Medications

When you have a spinal cord injury it can cause changes in the way your bladder works. Paralysis at any level will almost always affect bladder function. Taking care of the bladder is very important to anyone who has a spinal cord injury.

It may be necessary to prescribe medication which stimulates bladder activity. This may include:

• Distigmine
• Tamsulosin

On the other hand, you may have a hyperactive bladder where the reflex is very sensitive. Depending on your choice of bladder management we may want to calm this reflex down. These medications are known as anti-cholinergics.

• Oxybutnin
• Mirabegron
• Tolterodine
• Solifenacin
• Botox injections

Anticholinergic medications can cause a dry mouth and in some instances constipation.

For more information, see the page on Bladder management.

After a spinal cord injury, the messages sent by the nerves located in your bowel are not able to reach your brain as before. This means you will not get the message that tells you when your bowel is full. You may also lose control of the muscle at the opening from your back passage (sphincter). Your degree of loss will depend upon your level of injury and the extent of your spinal damage.

If your spinal cord injury is above T12, your bowel will continue to empty when stimulated. In order for this to happen we use a type of medication called a suppository or an enema, which is inserted rectally.

Types of stimulant include:

• Bisacodyl Suppository
• Glycerin Suppository
• Micralax enema

Where possible, we teach patients to carry out their own bowel routine to promote independence at home.

In addition to this, you may need to take tablets orally to promote what is called peristalsis (the involuntary contraction and relaxation of longitudinal and circular muscles throughout the digestive tract to move food through it).

Types of bowel medications we use are:

• Senna (natural laxative, stimulates peristalsis)
• Lactulose (a syrup used to soften the stool)
• Fybogel (a high fibre drink that makes stool softer and bulkier therefore easier to pass)
• Bisacodyl tablets (stimulant laxative)

Bowel routines are usually carried out in the morning. Bowel medicines are taken the day before to allow them to be absorbed into your digestive system and work efficiently. It is important to remember that it can take a while for a bowel routine to become established. Once discharged, it is up to you and your healthcare provider to recognise when to adjust your bowel medications. You will learn how to do this during your rehab journey.

For more information, see the page on Bowel management.

After a spinal cord injury, you may experience pain as a result of abnormal communication between the nerves in the spinal cord and the brain. This is treated using analgesia (also known as pain killers).

Common neuropathic agents in spinal cord injury are:

• Gabapentin
• Pregabalin
• Amitriptyline
• Lamotrigine
• Lidocaine Patches

Other types of pain include musculoskeletal, simple paracetamol and ibuprofen can be very effective for this type of pain.

You may also be prescribed stronger analgesia for example:

• Morphine
• Tramadol
• Codeine

However these come with side effects including reduced respiratory function and increased risk of constipation. Increased risk of constipation will result in increased spasm and increased neuropathic pain.

Chronic pain following spinal cord injury most commonly tends to be neuropathic for which opiates are not recommended.

It also may be necessary to use anti-inflammatory drugs such as:

• Ibuprofen
• Diclofenac
• Naproxen
• Movelat Gel

For more information, see the page on Pain.

You may experience spasms as a result of your spinal cord injury, as the normal flow of signals from the nerves to the brain has been disrupted. 

Anti-spasm medications include:

• Baclofen
• Tizanidine
• Dantrolene
• Diazepam
• Botox

For more information, see the page on Spasms.

After a spinal cord injury, your blood pressure may be lower than it was before the injury. Due to this, patients can sometimes be prone to dizzy spells as their blood pressure is too low. This is particularly noticeable when first mobilising. 

You should be aware of your normal blood pressure, as a rise in your blood pressure may take you into the "normal" range for people who don’t have a spinal cord injury and therefore could be missed in a medical assessment.  

Medications used to maintain blood pressure include:

• Ephedrine
• Midodrine
• Fludrocortisone

Given time your body will adapt to this new normal low blood pressure and you will be able to stop taking these mediations.

Autonomic dysreflexia is one of the most serious life-threatening complications of a spinal cord injury. It is something that can affect you if your SCI is T6 or above. If not treated quickly it can cause dangerously high blood pressure and lead to a medical emergency.

If you have the potential of developing dysreflexia you will learn how to prevent, recognise and manage it. You will be given a medical alert card with your normal blood pressure recorded (remember this is usually low) a significant rise for you could appear to be normal for someone without a spinal cord injury.

All patients with spinal cord injury at T6 or above will be prescribed nifedipine 10mg. This can be taken if symptoms of dysreflexia persist and you are unable to bring your blood pressure down. Nifedipine is taken sublingually (you bite the capsule and let the liquid be absorbed under your tongue).

If you cannot bring dysreflexia under control, you should dial 999.

For more information, see the page on Autonomic Dysreflexia.

You will become the expert in your own care and management and be able to recognise very quickly when things are not quite right. If you are using catheters then there is always the potential for infection. Should this happen, please do not delay in contacting your GP for a course of antibiotics.

Depending on the level of your injury, you may also be more susceptible to chest infections. You should take all of the preventative precautions prescribed to you by your medial team and physiotherapist. If you do develop a chest infection you should contact your GP for antibiotics.