Paraplegia involves paralysis that primarily affects the lower half of the body, including the legs and often parts of the trunk. This condition results from damage to the spinal cord, which disrupts nerve signals between the brain and the body below the injury site. While the immediate spinal cord injury is a singular event, it sets off a cascade of secondary health issues that significantly impact daily life and overall well-being. These ongoing challenges require careful management.
Skin and Tissue Health
Individuals with paraplegia are susceptible to pressure ulcers, commonly known as bedsores, due to impaired mobility and loss of sensation in affected areas. These ulcers develop when sustained pressure on the skin, particularly over bony prominences like the tailbone, hips, or heels, restricts blood flow to the tissue. Without adequate oxygen and nutrients, the cells begin to break down, leading to skin damage. Regular repositioning, at least every two hours in bed or every 15 minutes in a wheelchair, helps redistribute pressure and prevents tissue compression.
Maintaining proper skin hygiene, ensuring the skin remains clean and dry, and using specialized support surfaces like pressure-relieving cushions and mattresses are important preventive measures. Skin checks should occur daily to identify any early signs of redness, swelling, or warmth, as prompt attention can prevent progression. Once a pressure ulcer forms, healing can be a lengthy process, often requiring complete pressure relief from the affected area, specialized wound care, and attention to nutrition. Unhealed ulcers can lead to serious complications, including widespread infection.
Urinary and Bowel System Challenges
Spinal cord injury often disrupts the nerve signals controlling bladder and bowel function, leading to conditions known as neurogenic bladder and neurogenic bowel. With neurogenic bladder, nerve damage can result in either an inability to fully empty the bladder (urinary retention) or an uncontrolled urge to urinate and incontinence. This disruption may cause urine to back up into the kidneys, potentially leading to hydronephrosis or kidney damage over time. Recurrent urinary tract infections (UTIs) are a common complication, stemming from incomplete bladder emptying and the need for catheterization. If left untreated, UTIs can escalate to more severe infections.
Kidney stones may also develop more frequently in individuals with neurogenic bladder due to changes in urine chemistry and prolonged immobility. To manage these issues, intermittent catheterization, where a catheter is used at regular intervals to empty the bladder, is a common strategy to prevent retention and reduce infection risk. Some individuals may use indwelling catheters, which remain in place continuously.
Similarly, neurogenic bowel affects the coordination of intestinal muscles and sphincter control, often resulting in severe constipation, fecal impaction, or involuntary bowel movements. The slowed movement of stool through the colon and impaired sensation can make bowel management challenging. Establishing a regular bowel program, which may involve dietary adjustments, adequate fluid intake, oral medications, and specific evacuation techniques like digital stimulation or suppositories, helps promote predictable bowel movements. Effective bowel management helps prevent complications such as abdominal discomfort, hemorrhoids, and autonomic dysreflexia.
Musculoskeletal and Neurological Issues
Spasticity, characterized by involuntary muscle contractions and stiffness, is a common neurological complication following spinal cord injury. This condition arises because the spinal cord’s reflexes below the injury level are no longer modulated by signals from the brain, leading to exaggerated and uncontrolled muscle responses. Spasticity can range from mild muscle tightness to severe, painful spasms that interfere with movement, sleep, and daily activities. While some degree of spasticity can be beneficial for maintaining muscle tone or assisting with transfers, excessive spasticity can lead to joint deformities and further limit mobility.
Chronic pain affects a majority of individuals with paraplegia. This pain can manifest as neuropathic pain, which stems from damaged nerve fibers and is often described as burning, tingling, or stabbing sensations below the injury level. It can occur even in areas with lost sensation, as the brain misinterprets abnormal nerve signals. Musculoskeletal pain is also common, frequently arising from overuse injuries in the upper limbs due to increased reliance on arms for mobility, transfers, and self-care. This type of pain often worsens with activity and improves with rest.
Bone health is also affected. Osteoporosis, or bone density loss, is a concern in the limbs below the injury level due to lack of weight-bearing and muscle activity. This can increase the risk of fractures, even from minor trauma. Another complication is heterotopic ossification, where abnormal bone growth occurs in soft tissues, often around large joints like the hips or knees. This ectopic bone can cause pain, swelling, and restrict joint range of motion, potentially leading to ankylosis, a complete fusion of the joint.
Cardiovascular and Autonomic Concerns
Spinal cord injury can impact the autonomic nervous system, which controls involuntary bodily functions, leading to several cardiovascular issues. Autonomic dysreflexia (AD) is a sudden and dangerous surge in blood pressure that can occur in individuals with injuries at or above the T6 spinal level. This exaggerated reflex response is triggered by a noxious stimulus below the injury level, such as a full bladder, impacted bowel, or skin irritation. Symptoms often include a pounding headache, profuse sweating, flushing of the skin above the injury level, and a slow heart rate.
If not addressed by removing the stimulus, autonomic dysreflexia can lead to severe hypertension, increasing the risk of stroke, seizures, or other life-threatening events. Orthostatic hypotension is a sudden drop in blood pressure that occurs when moving from a lying to a sitting or standing position. This happens because the spinal cord injury impairs the body’s ability to constrict blood vessels in the lower body, causing blood to pool in the legs and abdomen. Symptoms can include lightheadedness, dizziness, blurred vision, and even fainting.
Deep vein thrombosis (DVT), the formation of blood clots in deep veins, most commonly in the legs, is a risk. Immobility following spinal cord injury leads to reduced blood flow (venous stasis) in the lower limbs, which promotes clot formation. These clots can be dangerous if they detach and travel to the lungs, causing a pulmonary embolism, which can be life-threatening. Preventive measures often include compression stockings and medications to thin the blood, especially in the acute phase after injury.
Mental and Sexual Health Impacts
Beyond the physical challenges, paraplegia can impact mental well-being. Individuals may experience depression, anxiety, and adjustment disorders as they navigate significant life changes and losses. Feelings of sadness, hopelessness, and a loss of enjoyment in previously pleasurable activities are common. These emotional responses are a natural part of adapting to a new reality, but persistent or severe symptoms warrant professional mental health support, including therapy and sometimes medication.
Sexual health is also affected, leading to changes in sexual function and intimacy. Spinal cord injury can alter sensation, interfere with erection and ejaculation in men, and impact lubrication and orgasm in women. The specific changes depend on the level and completeness of the injury, as nerve pathways responsible for sexual responses may be disrupted. Many individuals find ways to adapt and achieve satisfying sexual lives by exploring new erogenous zones, utilizing assistive devices, or employing various positions and stimulation techniques. Open communication with partners and healthcare providers helps address concerns and find adaptive strategies that promote intimacy and sexual satisfaction.