AD occurs primarily because of an imbalance in the body systems, which control the blood pressure. The human body is an incredibly complicated and beautifully balanced machine. There are balances to each system of the body, including blood pressure. One of the major ways the body controls blood pressure is by tightening or relaxing little muscles around the blood vessels. When the muscles contract, the blood vessels get small and blood pressure increases. Imagine a garden hose with water streaming through it; when you put your thumb over the opening of the hose, reducing the opening for the water to flow through, the water shoots out at a higher pressure. Similarly, when the blood vessels are smaller, the blood rushes around your body at higher pressure.

When a noxious stimulus occurs, a reflex is initiated that causes the blood vessels to constrict and raises the blood pressure. In an intact spinal cord, this same stimulus also sets in motion another set of reflexes that moderates the constriction of blood vessels. However, in someone who has SCI at the T-6 level or above, the signal, which tells the blood vessels to relax cannot get through the spinal cord because of the injury. Some of the nerves at the T-6 level also control the blood flow to and from the gut, which is a large reservoir of blood. Uncontrolled activity of these nerves may cause the blood from the gut to flow into the rest of the blood system. The result is that blood pressure can increase to dangerous levels and the increase in blood pressure must be controlled by outside means.

Recognizing Autonomic Dysreflexia

The symptoms of AD are fairly easy to recognize and surprisingly consistent. They include:

·         Hypertension (blood pressure greater than 200/100)

·         Sudden, pounding headaches

·         Flushed or blotchy skin, above the level of the spinal cord injury

·         Facial flush, perspiration(above the level of the injury)

·         Goosebumps (below the level of the spinal cord injury)

·         A "stuffy" nose

·         Cold, clammy skin below the level of the injury

·         Slow heart rate (reflex bradycardia); and, occasionally

·         Dizziness and nausea.

If any of these symptoms occur, pay attention. Start looking for the cause of AD and stop what ever is causing it.

Common Causes of Autonomic Dysreflexia

Causes of AD are things that irritate or stimulate the body. Common causes are:

·         Full or distended bladder (this is the most common source of AD)

·         Bladder-related causes, such as bladder infection, spasms, or stones

·         Overfilled collection bag

·         Non-compliance with intermittent catheterization program

·         Full or impacted rectum (including constipation)

·         Distention during bowl program

·         Hemorrhoids or anal fissures

·         Infection or irritation (e.g., appendicitis)

·         Pressure sores

·         Tight clothing, irritating wrinkles or folds, or creeping underwear or pants

·         Injury below the spinal cord injury, such as a broken ankle, cut or scrape

·         Burns (e.g., water burns, sunburns)

·         Anything that produces discomfort below the level of injury (e.g., ingrown toenails)

·         Over-stimulation during sexual activity

·         Menstrual cramps

·         Labor and delivery

·         Acute abdominal conditions(e.g., gastric ulcers)

·         Skeletal fractures.

Women may also experience AD during menstruation and especially during labor. For this reason, consulting a physician experienced with SCI and pregnancy is important, especially in anticipation of labor. Breast feeding and ovarian cysts have also been known to cause AD.

Other causes of AD are less common, but harder to detect. These include internal catastrophes, such as appendicitis. If the cause of the AD cannot be determined quickly, seek emergency medical help.

What to do when the Symptoms Appear

The first thing to do when you recognize AD is to raise the head above the knees, preferably in a sitting position. This position naturally reduces the blood pressure. Of course, if you experience AD when you are already sitting, this is not an option. The next action should be to remove the irritating stimulus.

·         Make sure your bladder is empty; catheterize or check to make sure the drainage hose to your leg bag is not blocked. Note that catheterizing may make AD worse, so be careful. In extreme situations, use a lubricant with anesthetic in it.

·         Make sure your bowel is not full or impacted. Use a regular bowel routine; again, this may make AD worse.

·         Check clothing to make sure nothing is irritating our body. Check for tight waistbands or straps, wrinkles, pinching seams, or tight shoes. Make sure your toes are not bent under in your shoes.

·         Check for in-grown toenails; see a doctor to treat them.

·         Check for pressure sores (this should be part of a routine), cuts or bruises. Don’t forget the possibility of a broken bone, especially if you have taken a fall. Get off the sore and take care of the problem.

If you think you may be at risk for AD, discuss it with a qualified physician, urologist or physiatrist, or a rehabilitation nurse. Have a plan for dealing with AD.

Medical Interventions

Medications are generally used only if the offending trigger/stimulus cannot be identified and removed, or when an episode persists even after removal of the suspected cause. The physician will prescribe based on the severity of need.

AD Prevention

Several simple steps can be taken to prevent AD and include:

·  Frequent pressure relief in bed or chair

·  Avoidance of sunburns/scalds

·  Clean catheters; adherence to schedule

·  Maintaining a well-balance diet and adequate fluid intake

·  Compliance with medications

·  Education of persons close o the person at risk, so that they can recognize symptoms, know preventative measures and emergency actions.

More Information

For more information on this subject, ask your physician, physiatrist, or rehabilitation nurse. Additional information can be obtained on the internet, more specifically, the RehabNET offers monographs on various topics, including AD.

Spinal Cord Injury Association of Illinois is a member of Community Health Charities of Illinois. For "Equal-opportunity-choices" in your payroll deduction program contact Mercedes Rauen, Spinal Cord Injury Association of Illinois, 708-352-6223.