Autonomic Dysreflexia (A.D.)
Autonomic Dysreflexia (A.D.) can happen to people with spinal cord injuries above the T6 level.
It occurs most often in the first year after the injury, but can happen throughout the person’s
lifetime. It occurs when something causes irritation below the spinal cord level of injury. A
warning signal travels up the spinal cord, but it is blocked at the level of injury. This starts a
reflex action in the “fight or flight” center of the nervous system causing the blood pressure to
increase until the irritant is removed. A.D. can be life-threatening.
Causes and Symptoms
Causes Bladder: full bladder (most common cause), bladder infections and kidney stones
Bowel: stool in the rectum (second most common cause), hemorrhoids
Skin: pressure sores, burns, tight-fitting clothing, ingrown toenails, pinched skin
Other: sitting on a foreign object, pregnancy/labor, sexual activity, incorrect
positioning, fractures, or stomach ulcers
Symptoms Rapid rise in blood pressure
Slowed heart rate
Headache –sudden and may be “pounding”
Blotching or flushing of the skin
Unexplained sweating above the level of injury
Chills, goose bumps
Few or no symptoms (silent autonomic dysreflexia)
Blood Pressure Changes
Even a small increase in the blood pressure of 20 mmHg or more can signal A.D. A small
increase in blood pressure might be normal for some people, but could be dangerous for someone
with A. D. We suggest that you have your blood pressure taken every year so that you will know
what your normal or baseline blood pressure is.
Normal blood pressure 100 Blood pressure during A. D. 124
Ask your team of doctors and nurses if you should have a blood pressure cuff at home. They can
teach you how to use one so you can check your blood pressure at home.
Do not ignore the symptoms of A. D.! If you are experiencing signs of A.D., the most
important thing to do is locate and remove the cause. Think about all causes and follow the steps
Step 1. Sit upright at a 90-degree angle and lower the legs if elevated. Blood pressure will drop
due to the effects of gravity.
Step 2. Loosen all tight clothing, like elastic stockings and abdominal binders.
Step 3. Empty your bladder. Use lidocaine jelly to help numb the body’s reaction to the catheter.
ξ If on an intermittent cath program, catheterize now. If the volume is more than
500ml, clamp off tube and wait 10 minutes. Then continue
ξ If using a Foley cath, check for kinks in the tubing. If no kinks are found, change the
Foley since there might be a blockage.
ξ Check for a full urine drainage bag and empty if needed.
Step 4. Check your bowel for stool. Insert lidocaine jelly into the rectum before checking the
rectum for stool. Remove stool, if present. Do not use digital stimulation.
Step 5. Check your skin and your positioning. Look for skin being pinched, clothing too tight
and pressure areas or broken bones.
Step 6. If you are prone to A.D., your doctor may give you a medicine to control the symptoms
until the source of A.D. is known. Make sure you know how and when to take this
If the symptoms are not resolved by using the methods described, call your doctor right
away or go to the nearest emergency room. A.D. can be life-threatening and needs to be
taken care of quickly.
If you have any questions or concerns about this information, please call the rehab clinic nurses
at (608) 263-6540.
We suggest that you carry a card listing the signs, symptoms, and treatment for A. D. with you at
all times since you may not be able to direct your care during the crisis. Please cut out the card
below. It can be folded to fit in your wallet.
Autonomic Dysreflexia (A. D.) is a medical emergency. It occurs with a spinal cord injury of T6
or above, causing high blood pressure that may be life threatening.
Causes: full bladder (90% of cases), full bowel, pressure ulcer, bone fractures, infections,
intercourse, tight clothing or shoes, blood clots, pregnancy or labor, bladder/kidney stones, internal
injuries (ulcers, appendicitis).
Symptoms: severe headaches, high blood pressure, slowed heart rate, flushed face, goose bumps,
sweating above level of injury, stuffy nose.
Treatment: Sit up at 90º, check blood pressure, empty bladder using anesthetic lubricant on the
catheter, or check Foley/condom catheter for kinks or plugging.
If blood pressure remains high:
ξ check rectum for stool--use anesthetic lubricant.
ξ check for skin sores or injury to skin or other parts of the body.
ξ take medicine as directed (e.g. Nitro paste) to lower blood pressure and continue to look for
source of dysreflexia.
If the source can't be found and blood pressure remains high, call your doctor or go to the
nearest emergency room.
Acute management of autonomic dysreflexia: individuals with spinal cord injuries presenting to health-care
facilities. National Guideline Clearinghouse. http://www.guideline.gov Accessed 1/2006.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 11/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing HF#4590.