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Autonomic Dysreflexia


  • Autonomic dysreflexia, or AD, is a condition where the body's reflexes overreact to a harmful stimulus (trigger). AD is most common in persons with spinal cord injury (SCI) at the neck or upper back. AD may also occur in persons who have tumors of the spine, nerve diseases, or had spinal cord surgery. The spinal cord is a pathway for nerve impulses (messages) travelling to and from the brain and body. AD often happens when the stimulus that brings pain or discomfort is located below the SCI. AD is commonly caused by a distended (overfull) bladder, constipation, or bowel obstruction (blockage).

  • Signs and symptoms of AD include a sudden increase in blood pressure, slow or fast heartbeat, headache, or blurred vision. Your skin above the level of SCI may be flushed (red) and sweaty. Below the injury, your skin may be cool with goose bumps. Treatment of AD aims to correct the cause of AD, and control blood pressure. Blood pressure medicines, a bowel and bladder program, and skin care may help prevent AD. With treatment and support, frequent AD attacks may be prevented and quality of life may be improved.


You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.


Autonomic dysreflexia is an emergency condition and should be taken seriously. Early diagnosis and treatment are very important but may cause unwanted side effects. Some tests or procedures, including inserting a catheter or surgery, may lead to an AD attack. Blood pressure lowering medicines may make your blood pressure decrease too fast. You may have nausea (upset stomach), vomiting (throwing up), fast heart beat, dizziness, or headache. If left untreated, AD can cause your blood pressure to go dangerously high. This may lead to heart, lung, or eye problems, seizures (convulsion), stroke, coma or even death. Ask your caregiver if you have concerns about your condition, medicines, or care.


Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

A Foley catheter

is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.


You may be given the following medicines:

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

  • Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.

  • Antiulcer medicine: This medicine helps decrease the amount of acid that is normally made by the stomach.

  • Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.

  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.


You may have one or more of the following tests:

  • Arterial doppler: An arterial doppler test is done to check blood flow through an artery. A small metal disc with gel on it is placed on your skin over the artery. You can hear a "whooshing" sound when the blood is flowing through the artery. An "X" may be marked on your skin where caregivers feel or hear the blood flowing best. Caregivers may need to check blood flow more than once.

  • Blood and urine tests: You may need blood taken for different tests. The blood can be taken from a vein in your hand, arm, or the bend in your elbow. A sample of your urine may also be collected and sent to the lab. These tests may be done to see how your body is doing. These can give your caregivers more information about your health condition. You may need to have blood drawn or urine collected more than once.

  • Cystoscopy: A cystoscopy allows caregivers to look for problems inside your bladder. A cystoscope is put into your bladder through your urethra. The urethra is the tube that urine flows through when you urinate. The cystoscope is a long tube with a lens and a light on the end. The scope may be hooked to a camera or monitor, and pictures may be taken. A tissue sample may also be taken during your cystoscopy. During this test, small tumors may be removed or bleeding may be stopped.

  • Sigmoidoscopy: A sigmoidoscopy test looks for changes in your intestinal (bowel) wall that may be caused by a disease or condition. This test may also help find the cause of bleeding or pain. A long, thin tube with a tiny camera on the end is put through your anus into your rectum (rear-end). It also goes to the part of your intestine called the sigmoid. Caregivers will look for problems in your rectum and lower colon. A small amount of tissue may be taken from the intestine wall and sent for tests. Follow your caregiver's instructions for what to do before, during and after the test.

  • X-rays: X-rays of different parts of your body may be taken. These may be pictures of your chest (lungs and heart), abdomen, or bones. X-rays may help caregivers look for signs of infection, broken bones, or other problems.

Treatment options:

Surgery may be done to treat problems which may cause an AD attack. Surgery may correct problems such as kidney stones, hemorrhoids, or anal tears. Fractures (broken bones) may also be treated with surgery.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Autonomic Dysreflexia (Inpatient Care)