Sweating after Neurological Injury

Posted by Nurse Linda in Life After Paralysis on July 01, 2022 # Health

Sweating is one of the body’s ways of protecting itself. It is fluid that is excreted through the sweat glands of the skin. The purpose of sweat is to regulate internal body temperature. If the body becomes too hot from environmental temperature or internal elevated temperature (fever), more sweat is produced as an external coolant for the skin. If you are chilled, the body produces less sweat. Sweat glands are everywhere on the skin of the body. Most people know there are a large number of sweat glands in the armpits. They are also prominent in the groin, on the palms of the hands, and soles of the feet. When sweat is excessive, the term hyperhidrosis is used.

Everyone sweats. However, the ability to sweat or too much sweat can be altered after neurological injury. After a neurological injury, the autonomic nervous system (ANS) can be affected. The ANS is the part of the nervous system that controls body functions without consciously thinking about it. When the ANS is affected, control of some automatic functions can be disrupted such as sweating. This can occur from messages unable to pass through the area of injury in the spinal cord or in the case of brain injury or stroke, from not being able to form or receive the message. However, this process is not all or nothing. Often some messages are communicated to the body but in varying amounts.

After brain injury or stroke, individuals may sweat normally, sweat just on one side of the body, or in parts of the body. After spinal cord injury, individuals typically sweat above the level of injury. There are some who sweat below the level of injury, but this occurs less often. However, sweating after a neurological injury can be usual, excessive, or absent. This is because control of sweating is not being processed by the hypothalamus of the brain, effects of the ANS, interruption of messages through the spinal cord, or a combination of these and other issues.

Issues of sweating from brain injury, spinal cord injury, or a dual diagnosis of brain injury and spinal cord injury, can be due to a disruption in the ANS. Autonomic dysreflexia (AD) is a complication of ANS dysfunction. AD has many symptoms, the classic being a severe, pounding headache, but there are other symptoms as well such as sweating. People often dismiss AD if they do not have a headache, but it occurs with many other symptoms as well.

Sweating is a common AD symptom. If you have excessive sweating, be sure to check your blood pressure to see if you are having an AD episode. Treatment is imperative to avoid long-term cardiac and brain dysfunction. To avoid an AD episode, be mindful of your bladder and bowel programs as well as prevention of any other annoying stimulation away from affected areas of your body. Request a free wallet card with vital information about autonomic dysreflexia (AD).

If you are sweating because of AD, you must treat the cause of AD. Treating sweating without treating the AD source will lead to other health issues.

Thermometer reads over 90 degrees on a hot day with sun in background. IStockPhoto image by rommmaNot being able to sweat can overheat your body. If the body cannot cool itself through sweating, you need to provide external actions to keep your body cool. The inability to sweat can lead to heat-related illnesses such as heatstroke. In heatstroke, your body temperature can rise to 106° in 10 to 15 minutes. Symptoms include confusion, slurred speech, slow thinking, loss of consciousness, and/or seizures. This is a 911 emergency. You can also develop heat exhaustion, rhabdomyolysis (muscle breakdown), dizziness, cramps, and rashes.

Some individuals find that they sweat excessively in body areas unaffected by neurological injury. The sympathetic nervous system, which is the overarching section of the ANS, does not follow a segmental distribution as do nerves and muscles of the body. It more ambles about the body. Therefore, you can have sweating ability and amounts differently throughout the body, especially after neurological injury or disease. When the ANS perceives that your body needs to sweat, it sends out an all-or-nothing message to do so. If the body needs to be cooled or if the ANS thinks the body needs to be cooled when perhaps it does not (mixed message) a full sweat message is sent even if the message cannot be received in the affected areas. This is why some people sweat excessively in the areas of the body not affected by neurological injury or disease.

Because the ANS sort of ambles throughout the body, some people will sweat excessively in the affected areas of the body. It all comes down to where the ANS is receiving messages. The ‘full sweat ahead’ message may be sent to just parts of the body. With ANS injury, there may be no messaging for sweat a little here and more there. The message to sweat is an all or nothing: SWEAT.

Hyperhidrosis or too much sweating can be an issue for anyone with or without neurological injury. This is sweating that drenches any or all parts of your body. Bacteria love to thrive in moist, warm, dark areas of the body. This includes underarms, groin, and skin folds. Sweat contains enzymes that can affect the skin. Keeping the skin clean and dry is important to avoiding rashes and even pressure injuries. Quality of life can be affected by excessive sweating in appearance as well as hygiene, changing clothes and linen, as well as laundry.

The following actions can help keep your body temperature regulated as well as avoid sweating too much.

Too much fluid released through excessive sweating can lead to dehydration. Maintaining hydration is important from within the body by drinking water. This can be a challenge if you are on a bladder management program where you are limited in your fluid intake. Speak with your healthcare professional about how to manage fluids during periods of hyperhidrosis as well as how to control it. Water is the best for hydration. Drinking fluids containing alcohol, caffeine, and sugar can dehydrate your body further plus since your body is dehydrated, these can trigger the ANS to try to fix the dehydration by sweating more. Moisturizing the surface of your skin can be helpful however keep clear of those moist, warm, dark areas where moisture can assist with bacteria growth.

Maintain your body temperature. Fever should be treated with medication to lower internal temperature. Dress for the weather. If it is very warm, wear layers of clothes that can be adjusted as temperature elevates or if you go from extremely hot to a cool, air-conditioned setting. Use cooling towels if outside in hot weather. Drink cool water. Use an umbrella, wide-brimmed hat, and fan. If you are going to be in warm areas, find a cool place where you can take a break to cool your body.

Spicy food can trigger your body to sweat. Avoid extremely spicy foods so your body does not trigger a sweating episode.

If you have ruled out AD as the source of your sweating, there are some medical treatments that will help your sweating.

Iontophoresis is a low voltage current that is provided when your hands or feet are in water. This shocks the sweat glands into slowing the production of sweat. It works especially if you are sweating in your palms or soles.

Botox injections can be used to slow the production of sweat. These are done in the areas where you are sweating excessively. Botox injections most likely will need to be repeated but may reduce excessive sweating over time making the injections no longer needed.

Some creams and lotions can be applied such as antiperspirants that block sweat glands. These need to be used with caution as blocking all your sweat can overheat the body as mentioned above.

Anticholinergic medications reduce sweat production throughout the entire body. As you can become overheated from lack of sweat you will need to be cautious of the environment to avoid overheating. If you take anticholinergic medication for other issues, you may find you sweat less or have fewer issues with hyperhidrosis in general.

A surgical procedure performed only in the rarest situation is a sympathectomy where nerves are severed to block sweat production. This also can affect other body functions, so it is very rarely done.

Maintaining your body temperature is a challenge after a neurological injury. Both not being able to sweat or sweating too much have healthcare and quality of life issues. The important thing to remember is you can control your environment to maintain your body temperature with a little pre-planning.

Pediatric Consideration:

Children are often unable to tell you their body temperatures are uncomfortable. As an adult, you will need to assess the environment to ensure your child is safe, especially if your child is unable to sweat. Excessive sweating can affect anyone at any age with neurological injury or disease. Teens are especially body conscious. Excessive sweating can affect their interactions.

Planning ahead to maintain temperature regulation as well as knowing the symptoms of AD, heatstroke and other heat-related injury is imperative.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

Find out more about Nurse Linda here.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.