Common problems are so frequently over-looked and forgotten. For example, several patients I know have ended up in very tight corners because their healthcare professionals didn’t know about, and failed to respond to a common spinal cord injury complication called Autonomic Dysreflexia. I am sometimes amazed that people have not been taught about this problem in rehab
Autonomic Dysreflexia occurs in people who have spinal cord injuries above the level of T6 or T7 and happens when a sensation that would normally be painful occurs below the level of the spinal cord lesion and results in excessive reflex activity in the autonomic nervous system (the section of the nervous system that controls the bladder, bowel and other internal organs and blood vessels).
If the cause of the dysreflexia is not promptly found and treated, the blood pressure can rise to dangerously high levels and may even result in loss of consciousness, brain haemorrhage, fits or heart palpitations.
Autonomic Dysreflexia is most commonly a result of:
A bladder problem – an over filled bladder, a blocked or kinked catheter or a bladder infection.
A bowel problem – abdominal distension, constipation or piles.
A skin problem - pressure sores, burns, ingrown toenails or too-tight clothing or shoes.
Other causes – fractures of bones, kidney stones, menstrual cramps or labour pains.
So how do you feel if this happens to you? Well, usually you would have one or more of the following:
Flushing/ blotching of skin on the head and neck
A blocked nose
Chills without fever
Shortness of breath and anxiety
Severe pounding headache
A sudden rise in blood pressure
A very slow pulse
So what do you do if this does happen to you?
Firstly – Autonomic dysreflexia is a true medical emergency – you must respond immediately! If you think you have this condition:
Sit up or at least raise your head in bed and try to lower your legs – this will help to lower your blood pressure.
Loosen tight clothing.
Look for the cause.
Check for a blocked or kinked catheter tube or an overfull urine bag.
Irrigate your catheter.
Change your catheter.
Check for constipation by doing a rectal examination or asking someone to do this for you. Use anaesthetic gel if you have it. If you are constipated, you may have to do a manual evacuation.
Take your blood pressure or have it taken for you.
If your blood pressure and symptoms do not settle immediately or if you can’t find a reason – take an Adalat 5 or 10 mg capsule. (It may be an idea to discuss this with you doctor and keep an emergency supply on hand.)
Just be careful because anything you do to solve the problem may also worsen the situation as it may irritate your system more. Anything you do (unblocking your catheter, inserting a new catheter or emptying your bowel) must be done with great care.
If your blood pressure and symptoms still do not settle, get medical help urgently. You must know what to do because other people, including doctors, may not know. It helps to carry an information sheet on autonomic dysreflexia with you so that you can remind yourself and show other people what to do.
Take home message: Understand what Autonomic Dysreflexia is, know how to manage it yourself and seek help if it does not settle immediately.