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Complications
By Mayo Clinic staffAt first, changes in the way your body functions may be overwhelming. However, you can learn new skills and ways to adapt old skills to deal with the physical effects of a spinal cord injury. Possible difficulties you may encounter include:
- Bladder control. Your bladder will continue to store urine from your kidneys. However, your brain may no longer be able to control bladder emptying, as the message carrier (the spinal cord) has been injured. The loss of bladder control increases your risk of urinary tract infections. It may also cause kidney infection and kidney or bladder stones. Drinking plenty of clear fluids may help. And during rehabilitation, you'll learn new techniques to empty your bladder.
- Bowel control. Although your stomach and intestines work much like they did before your injury, your brain may no longer be able to control the muscles that open and close your anus. This may cause fecal incontinence. A high-fiber diet may help regulate your bowels, and you'll learn techniques to better control your bowels during rehabilitation.
- Impaired skin sensation. Below the neurological level of your injury, you may have lost part or all skin sensations. Therefore, your skin can't send a message to your brain when it's injured by things such as prolonged pressure, heat or cold. This can make you more susceptible to pressure sores, but changing positions frequently — with help, if needed — can help prevent these sores. And, you'll learn proper skin care during rehabilitation, which can help you avoid these problems.
- Circulatory control. A spinal cord injury may cause circulatory problems ranging from spinal shock immediately following your spinal cord injury to low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities throughout your lifetime. These circulation changes may increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus. Another problem with circulatory control is a potentially life-threatening rise in blood pressure (autonomic hyperreflexia). Your rehabilitation team will teach you how to prevent autonomic hyperreflexia.
- Respiratory system. Your injury may make it more difficult to breathe and cough if your abdominal and chest muscles are affected. These include the diaphragm and the muscles in your chest wall and abdomen. Your neurological level of injury will determine what kind of breathing problems you may have. If you have cervical and thoracic spinal cord injury you may have an increased risk of pneumonia or other lung problems. Medications and therapy can treat these problems.
- Muscle tone. Some people with spinal cord injuries may experience one of two types of muscle tone problems: spastic muscles or flaccid muscles. Spasticity can cause uncontrolled tightening or motion in the muscles. Flaccid muscles are soft and limp, lacking muscle tone.
- Fitness and wellness. Weight loss and muscle atrophy are common soon after a spinal cord injury. However, limited mobility after spinal cord injury may lead to a more sedentary lifestyle, placing you at risk of obesity, cardiovascular disease and diabetes. A dietitian can assist you in attaining a nutritious diet to sustain an adequate weight. Physical and occupational therapists can help you develop a fitness and exercise program.
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Sexual health. Sexuality, fertility and sexual function may be affected by spinal cord injury. Men may notice changes in erection and ejaculation; women may notice changes in lubrication. A spinal cord injury may cause decreased or absent sensation and movement below the level of injury, but a person may notice a heightened sensitivity in areas above the level of injury. Doctors, urologists and fertility specialists who specialize in spinal cord injury can offer options for sexual functioning and fertility.
There's usually no physical change in women with a spinal cord injury that inhibits sexual intercourse or pregnancy. Most women with a spinal cord injury can experience labor, have a normal delivery and breast-feed.
- Pain. Some people may experience pain, such as muscle or joint pain from overuse of particular muscle groups. Nerve pain, also known as neuropathic or central pain, can occur after a spinal cord injury, especially in someone with an incomplete injury.
- Spinal cord injury: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/sci/detail_sci.htm. Accessed July 2, 2009.
- Spinal trauma. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec21/ch311/ch311a.html. Accessed June 17, 2009.
- Spinal cord injury FAQ. American Association of Neurological Surgeons. http://www.neurosurgerytoday.org/media/fact/spinal.asp. Accessed July 2, 2009.
- Hansebout RR. Acute traumatic spinal cord injury. http://www.uptodate.com/home/index.html. Accessed June 16, 2009.
- Mayer RS. Rehabilitation of individuals with cancer. In: Abeloff MD, et al. Abeloff's Clinical Oncology. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.mdconsult.com/das/book/body/147442859-5/0/1709/1.html?tocnode=55014515&fromURL=1.html#4-u1.0-B978-0-443-06694-8..X5001-5--TOP_1. Accessed July 2, 2009.
- Spinal cord injury (SCI): Prevention tips. Centers for Disease Control and Prevention. http://www.cdc.gov/ncipc/factsheets/sciprevention.htm. Accessed July 2, 2009.
- Chiodo AE, et al. Spinal cord injury medicine: Long-term medical issues and health maintenance. Archives of Physical Medicine Rehabilitation. 2007;88:S76.
- Wuermser LA, et al. Spinal cord injury medicine: Acute care management of traumatic and nontraumatic injury. Archives of Physical Medicine Rehabilitation. 2007;88:S55.
- Beck LA (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 21, 2009.
- Facts and figures at a glance. National Spinal Cord Injury Statistical Center. http://www.spinalcord.uab.edu/show.asp?durki=119513&site=4716&return=19775. Accessed Aug. 25, 2009.
