📋 In This Article
A spinal cord injury changes how circulation, breathing, skin, blood pressure, muscles, bladder and bowel all work. These “secondary conditions” are common — but most can be prevented or caught early once you know the warning signs. This guide gives you an overview of each one and points you to our in-depth AccessLife guides where they exist.
Blood clots are common in the first few months after injury, and can appear again later whenever you are ill. Walking and leg movement normally keep blood circulating; when the legs cannot move, clot risk rises. Too much bed rest raises it further.
Support Hose
Special stockings that keep steady pressure on the legs.
Sequential Compression Devices
Machines that use air-filled bags to apply pressure to the legs.
Blood Thinners
Used in some cases, as prescribed by your doctor.
Vein Filters
Some people have a filter placed to stop clots from reaching the lungs, heart and brain.
Warning signs of a clot in the leg
Swelling, redness, bluish or whitish skin discoloration, warmth to the touch, and pain. Check your legs every day — you may not feel a clot forming. The Reeve Foundation also offers a DVT wallet card summarising your medical history to speed up emergency care.
This is a medical emergency
Autonomic dysreflexia (AD) must be treated immediately. It usually occurs with injuries at T6 and above: the autonomic nervous system over-reacts, causing a sudden and dangerous rise in blood pressure. It is triggered by an irritating, painful or uncomfortable stimulus below the level of injury.
Severe headache
Goosebumps
Sweating above the level of injury
Nasal congestion
High blood pressure — significantly above your baseline
Slow pulse — under 60 beats per minute
Flushed face and clammy skin
Check the bladder or catheter for fullness or kinks in the tubing.
Check the bowel for impaction.
Check the skin for bruises, burns, ingrown toenails, pressure sores or a broken bone.
Check clothing for tightness, and watch for extreme heat or cold.
In women, menstrual cramps or ovarian cysts may also be the cause.
Prescription medicines can help lower blood pressure during an AD episode — work with your doctor to learn your signs and build a treatment plan. Some medical professionals are unfamiliar with AD, so anyone at risk should carry an information card, such as the Reeve Foundation AD wallet card, to ensure fast and correct treatment.
🚨 Read our full Autonomic Dysreflexia emergency guide →With cervical and mid-thoracic injuries, secretions can build up in the lungs. Many people with SCI cannot breathe in or out forcefully or cough effectively, which lets bacteria collect and infect the lungs. People injured during water sports may face added risk of pneumonia and lung damage from water entering the lungs at the time of the accident.
🤒 Symptoms
Shortness of breath, pale skin, fever and increased chest congestion.
✅ Prevention
Be consistent about clearing secretions. Treat lung infections aggressively and seek medical care early.
Pressure sores — also called decubitus ulcers or pressure ulcers — form when an area of the body stays under pressure for too long and blood flow drops. Relieve the pressure and the skin can recover; let it persist and a sore can develop. Bony areas are most at risk. Even a trivial scrape during a transfer, or a small cut from going barefoot, can become an ulcer — no skin injury should be ignored after paralysis.
Change position every two hours
Loose clothing — comfortable, never tight
Keep skin dry and free of moisture
Proper seating and positioning
| Stage | What you see | What to do |
| 1 | Skin is not broken but is red, and the color does not fade 30 minutes after pressure is removed. | Stay off the area and keep up good hygiene. |
| 2 | The top layer of skin (epidermis) is broken; a shallow, open sore that may drain. | Stay off the area. Cleanse with water or saline, dry it, and apply a transparent or hydrocolloid dressing. |
| 3 | Breakdown reaches the second skin layer (dermis) and the fat tissue beneath. | Consult a doctor for treatment. |
| 4 | Breakdown reaches muscle and bone. | Needs immediate medical attention and surgery — this can be life-threatening. |
After injury, blood pressure can drop suddenly when you move from lying flat to sitting upright. It happens most often in people with quadriplegia. Symptoms include lightheadedness, dizziness and faintness.
Compression
Wrap the legs with support bandages or elastic stockings, or wear an elastic belt around the abdomen.
Move up slowly
Rise to an upright position gradually rather than all at once.
Medication
Your doctor may prescribe medicine to keep blood pressure stable.
Neurological injury can affect the muscles, producing spasticity (increased tone). It is seen most often after spinal cord injury, stroke, brain injury, cerebral palsy and multiple sclerosis.
A change in spasticity is a signal
A sudden increase in tone, or a new spasm pattern, can point to a developing complication such as a urinary tract infection or a pressure injury. After SCI, increased spasticity can also be one of the first signs of a syrinx — a fluid-filled cyst enlarging at the injury site.
Most pain is part of the body’s recovery and can be treated with medication. But pain can persist and become chronic or neuropathic (nerve) pain. Neuropathic pain is not caused by a direct painful stimulus — it comes from “jumbled” sensory signals travelling from below the injury through the damaged cord. It may feel like burning, stinging or tingling, and can come and go or be constant.
Medications
Antidepressants and anti-epileptic drugs
Non-steroidal anti-inflammatory agents
Narcotic painkillers
Other approaches
Nerve blocks
Acupuncture and biofeedback
Psychological approaches
Pain can itself trigger other secondary conditions, including spasticity and autonomic dysreflexia.
Paralysis can disrupt the bladder’s normal control. The two most common patterns are:
Spastic Bladder
High tone · injuries above T12
As the bladder fills, a reflex automatically triggers it to empty.
Flaccid Bladder
Low tone
Bladder reflexes are sluggish or absent.
Common management methods are intermittent catheterisation, an indwelling (urethral) catheter, a suprapubic catheter placed surgically through the abdomen, and/or an external condom catheter.
Urinary tract infections (UTIs)
UTIs develop when the bladder is not fully emptied or when bacteria from a catheter enter the bladder. Signs include fever, chills, nausea, headache, spasms and autonomic dysreflexia. Reduce the risk with a consistent bladder routine, the right amount of fluids and sterile equipment. Treatment is usually oral antibiotics; a severe infection with fever can reach the kidneys and may need injectable antibiotics.
SCI affects the bowel much as it affects the bladder:
Spastic Bowel
Injuries above T12
The ability to sense a full rectum may be lost.
Flaccid Bowel
Injuries below T12
Damage to the defecation reflex relaxes the anal sphincter and prevents a bowel movement.
Follow a schedule
A regular bowel program is the best prevention — bowel problems can trigger autonomic dysreflexia. Programs typically take 30–60 minutes and should be done at least every other day. Options include digital stimulation, suppositories, laxatives and enemas; surgery can help when less aggressive methods fail.
Reeve Foundation Information Specialists
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Hundreds of topics, from aging with SCI to secondary complications — including the AD and DVT wallet cardsOriginal Source Article
What are the secondary conditions? — Christopher & Dana Reeve FoundationAccessLife SCI Categories Hub
All AccessLife SCI health guides in one placeAutonomic dysreflexia is an emergency for injuries at T6 and above — find and remove the trigger immediately, and carry an AD wallet card.
Check your legs daily for signs of a blood clot and your skin daily for redness or wounds — you may not feel either developing.
Change position every two hours to prevent pressure sores; a stage 4 sore can be life-threatening.
A sudden change in spasticity can be an early warning of a UTI, pressure injury or syrinx.
Consistent bladder and bowel routines prevent infections, impaction and AD episodes.
Adapted from “What are the secondary conditions?” by the Christopher & Dana Reeve Foundation. This guide is for education only and does not replace advice from your medical team · © 2026 AccessLife
