Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury.
METHODS
Randomized, controlled clinical trial.


OBJECTIVE
Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI.


METHODS
Aarhus University Hospital, Denmark.


METHODS
Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of ⩾30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures.


RESULTS
During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86-154) to 188 (range: 140-206) mm Hg (P<0.02), TAI from 126 (range: 91-146) to 163 (range: 130-188) mm Hg (P<0.02) and FC from 125 (range: 106-149) to 200 (range: 179-220) mm Hg (P<0.01). The sBP increase was lower during TAI than during DE (P<0.05) or FC (P<0.02). In high SCI subjects, the blood levels of norepinephrine, but not those of epinephrine, increased significantly during all three stimuli (all P<0.05).


CONCLUSIONS
Bowel and bladder management caused AD in high SCI. The response is less severe during TAI than during FC or DE.
1] Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark [2] Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
P M
PM
Faaborg
Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
P
P
Christensen
Division of Physical Medicine and Rehabilitation, ICORD, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
A
A
Krassioukov
Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
S
S
Laurberg
Department of Clinical Physiology and Nuclear Medicine, Glostrup University Hospital, Copenhagen, Denmark.
E
E
Frandsen
Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
K
K
Krogh
D000328:Adult; D000368:Aged; D020211:Autonomic Dysreflexia / Q000209:etiology / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D004733:Enema; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055496:Neurogenic Bowel / Q000503:physiopathology; D009638:Norepinephrine / Q000097:blood; D012007:Rectum / Q000503:physiopathology*; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D001743:Urinary Bladder / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology; D014546:Urinary Catheterization
D009638:Norepinephrine; D004837:Epinephrine