Blood clots (deep vein thrombosis or DVT)

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.

The Reeve Foundation created a wallet card that provides an overview of DVT and your medical history to expedite care during a medical emergency.

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
  • Goosebumps
  • 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.

Treatment for AD: identify and remove the stimulus causing the discomfort

  • Check bladder or catheter for fullness or kinks in tubing
  • Check the bowel for impaction
  • Check 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.

Some medical professionals may be unaware of autonomic dysreflexia. Those at risk should carry information or a card like the Reeve Foundation AD wallet card, which explains the condition and provides medical information in case of an emergency. This is to ensure prompt and appropriate treatment of AD.

For more information on autonomic dysreflexia and additional resources from trusted Reeve Foundation sources, please download our fact sheet on AD and check out our repository of fact sheets on hundreds of topics ranging from aging with a spinal cord injury to secondary complications of paralysis.

Pneumonia

With cervical and mid-thoracic level injuries, pneumonia is a possible complication due to secretions building up in the lungs. Some individuals living with spinal cord injury cannot inhale or exhale forcefully, and struggle to 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 and pressure sores

Pressure sores (decubitus ulcers or pressure ulcers) 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. If the pressure is relieved, skin can improve. 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 like a scrape occurring during a transfer or a minor cut from not wearing shoes. However, no skin injury is to be ignored in the setting of paralysis.

There are four stages of pressure sores:

  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.
  2. The top layer of skin (the epidermis) is broken. The sore is shallow but open and drainage may be present. Stay off the affected area and cleanse the wound with water or saline solution. Dry the wound site and apply a transparent or hydrocolloid dressing.
  3. The skin has broken down further into the second layer of skin (the dermis) and subcutaneous fat tissue. Consult a doctor for treatment.
  4. The skin has broken down to bone and muscle and will need immediate medical attention and surgery as this condition may be life threatening.

For more information on skin care and additional resources from trusted Reeve Foundation sources, please download our fact sheet on pressure sores and check out our repository of fact sheets on hundreds of topics ranging from aging with a spinal cord injury to secondary complications of paralysis.

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

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.

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 but rather a “jumbled” transmission of sensory signals from below the 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.

Treatments include antidepressants and anti-epileptic drugs, non-steroidal anti-inflammatory agents, and narcotic painkillers.

Nerve blocks, acupuncture, biofeedback, as well as psychological approaches have also been used to help manage pain.

Other secondary conditions of paralysis, such as spasticity and autonomic dysreflexia, may be triggered by pain.

Learn more about pain

Bladder and urinary tract infections (UTIs)

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 (through the urethra), supra pubic catheter (catheter surgically placed through 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.

Learn more about bladder management

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.

Learn more about bowel management

Learn more about secondary conditions in the health section

This project was supported, in part by grant number 90PR3002, 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.