› Responding to Autonomic Dysrreflexia

Autonomic Dysreflexia in SPinal Cord Injury Patients

All the information you will need to understand automatic dysreflexia in spinal cord patients is pretty much in this video. Below the video is a transcript, in case you are are more of a reader than a watcher. After this you should know how to recognize and respond to this serious situation.

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What Is Autonomic Dysreflexia?

Autonomic dysreflexia also called autonomic hyperreflexia which is the abnormal response to a problem below the level of your spinal cord injury. The cause is often associated with an overfilled bladder or bowel but could be attributed to any type of stimulation below the level of your SCI (Spinal Cord Injury). 

Because of this, your body is unable to properly respond to the signal that something is wrong. Before injury your brain receives a signal for pain or discomfort. It then works with your autonomic nervous system and balancing out any reaction to pain, surprise or discomfort. 

In the event of a spinal cord injury the autonomic nervous system continues to function but is unable to communicate with your brain due to an interruption at the level of the injury.

Who Is At Risk For Autonomic Dysreflexia?

Well it really depends on the level and extent of your spinal cord injury. 

  • If you are injured at T6 and above you are at risk. 
  • If your spinal cord injury is between T6 and T10 then you may or may not be at risk. 
  • If your level is below T10 you are not at risk. 

The important thing to remember is that autonomic dysreflexia can be very dangerous. It can cause a rapid increase in your blood pressure. High blood pressure is a serious medical situation. It could lead to stroke, seizure and even death. 

What Happens During an Autonomic Dysreflexa Episode?

Something is wrong. Often times it is an overfilled bladder or bowel. In response, your body sends a message of pain or discomfort to your spinal cord. Your spinal cord tries to send these messages to your brain but because of your injury, the message is blocked which is probably why you cannot feel the pain in the first place because of the disruption in communication.

Those messages caused your spinal cord to turn on special autonomic nerves. They make blood vessels in your legs and abdomen squeeze tight and become smaller. This process squeezes extra blood into the blood vessels and the rest of your body the extra blood in conjunction with the tightly squeezed blood vessels makes your blood pressure go up quickly. Sensors near the brain tell you that your blood pressure is becoming too high. 

  • In response, your brain attempts to lower your blood pressure by sending out three signals. 
  • Signal one tells your heart rate to slow down. A slow heartbeat is called bradycardia. 
  • Signal two, blood vessels in your face neck and upper chest become larger therefore holding more blood this can make you look flushed or red and blotchy. 
  • Signal three, the brain tries to tell the blood vessels in your legs and abdomen to stop squeezing but your spinal cord injury blocks the messages from getting through. 

Your blood vessels keep squeezing and your blood pressure remains high. It may even keep rising.

What Causes Autonomic Dysreflexia?

Bladder problems are the number one cause of AD but any problem below your level of injury could cause this condition. Think of it this way, if there is any stimulation below your level of injury that would have been painful or unpleasant before your injury could now cause an episode of AD.

Bladder problems can occur when the bladder is overfilled due to a blocked catheter, kinked or clogged tubing or a leg bag that is too full, causing the urine to back up into the bladder. Be aware of a possible bladder infection, watch the color of your urine. If it is darker than usual or smells bad and you have low energy you may have a bladder infection. Be careful with the drinks that contain caffeine or alcohol they may cause your bladder to fill up suddenly and may even make you dehydrated.

If your catheter becomes clogged frequently with gritty material ask your doctor about a checkup. You may be developing bladder stones that will need to be removed. You will also want to check your tubing and leg bag after you transfer or turn in bed. If you find any kinks or twists fix them to keep the catheter flowing. 

If you have been up all day and then lay down for a while your leg bag may fill up quickly due to the increased flow of fluids circulating from the lower parts of your body. Have someone check your bag soon after lying down. 

Change your catheter according to your doctor's recommended schedule, usually once per month. However if your catheter is clogged and not draining change it immediately. 

If you are taking medications that help relax your bladder and reduce bladder spasms, continue taking them. This will help keep your bladder relaxed so that it holds urine and will not be irritated by a catheter. 

If you are on the intermittent catheterization program (called ICP) you must empty your bladder on schedule. Don't skip your catheterizations. Keep your fluid intake to about 4 ounces or 120 ccs an hour. If you drink more fluids than usual, catheterize yourself early and more often to prevent overfilling. 

There are other possible causes of Autonomic Dysreflexia as well. Bowel stimulation due to constipation or hard stools bowel impaction or the digital stimulation during a bowel program could lead to AD. Keep your bowel program on a regular schedule to prevent constipation or bowel accidents. 

If you're constipated, try drinking more water and eating at least 5 vegetables and fruits a day to soften up the stool making it easier to come out. If during your bowel program, you are experiencing Autonomic Dysreflexia try using more lubricant or try a lubricant containing an anesthetic ointment like lubricaine. 

You might also try using a more gentle digital stimulation. You will need to speak with your health care provider if the AD is occurring often during your program. Be sure to talk with your healthcare provider if you're going in for any tests of your bladder. 

A common urology exam that patients at Craig Hospital receive is the cystoscopy. The urologist examines the bladder with a scope inserted through the urethra this exam could because Autonomic Dysreflexia. 

Talk with your doctor about AD before the exam.

Other causes of AD are skin irritation, sores, pressure, burns, contacts with objects that are hard and/or sharp. Check your skin once in the morning and once again at night for any pink or red marks or for scrapes or scratches. Check anytime you think you might have a skin problem. Keep bed sheets and clothing smoothed out under you, to avoid pressure spots and keep wallets and other hard objects out of your pockets.

If any skin sores do develop, then be sure to keep pressure and irritation off the sore. 

Check regularly for ingrown toenails and check your feet often for sores or irritations. 

Damage under the skin could also cause AD. Broken bones, blood clots, extreme temperatures or something as simple as clothing that is too tight. Shoes or braces may also provide enough irritation. Any bruising, bleeding sores or other aggravation should receive immediate medical attention. It is important to remember than any stimulation below the level of injury could lead to Autonomic Dysreflexia.

Sexual activity, the stimulation of the genitals could cause AD. The use of a vibrator or other external devices could cause pressure and irritation for Men and erection ejaculation or pressing or squeezing of the testicles could cause AD. The physical activity and stimulation during sexual activity increasing the pressure on the skin, genitals and other sensitive areas could cause Autonomic Dysreflexia in some individuals with Spinal Cord Injury. Intercourse, erections and orgasm could cause AD.

Not every stimulus will cause autonomic dystreflexia and every person with spinal cord injury should be aware of what stimulation triggers Autonomic Dysreflexia in you.

For women cramping and discomfort during the menstrual cycle could cause AD. The use of certain birth control devices such as the IUD or sponges may provide enough stimulation to cause AD. Speak with your healthcare provider to learn about other methods of birth control if this is a problem for you. If you are planning on a pregnancy you will want to talk with your health care providers about AD during the pregnancy and childbirth. 

Be aware that some medications can increase your susceptibility to AD. For example, medications used to increase your blood pressure or for migraine headaches. You need to check with your doctor to see if any medications you are taking could possibly increase your chances of AD. You will also want to discuss with your doctor any over-the-counter medications or herbal products you are taking. 

Be aware that the use of alcohol and street drugs might make you unaware of problems happening in your body thus increasing the chance of AD occurring.

So in review, the most common warning signs are: 

  • a fast rise in blood pressure a major increase is 20 to 40 millimeters higher than usual for you 
  • a deep pounding headache that may cover your entire head or a single point flush face red and skin especially in the face neck and shoulder 
  • heavy sweating above level of spinal cord injury especially your face neck and shoulders 
  • blotchy skin or goosebumps 
  • blurry vision or stuffy nose 
  • anxiety or jitters (I’m feeling that something is just not right
Illustration of human nervous systemNervous System

What Should I Do If I think I have Autonomic Dysreflexia?

Step 1: sit-up to at least 90 degrees and raise up your head. Lower your legs too if you can you will need to remain in an upright and stay in the position until your blood pressure is back to normal. Lying down may make your blood pressure go even higher 

Step 2: loosen or take off anything that may be tight-fitting that means abdominal binders, TED hose or stockings, clothes, belts, shoes or external catheter tape 

Step 3: find and correct the cause start with the bladder. Check the catheter and leg bag for draining. Check the catheter for any kinks, bending or clogging. Be sure the indwelling catheter is draining. If it is plugged, change it immediately, don’t waste time irrigating it. 

If you do the IC program perform an intermittent catheterization and make sure the bladder is empty.

If you are doing the bowel program and a digital stimulation, stop the procedure. Resume digital stimulation only when the symptoms have gone away. If you are not in the middle of your bowel program you may have to perform a rectal check to be sure there is no stool in the rectum causing the irritation. 

Check your skin thoroughly for any bruises and sores or pressure spots that could be irritating the skin 

Step 4: if you can have someone check your blood pressure if it is elevated by 20 to 40 millimeters of pressure over your normal blood pressure this may mean that you are experiencing AD.

Step 5: if you are not able to find the cause of the AD or your attempts to find the cause have not worked, seek emergency medical treatment. You may have to call 911 if you are not able to find and correct the cause to bring your blood  pressure down. Take your AD wallet card with you as a reference because many physicians are not familiar with AD. 

If they have questions, tell them to call Craig hospital for assistance. 

Living life to the fullest is what is expected for people after spinal cord injury so by understanding the various symptoms causes and what to do for Autonomic Dysrefexia, you may be able to prevent the possibility of severe complications such as seizure or stroke.

Early recognition and prevention measures will protect you from discomfort and from the serious complications of AD.

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