.
• Broken bones or other injuries.
• Severe menstrual cramps.
• Medical devices, such as insulin pumps.
• Infection.
• Pregnancy or labor and delivery.
• Tight clothing or devices (seat belts, tight shoes, abdominal binder).
• Extreme temperatures or quick temperature changes.

How can you prevent it?

There are ways you may be able to prevent autonomic dysreflexia. This means doing things to avoid the things that cause it.

• To avoid an overfull bladder or urinary tract infections (UTIs), follow your bladder management program.
• Check your catheter for any kinks or blockages, and make sure the drainage bag is not too full.
• For more information, visit Spinal cord injury - Frequently asked questions about bladder management.
• To avoid an overfull bowel or constipation or gastrointestinal problems such as gallstones, stomach ulcers, or gastritis, follow your bowel management program. Eat fibre and consume fluids as your healthcare provider suggests.
• To avoid pressure injuries, ingrown nails, or other skin problems, check your skin daily. Make sure that all clothing or devices fit right.
• Have regular foot care.
• Change your position in a chair or bed often.
• For some people, sexual activity can cause autonomic dysreflexia. Discuss this with your healthcare provider.
• Be aware of what else can cause the condition. This includes broken bones or other injuries, tight clothing or devices, and extreme temperatures or quick changes in temperature. Discuss this with your doctor. Make sure that all clothing and devices fit right.

How can you care for yourself?

There are ways you may be able to treat autonomic dysreflexia at home.

• Sit up straight, or raise your head so you are looking straight ahead. If you can lower your legs, do so. You need to be sitting upright until your blood pressure is back to normal.
• Loosen or take off any tight clothing or accessories. This includes braces, binders, catheter tape, socks or stockings, shoes, and bandages.
• Empty your bladder by draining your Foley catheter, check your catheter for kinks or blockages, or perform a self-catheterization right away. Bladder issues are the most common cause of autonomic dysreflexia.
• Gently put your finger inside your rectum to help empty your bowel. This is called digital stimulation. Digital stimulation may cause small tears in the lining of the rectum and irritate the area or cause pain. It can also cause your blood pressure to rise. If your blood pressure is already above 150 mmHg, digital stimulation may cause your blood pressure to rise to dangerous levels.
• Check your skin to see if it looks like you may be sitting on something hard or something is poking you.
• If you can, check your blood pressure every 5 minutes to see if it improves.
• Check the position of your body, arms, and legs to see if something may be making you uncomfortable. If you can, check your blood pressure every 5 minutes. Also check your blood pressure after you move something away from your body that may have been the cause of your pain and rise in high blood pressure.
• Take any medicine that your healthcare provider prescribes for autonomic dysreflexia.
• Call your healthcare provider, even if symptoms go away and your blood pressure goes down.
• If the symptoms return or do not go away,, repeat the above steps and go to the emergency room or call 911.

Be sure to talk to your health care team ahead of time about what to do when you have symptoms of autonomic dysreflexia. Call your doctor immediately or get emergency medical care if symptoms of autonomic dysreflexia don't get better right away. If you or a caregiver can't treat it promptly and correctly, it may lead to seizures, stroke, and even death.