Symptoms
Common signs and symptoms of Decompression Sickness (The Bends) include:
When to see a doctor
If you experience severe or worsening symptoms, seek immediate medical attention. Always consult with a healthcare professional for proper diagnosis and treatment.
Causes & Risk Factors
Several factors can contribute to Decompression Sickness (The Bends).
Decompression sickness occurs when dissolved nitrogen in blood and tissues forms bubbles during rapid pressure reduction.
Decompression sickness occurs when dissolved nitrogen in blood and tissues forms bubbles during rapid pressure reduction. Under normal atmospheric pressure, nitrogen dissolves harmlessly in body fluids. When pressure increases - such as during diving or working in compressed air environments - more nitrogen dissolves into the bloodstream and tissues. The deeper or longer the exposure, the more nitrogen accumulates.
When pressure drops too quickly, this dissolved nitrogen cannot be eliminated through normal breathing fast enough.
When pressure drops too quickly, this dissolved nitrogen cannot be eliminated through normal breathing fast enough. Instead, it forms bubbles throughout the body, similar to opening a carbonated beverage. These bubbles can block blood vessels, damage tissues, and interfere with normal organ function. The bubbles tend to collect in joints, skin, lungs, brain, and spinal cord.
The severity depends on several factors: how deep the person went, how long they stayed at depth, how quickly they ascended, and their individual physiology.
The severity depends on several factors: how deep the person went, how long they stayed at depth, how quickly they ascended, and their individual physiology. Even following established decompression tables does not guarantee complete protection, as individual responses vary significantly. Repetitive dives, especially over multiple days, increase nitrogen loading and risk even when each individual dive seems safe.
Risk Factors
- Rapid ascent from depth without proper decompression stops
- Repetitive diving within 24 hours
- Deep dives beyond 100 feet
- Flying within 18-24 hours after diving
- Older age, particularly over 40
- Dehydration before or during diving
- Alcohol consumption before diving
- Obesity or poor physical fitness
- Previous history of decompression sickness
- Patent foramen ovale (hole in heart)
- Cold water diving
- Strenuous exercise immediately after diving
Diagnosis
How healthcare professionals diagnose Decompression Sickness (The Bends):
- 1
Doctors diagnose decompression sickness primarily through medical history and symptom assessment, as no single test can definitively confirm the condition.
Doctors diagnose decompression sickness primarily through medical history and symptom assessment, as no single test can definitively confirm the condition. The physician will ask detailed questions about recent diving activities, altitude changes, or compressed air work, along with the timing and nature of symptoms. A thorough neurological examination helps identify subtle signs of nervous system involvement.
- 2
Several tests may support the diagnosis or rule out other conditions.
Several tests may support the diagnosis or rule out other conditions. Chest X-rays can reveal air bubbles in blood vessels or lung problems. Brain MRI or CT scans may show areas of damage from gas bubbles, particularly in severe cases affecting the nervous system. Blood tests check for signs of tissue damage and help exclude other medical problems that might cause similar symptoms.
- 3
The challenge lies in recognizing that symptoms can develop hours after diving and may initially seem unrelated to pressure exposure.
The challenge lies in recognizing that symptoms can develop hours after diving and may initially seem unrelated to pressure exposure. Some people dismiss early joint pain as normal post-diving soreness or attribute fatigue to other causes. Healthcare providers in areas with diving activity maintain high awareness of decompression sickness, but emergency rooms elsewhere might not immediately consider this diagnosis.
Complications
- Neurological complications represent the most serious consequences of untreated or severe decompression sickness.
- Spinal cord damage can cause permanent paralysis, numbness, or bladder and bowel dysfunction.
- Brain involvement may result in memory problems, personality changes, or cognitive difficulties that persist long-term.
- These complications are more likely when treatment is delayed beyond 6-12 hours after symptom onset.
- Other long-term effects include joint damage from repeated episodes of decompression sickness, particularly affecting the shoulders and hips.
- Some people develop chronic pain syndromes or arthritis in previously affected joints.
- Lung complications, while less common, can include permanent scarring or persistent breathing difficulties.
- However, most people who receive prompt appropriate treatment recover completely without lasting effects.
Prevention
- Proper dive planning and execution provide the best protection against decompression sickness.
- Follow established decompression tables or dive computer recommendations religiously, and always include safety stops during ascent.
- Plan conservative dive profiles, especially on repetitive dives, and avoid pushing depth or time limits.
- Make your ascent slowly and steadily - no faster than 30 feet per minute for the final 60 feet.
- Physical preparation significantly reduces risk.
- Stay well-hydrated before and after diving, avoid alcohol for at least 8 hours before diving, and maintain good physical fitness.
- Get adequate rest before diving and avoid strenuous exercise immediately after surfacing.
- Consider shorter, shallower dives if you are older, overweight, or have health conditions that might increase susceptibility.
- Special precautions apply to flying after diving.
- Wait at least 18-24 hours after single dives before flying, and longer after multiple days of diving.
- The reduced cabin pressure during flight can trigger decompression sickness even from seemingly safe dives.
- Professional divers and those making technical dives should follow more conservative guidelines and consider extended surface intervals between dive series.
Hyperbaric oxygen therapy represents the definitive treatment for decompression sickness and should be started as soon as possible.
Hyperbaric oxygen therapy represents the definitive treatment for decompression sickness and should be started as soon as possible. During this treatment, patients breathe pure oxygen while inside a pressurized chamber. The increased pressure shrinks gas bubbles and forces them back into solution, while high-concentration oxygen speeds healing of damaged tissues. Treatment typically involves several hours in the chamber following established protocols.
Immediate first aid measures can help while arranging hyperbaric treatment.
Immediate first aid measures can help while arranging hyperbaric treatment. Patients should lie flat, breathe high-concentration oxygen if available, and drink fluids to combat dehydration. Pain medications may provide relief, but aspirin should be avoided due to bleeding risk. Transportation to a hyperbaric facility takes priority over other treatments, and patients may need helicopter or airplane transport to reach appropriate care.
Supportive care addresses specific symptoms and complications.
Supportive care addresses specific symptoms and complications. Intravenous fluids correct dehydration and support blood pressure. Medications can control nausea, pain, and neurological symptoms. Severe cases may require intensive care monitoring, especially when brain or spinal cord involvement occurs. Some patients need multiple hyperbaric treatments over several days.
Most people recover completely when treatment begins within hours of symptom onset.
Most people recover completely when treatment begins within hours of symptom onset. Delays in treatment increase the risk of permanent damage, particularly with neurological symptoms. Research continues into adjunctive treatments like anti-inflammatory medications and neuroprotective agents, but hyperbaric oxygen remains the proven standard of care.
Living With Decompression Sickness (The Bends)
Recovery from decompression sickness typically allows full return to normal activities, including diving, once healing is complete and medical clearance is obtained. Most doctors recommend waiting several weeks to months before returning to diving, depending on the severity of the episode. Some people choose to adopt more conservative diving practices afterward, such as shorter dives, shallower depths, or longer surface intervals.
Latest Medical Developments
Latest medical developments are being researched.
Frequently Asked Questions
Update History
May 5, 2026v1.0.0
- Published by DiseaseDirectory