Orthostatic Hypotension
When sitting up makes you feel faint — and how to manage it.
What is it?
Orthostatic hypotension (OH) is a drop in your blood pressure when you go from lying flat to sitting up or standing. After a spinal cord injury, your body cannot tighten the blood vessels in your legs and belly fast enough, so blood pools below your injury. Less blood reaches your brain. You feel dizzy, lightheaded, or pass out.
OH is most common in the first weeks after injury, but it can stick around or come back when you are sick, dehydrated, or after a hot shower.
How you might feel
- Lightheaded or dizzy when sitting up or standing
- Fading or tunnel vision
- Hearing sounds far away
- Yawning
- A sense of "I am about to pass out"
- Nausea
- A drop of 20 mmHg or more in your top number (systolic) when you change position
What you can do
- Go slow. Raise the head of your bed in steps. Sit on the edge for a minute before transferring.
- Wear compression. Knee-high or thigh-high compression stockings (20–30 mmHg) plus an abdominal binder pressing on your belly.
- Drink fluids. Aim for the amount your team set — usually 2–3 liters a day unless you are on a fluid limit.
- Salt your food. Adding 2–4 grams of extra salt per day raises blood volume. Skip this if you have heart or kidney problems.
- Skip the long, hot shower. Heat opens blood vessels and makes OH worse. Use warm, not hot.
- Time your meals. Big meals pull blood to the gut. Eat smaller, more often.
- Caffeine in the morning can give a short boost.
💊 Medicines if lifestyle steps are not enough
- Midodrine 5–10 mg by mouth, 30 minutes before getting up. Wears off in 4 hours. Do not take within 4 hours of bedtime — you can spike your BP while lying down.
- Fludrocortisone 0.1 mg by mouth in the morning. Builds up over a week.
- Pyridostigmine 30–60 mg up to three times a day.
Ask before you take any new medicine, even over-the-counter cold medicine.
📞 Call your doctor if
- You pass out (lose consciousness).
- Episodes are getting more frequent.
- New chest pain or trouble breathing.
At your next clinic visit
Bring a 1–2 week home blood pressure log: lying, sitting, standing, with the time of any new medicine dose. Patterns guide treatment.
Education only. Not medical advice. If you have a clinical question, talk to your rehab team. For emergencies call 911.