Autonomic dysregulation

What is autonomic dysregulation?

Autonomic dysregulation is a regulation problem that leads to an overstimulation of the autonomic nervous system. In the case of a spinal cord injury (SCI), this may occur above the seventh thoracic vertebra. Autonomic dysregulation can be triggered through various stimuli, mostly through stimuli in the bladder or bowel area. These stimuli cause an uncontrolled spasmodic contraction of the vessels below the lesion level. As a consequence, the blood pressure increases rapidly and the symptoms described below may arise. The brain notices that the blood pressure is much too high and tries to lower the blood pressure by reducing the heart rate.

What may be the causes?

The most frequent causes are:

• Bladder congestion, bladder overstretching, spastic bladder
• Full bowel (severe constipation)
• External stimuli (pressure, bed sores, burns)

Other possible causes:

• Infections (bladder, skin, in-grown or inflamed toenails, etc.)
• Urological / gynaecological examinations
• Pregnancy / childbirth
• Intensive sports activities with a full bladder

How to react?

The most important measure is to eliminate the cause:

• Empty the bladder immediately using a disposable catheter.
• If using a permanent or suprapubic catheter, check whether it is bent or the urine bag is too full.
• If this is not the case and symptoms persist, try flushing the catheter; if this is not possible, the catheter needs to be exchanged immediately.

If the bladder is empty:

• Check whether the bowel is full and, if necessary, empty bowel.
• Change sitting or lying position to check whether there is an object hidden beneath the buttocks / body.