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Spinal Cord Injury Paralysis Resource Center

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What are the secondary issues related to SCI that might impact my health?

(Note: Learn more about secondary conditions.)

Blood clots (deep vein thrombosis or DVT)

- Request a FREE Deep Vein Thrombosis (DVT) wallet card

Blood clots can be common in the first few months after a spinal cord injury and later whenever illnesses occur. Walking and leg movement promote blood circulation and prevent blood clots from forming. However, when legs lack the ability to have movement or walk, the risk of blood clots increases. Excessive bed rest may also raise your risk.

One way to prevent clots is the use a special type of support hose that maintain pressure on the leg. Sequential compression devices are used as well. These machines use bags of air to put pressure on the legs. Blood thinners may be used in some cases. Some individuals may have filters placed in their femoral artery. These filters stop the blood clots from reaching the lungs, heart and brain. Warning signs of blood clots in legs are swelling, redness, bluish or whitish discoloration of skin, warmth to the touch, and pain. Be proactive and examine your extremities daily for signs of a possible clot.

Autonomic Dysreflexia
Autonomic dysreflexia (AD) is a medical emergency that must be treated immediately. It usually occurs with injuries at T6 level and above as an over-activity of the autonomic nervous system causing an abrupt and dangerous rise in blood pressure. It is triggered from an irritating, painful, or uncomfortable stimuli below the level of injury. Symptoms may include severe headache, goose bumps, sweating above level of injury, nasal congestion, hypertension (blood pressure significantly above the patient's baseline pressure), slow pulse (less than 60 beats per minute), flushed face, and clammy skin. It is important that individuals with spinal cord injury learn to recognize their symptoms so they can start treatment.

Since some medical professionals may be unaware of autonomic dysreflexia, those at risk for AD should carry information or a card about this condition in case of a medical emergency. This is to ensure prompt and appropriate treatment of AD.

Treatment - Identify and remove the stimulus causing the discomfort. Check bladder or catheter for fullness or kinks in tubing; check the bowel for impaction, the skin for abnormalities such as bruising/burns/ingrown toenails/pressure sores and broken bone. Check clothing for tightness and be aware of extreme hot and cold temperatures. In women, menstrual cramps or ovarian cysts may also be the cause. There are prescription medicines that can help in lowering blood pressure during an AD event. Work with your doctor to learn your signs and to develop a treatment plan.

Pneumonia
With cervical and mid-thoracic level injuries, pneumonia is a possible complication due to secretions building up in the lungs as a result of inability to inhale and exhale forcefully or cough effectively. This allows bacteria to build up and infect the lungs. Those injured during water sports may be at risk of pneumonia, lung damage, and other respiratory problems as a result of water entering their lungs at the time of the accident. The symptoms of pneumonia are shortness of breath, pale skin, fever, and increased chest congestion. It is important to be aggressive with pulmonary-based infections and seek medical treatment. The best way to prevent pneumonia is to be consistent with clearing secretions.

Skin Care/Pressure Sores (decubitus ulcers or pressure ulcers):
Pressure sores can have many different names but they all refer to a serious and potentially dangerous condition. Pressure sores develop when certain areas on the body are under prolonged pressure, which creates a decrease in blood flow to the area. If the pressure is relieved, skin can improve; but if the pressure persists it can potentially turn into a pressure sore.

The common areas for pressure sores to develop are any bony area of the body. Skin ulcers may be prevented by changing body position every two hours, wearing loose, comfortable clothing, keeping skin moisture free, and by using proper seating and positioning.

Sometimes, skin ulcers occur as a result of a trivial trauma (scrape occurring during a transfer, minor cut from not wearing shoes). No skin injury is to be ignored in the setting of paralysis.

There are four stages of pressure sores:

Stage 1: Skin is not broken but it is red and color does not fade 30 minutes after pressure is removed. Stay off the affected area and maintain proper hygiene.

Stage 2: The top layer of skin (the epidermis) is broken. The sore is shallow but open and drainage may be present. Follow Stage 1 procedures and cleanse the wound with water or saline solution and dry the wound site, then apply a transparent or hydrocolloid dressing.

Stage 3: The skin has broken down further into the second layer of skin (the dermis) and subcutaneous fat tissue. Consult a doctor for treatment.

Stage 4: The skin has broken down to bone and muscle and will need medical attention and surgery as this condition may be life threatening.

Low blood pressure (hypotension)
Blood pressure after injury may suddenly drop when changing from a flat position to an upright position. Some ways to prevent blood pressure from dropping are to wrap your legs with support bandages or elastic stockings or place an elastic belt around your abdomen. Moving to an upright position slowly can help, as well. Symptoms of low blood pressure can be lightheadedness, dizziness, and/or faintness. Low blood pressure most commonly occurs in people with quadriplegia. Medications may be prescribed to keep blood pressure stable.

Spasticity
Following a spinal cord injury, some patients may suffer from an increased amount of stiffness, muscle jerks and involuntary spasms in some muscle groups below injury level. This is called spasticity and it results from loss of inhibition of reflex muscle activity associated with central nervous system (brain and/or spinal cord) injury. If spasticity becomes a significant health issue for many people with a spinal cord injury, there are drugs used to alleviate spasticity. They include Baclofen, Botox, Valium, Zanaflex, and Dantrium. Physical therapy including muscle stretching, range of motion, electrical stimulation, and other activities can also help prevent spasms. (Download this booklet on spasticity.)

Pain
In most cases, pain is a part of the body's recovery process and can be treated with various medications. However, pain may persist and turn into chronic pain or nerve pain (also called neuropathic pain). This type of pain is not caused by a direct painful stimulus; it stems from “jumbled” transmission of sensory signals from below injury level through the injured cord. Neuropathic pain might be felt as a burning, stinging, tingling sensation. These sensations may be sporadic or they may be a chronic issue.

Commonly used drugs are antidepressants and anti-epileptic drugs, non-steroidal anti-inflammatory agents, Tylenol and narcotic painkillers. Other helpful interventions are nerve blocks, acupuncture, biofeedback, as well as psychological approaches. The goal of pain management is to decrease pain while allowing people to continue functioning with their lives. Other secondary conditions of paralysis, such as spasticity and autonomic dysreflexia, may be triggered by pain.

Bladder/Urinary Tract Infections:
After paralysis, the bladder's normal system of control may be affected. Two of the most common ways the bladder is affected post injury are either spastic bladder (high tone) or flaccid bladder (low tone). Spastic bladder occurs when the bladder fills and a reflex automatically triggers the bladder to empty. This is common in injuries above T12. Flaccid bladder occurs when the reflexes of the bladder are either sluggish or absent.

The most common methods of bladder management are intermittent catheterization, indwelling catheter (thru urethra), supra pubic catheter (catheter surgically placed thru the abdomen into the bladder) and/or an external condom catheter.

Urinary tract infections (UTIs) can occur when the bladder is not completely emptied, or when bacteria from the catheter get into the bladder. Some symptoms of UTIs are fever, chills, nausea, headache, spasms, and autonomic dysreflexia. The best way to minimize UTIs is maintaining a proper bladder management routine, drinking the proper amount of liquids, and using sterile equipment. Treatment for a UTI is usually oral antibiotics. In severe cases with a fever, the infection can affect the kidneys and may require injectable antibiotics.

Bowel Management:
The bowel is affected by the spinal cord injury in a similar way with the bladder. If the injury is above T12, there is resultant spastic bowel. The ability to sense a full rectum may also be lost. Flaccid bowel is common below T12 injuries and results in an inability to have a bowel movement. Flaccid bowel means that there is damage to the defecation reflex causing the anal sphincter to relax. The best way to prevent bowel issues is to follow a schedule since bowel issues can lead to other issues such as autonomic dysreflexia.

Bowel programs typically require 30-60 minutes and should be done at least every other day. There are many different options available for bowel management, including digital stimulation, suppositories, laxatives and enemas. Surgical procedures can be done to facilitate bowel evacuation if less aggressive methods are not successful.

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The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm Eastern U.S. Time. International callers use 973-467-8270. You may also schedule a call or send a message online.

This project was supported, in part by grant number 90PR3001, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.