What can I expect after spinal cord injury?

Psychological and Medical complications

This section is an overview of the kinds of medical complications that come with a spinal cord injury. Most people don't experience all of these complications, but it can be useful to know what's out there. You should consult with your own health care providers about what kinds of complications you might expect, and how you can manage them most effectively.

Grieving

The first complication you'll encounter is profound grief for the life you've lost, the life in which everyday activities like getting dressed or going to the bathroom or driving to work were just that: everyday activities. Now everything you do takes more work, and many things you used to do for yourself require someone else's help. Anger and sadness are expectable reactions, and for most people the acute sense of loss persists for months. It's especially important to find other people with SCI, who've been where you are now. A support group is one of the most useful connections you can make. The people in support group understand what you're going through as no one else can.

Depression

If your grief and sadness are affecting your personal care, causing you to isolate yourself from others, or causing you to abuse alcohol or other drugs, you may be dealing with some significant depression. It's time to seek help. People with spinal cord injury are at increased risk of suicide, especially in the first 10 years following the injury.

Physical complications of a spinal cord injury may include:

Pressure sores.

Sitting or lying in the same position for a long period of time can cause pressure sores, which are also called decubitus ulcers or bedsores. People with a spinal cord injury are particularly susceptible to pressure sores because the injury reduces or eliminates sensations, making it difficult to know when a sore is developing. Changing positions frequently — with help, if needed — is the best way to prevent these sores. It's important to learn about pressure sores, and to work out a regular routine for changing positions. Whatever the effort, it's a situation where an ounce of prevention is worth a ton of cure.

Deep vein thrombosis and the risk of pulmonary embolism.

When you sit without moving for long periods of time blood flow through your veins decreases and blood clots are more likely to form. Blood clots can develop in a vein deep within a muscle (deep vein thrombosis), and they can lead to a blocked pulmonary artery in your lungs (pulmonary embolism). A large embolism that blocks blood flow in the lungs can be fatal, so people with spinal cord injury may need devices or medications to try to prevent clotting.

Weight control

After a spinal cord injury, weight loss and muscle atrophy are common. But the reduction inactivity may lead to weight gain. Increased weight which can make harder for you to lift yourself or be lifted. Weigh gain also increases the risk of heart disease and other physical problems. It's a good idea to get proactive, and work with a rehabilitation therapist to develop an exercise and diet plan.

Urinary tract problems.

Many spinal cord injuries affect the nerves that control the bladder. Urinary incontinence, the inability to control the release of urine from your bladder, can be a result of SCI. Lack of bladder control increases your risk of urinary tract infections, kidney infections and kidney or bladder stones. Drinking plenty of water and other clear fluids helps keep your kidneys and bladder working well. Many people with SCI also use a catheter, a thin, soft tube that you insert into your urethra and bladder to drain your urine, several times a day.

Lung and breathing problems

People whose injury is to the cervical or thoracic spinal cord face weakening of abdominal and chest muscles. They may find it more difficult to breathe and cough, and face a greater risk of lung problems such as pneumonia. There are medications and respiratory therapy which can help with these problems. Flu shots and other immunizations are particularly important after a spinal cord injury.

Bowel control

Voluntary control of your bowels may be another casualty of SCI. You may experience constipation fecal incontinence, the inability to control your bowel movements. A high-fiber diet can help with bowel regulation, and it's a good idea to consult with a dietitian about changes in your diet. Your rehabilitation specialist can also recommend medications and other products that will help.

Spasticity

After a spinal cord injury, some people experience muscle spasms, jumping or twitching in their arms and legs. These result from increased sensitivity that develops in the nerves in the lower spinal cord after the injury; the nerves trigger muscle contractions. Because of the cord injury, the brain's signals cannot reach the lower nerves to control the contractions. If the spasms persist, medical interventions may help.

Pain

After a spinal cord injury some people feel pain in areas of the body where they have little or no feeling. Pain can also happen from overusing muscles in one part of the body, like shoulder tendonitis from manually operating a wheelchair for a long period of time. Any kind of pain can make daily living less pleasant. It's important to let your doctor and other members of your treatment team know about pain, so they can help relieve it with medication and help you figure out how to modify your activities to reduce the causes of pain.

Autonomic dysreflexia, AD

This condition most often occurs in SCI above T6. This condition is triggered by an irritation or pain, sometimes as simple as a full bladder or clothing that's too tight, sends a signal that fails to reach your brain. The body responds by constricting blood vessels, driving up blood pressure to dangerous levels. Heart rate can also drop, increasing the risk of stroke or seizure. Changing positions or eliminating the cause of the irritation is often helpful.

Sexual function after SCI.

After a spinal cord injury many men can still have erections, even if they have little feeling in the genital area. The erections may not be firm enough or last long enough for sexual activity. Ninety percent of men with a spinal cord injury aren't able to ejaculate during intercourse. Men with a SCI can still be sexually active, and even father a child. Men may want to consult a urologist with expertise in spinal cord injury to learn what they can do for better sexual functioning and fertility.

Women may lose the ability to produce vaginal lubrication or experience orgasm, and many feel very differently about their sexuality after spinal cord injury, all of which can affect their feelings about sexual activity. Women also may benefit from seeing a doctor about the changes they're experiencing. Women can still become pregnant, but a pregnancy will likely be considered high risk. It's important to consult with a doctor before becoming pregnant.

New injuries

A spinal cord injury puts you at greater risk of injury to the parts of your body in which sensation is lost or impaired. You may receive a burn or cut and not be aware of it. It's important to be careful to prevent new injuries, and also to inspect your body for cuts, sores or infections, and to seek prompt medical attention.