AD, SCI and U: get to know how autonomic dysreflexia can affect you after SCI, how it can affect your bowel, bladder and other systems, and when to seek help.
Autonomic Dysreflexia (AD) is a potentially life threatening complication of a spinal cord injury that is common in people with injuries at T6 or above. AD is a medical emergency – if you have symptoms, initiate treatment immediately according to your doctor’s advice, or seek help at a hospital emergency room.
The following information is derived from our Living with SCI resource website—designed in partnership with G. F Strong Rehabilitation Centre clinicians and Peers like you—to support individuals living with, adjusting to, and thriving with a spinal cord injury.
Please note: All information, content, and material of the website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.
IS YOUR INJURY AT T6 OR ABOVE? GET INFORMED ABOUT AD
The classic symptom of autonomic dyseflexia (AD) is suddenly elevated blood pressure, well above your normal.
Typically, this is an elevation in blood pressure of 20-40 mmHg. Many people with SCI have lower than average blood pressure, so with AD your blood pressure may appear “normal” while being well above your usual BP.
Some common signs of sudden changes in blood pressure include:
- a sudden pounding or throbbing headache,
- feelings of apprehension or anxiety,
- blurred vision,
- tight chest and stuffy nose
Some SCI-specific indicators of AD include:
- sweating or flushing above the level of injury,
- goose bumps above the level of injury,
- increase in frequency or severity of spasms.
Above all, know your baseline (everyday) blood pressure so you will know when your BP is well outside your personal norm (20-40 mmHG).
Information For Your Wallet
Is autonomic dysreflexia (AD) a potential risk with your injury level?
AD is often not a common condition that care workers, first responders, doctors, nurses, hospitals and emergency ward staff are familiar with.
Created by Spinal Cord Injury BC and Vancouver Coastal Health’s G. F. Strong Rehabilitation Centre, the Autonomic Dysreflexia (AD) wallet card is designed to keep on you for emergency situations. Whether you’re unable to communicate or an emergency personel doesn’t understand AD—this resource is designed to support you wherever you go.
The AD wallet card is available to download from the SCI Information Database, or you can head to the SCI BC office in G. F. Strong Rehab Centre for a physical copy.
WHAT CAUSES AD?
Autonomic dysreflexia is caused by something that would be painful below the level of your injury that you may not be aware of, depending on your level of sensation. Think of AD as a kind of red-alert that signals you that you need to check for signs of injury, pain or dysfunction that you might not be able to feel. Many cases of AD will resolve once that stimulus is removed or addressed. It’s important though to think about AD like a Red Alert and address the signs immediately. If you can’t, you should seek help at the ER or your physician immediately.
There are a few common causes of AD in people with SCI and injury levels above T6:
- The most typical cause of AD is an irritated, overfull bladder. If using a Foley catheter, the tubing or drainage bag may be kinked or blocked causing back pressure, or overfilling. A condom catheter set too tight may also cause AD. Urinary tract infections (UTIs) or bladder/kidney stones can also result in AD.. Bladder tests such as urodynamics and cystoscopy may also irritate the bladder resulting in AD. Check out the Living with SCI chapter on Bladder Management for further information on preventing these AD-causing symptoms.
- An overfull bowel, constipation or impaction can lead to AD. Read the Living with SCI chapter on Bowel Management for ways to combat these symptoms leading to AD.
- Pressure injury or irritated skin, which includes extreme heat, cold or pressure on the skin below the level of injury; trauma to the skin including sunburn, cuts, burns and insect bites; tight clothing or rivets on jeans; pinched genitalia, ingrown toenails; etc. Learn to take close care of your skin health in the Living with SCI skin chapter to avoid AD.
- Sexual or reproductive activity can also be a cause of AD for some. This includes intercourse, the use of vibrators, orgasm and ejaculation. Menstrual cramping and labour (uterine contractions) can also cause AD. Lean more on our sexual health and SCI website.
IS THERE ANYTHING I CAN DO TO PREVENT AD?
Be aware of the possible triggers that lead to AD mentioned above, including the triggers that are most common for you, if you know them. There are also some adjustments you can make to your clothes, health and lifestyle to mitigate your risks:
- Wear loose clothing
- Follow a bladder program to avoid any potential irritants to your system
- Maintain a bowel program so your bowel is emptied regularly
- Check your skin regularly, or have someone check the areas you cannot see
- Keep clothing and bed sheets smooth to prevent irritation from wrinkles
- Perform regular foot care to prevent ingrown toenails
- Attend to any infections early, as soon as you find them
- Teach your family, friends and caregivers how to help you through an episode of AD
Avoiding triggers is the key to preventing AD.
Autonomic Dysreflexia is a sudden dramatic increase in blood pressure that is a part of life for many people with SCI above T6, and may become a medical emergency if you cannot resolve it on your own. It is often preventable, but some may experience it often and require more treatment. The most crucial way to prevent AD is to know your blood pressure and learn how to spot and treat the symptoms.
Learn more tips to resolve AD and who to turn to on our Living With SCI AD information page, along with many other aspects of life with a spinal cord injury on LivingWithSCI.ca.