Autonomic Dysreflexia
A sudden spike in your blood pressure that needs fast action.
What is it?
Autonomic dysreflexia (AD) is a sudden, very high rise in your blood pressure. It happens to many people with a spinal cord injury at or above the T6 level. Something below your injury — most often a full bladder or bowel — sends a strong signal to your nervous system. Your body cannot manage the signal the normal way, so your blood pressure jumps fast.
AD is an emergency. If you do not fix it quickly, it can cause a stroke, seizure, or worse.
How you might feel
- Pounding headache that comes on fast
- Sweating, flushing, or goosebumps above your injury
- Cold, pale skin below your injury
- Stuffy nose
- Blurry vision or seeing spots
- Slow heart rate
- A feeling of dread or anxiety
Some people do not feel any of this. The only sign may be a high blood pressure reading. In SCI, normal blood pressure is often around 90/60 or 100/70. A reading of 150/90 or higher is a red flag.
What to do — the AD steps
- Sit up. Get upright. This drops your blood pressure on its own.
- Loosen tight clothes, shoes, leg bag, abdominal binder.
- Check your bladder. Catheterize right away. If you have an indwelling catheter, look for kinks or blockage. If it drains poorly, replace it.
- Check your blood pressure every 5 minutes.
- If your bladder is empty and the pressure is still high, check your bowel. Use plenty of 2% lidocaine jelly on a gloved finger to numb the rectum, then gently disimpact.
- Look for other triggers. Pressure injury, ingrown toenail, tight clothing, fracture, or infection.
🚨 Call 911 if
- Your blood pressure stays at or above 150/90 after the steps above.
- Your headache is severe.
- You feel chest pain or trouble breathing.
- You feel weak, confused, or like you might pass out.
💊 Rescue medicines (only if your doctor has prescribed them)
- Nitroglycerin paste (Nitro-Bid 2%) — 1 inch on the skin above the injury. Wipe off as soon as your blood pressure drops.
- Nifedipine immediate-release 10 mg — bite and swallow.
At your next clinic visit
Bring a written log of any AD episode — date, blood pressure readings, what triggered it, and what fixed it. This helps your team find patterns and prevent the next one.
Education only. Not medical advice. If you have a clinical question, talk to your rehab team. For emergencies call 911.