Autonomic neuropathy: Symptoms, causes and treatments

2021-09-07 11:01 PM

Autonomic neuropathy can be a complication of a number of diseases and conditions. And some drugs can cause autonomic neuropathy as a side effect.

Autonomic neuropathy: Symptoms, causes and treatments

Autonomic neuropathy: Symptoms, causes and treatments


Autonomic neuropathy is a neurological disorder that affects involuntary function, including heart rate, blood pressure, sweating, and digestion.

It is not a specific disease, autonomic neuropathy refers to damage to the autonomic nerves. Damage that disrupts signaling between the brain and parts of the autonomic nervous system, such as the heart, blood vessels, and sweat glands, resulting in a decreased or abnormal performance of one or more involuntary bodily functions. wish.

Autonomic neuropathy can be a complication of a number of diseases and conditions. And some drugs can cause autonomic neuropathy as a side effect. The signs, symptoms, and treatment of autonomic neuropathy vary depending on the cause on which the nerves are affected.


Signs and symptoms of autonomic neuropathy vary, depending on which parts of the autonomic nervous system are affected. May include:

Dizziness and fainting when standing (orthostatic hypotension), caused by a drop in blood pressure

Urinary problems, including difficulty initiating urination, incontinence, and inability to completely empty the bladder, can lead to urinary tract infections.

Sexual difficulties, including erectile dysfunction or ejaculation problems in men and vaginal dryness and difficulty arousal and orgasm in women.

Difficulty digesting food, due to abnormal digestive function and slow emptying of the stomach (gastroparesis), can cause a feeling of fullness after eating less, loss of appetite, diarrhea, constipation, bloating, nausea, vomiting, and heartburn.

Irregular sweating, such as excessive or decreased sweating, affects the body's ability to regulate body temperature.

Slow response, difficulty to adjust, and cause problems with driving at night.

With exercise intolerance, it is possible that the heart rate remains unchanged instead of increasing and decreasing in an appropriate response to the level of activity.

Seek medical attention promptly, if you begin to experience any of the signs and symptoms of autonomic neuropathy. If you have diabetes, a compromised immune system, or a chronic medical condition, your doctor regularly checks for nerve damage.

The American Diabetes Association (ADA) recommends that people with type 2 diabetes have annual screenings for autonomic neuropathy beginning as soon as they receive a diabetes diagnosis. For people with type 1 diabetes, the ADA recommends annual screening beginning five years after a diabetes diagnosis.


Autonomic neuropathy can be caused by a large number of diseases and problems or as a side effect of treatment for diseases that do not involve the nervous system. Some common causes of autonomic neuropathy include:

Alcoholism, a progressive chronic disease that can lead to nerve damage.

Abnormal protein buildup in the organs (amyloidosis), which affects the organs and nervous system.

Autoimmune diseases, in which immune and systemic attacks often damage parts of the body, including nerves. Examples include Sjogren's syndrome, systemic lupus erythematosus, and rheumatoid arthritis. Autonomic neuropathy can also be caused by an abnormal attack of the immune system that occurs in certain cancers (paraneoplastic syndromes).

Diabetes, the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.

Multiple system atrophy, a degenerative disorder that leads to loss and malfunction of certain parts of the central nervous system.

Nerve damage caused by surgery or trauma.

Treatment with certain drugs, including some drugs used in cancer treatment and anticholinergic drugs, is sometimes used to treat irritable bowel syndrome and overactive bladder.

Other chronic diseases, such as Parkinson's disease and HIV/AIDS.

The danger elements

Factors that may increase the risk of autonomic neuropathy include:

Diabetes. Diabetes, especially one that is difficult to control, increases the risk of developing nerve damage, including autonomic neuropathy. The risk is greatest for people who have had the disease for more than 25 years and have difficulty controlling blood sugar. In addition, people with diabetes, those who are overweight or have high blood pressure or high cholesterol are at increased risk of autonomic neuropathy.

Alcoholism. People who abuse alcohol are at high risk of nerve damage.

Other diseases. Several other diseases also increase the risk of autonomic neuropathy, including amyloidosis, cancer, systemic lupus erythematosus, and other autoimmune diseases, HIV/AIDS, Parkinson's disease, botulism.

Testing and diagnosis

Autonomic neuropathy is a possible complication of a number of diseases, and the need for regular testing depends on the presence or absence of known autonomic neuropathy risk factors.

When known risk factors for autonomic neuropathy

If you have a problem that increases your risk of autonomic neuropathy, such as diabetes, your doctor usually makes a diagnosis based on your signs and symptoms. Likewise, if you have cancer and are being treated with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.

In the absence of risk factors for autonomic neuropathy

If symptoms point to autonomic neuropathy and the underlying cause is unknown, the diagnosis is more difficult. Your doctor may review your medical history, ask for a thorough description of your symptoms, and do a physical exam. Tests can help diagnose and evaluate the response of certain body functions controlled by the autonomic nervous system. These may include:

Breathing test. Measures heart rate and blood pressure response to breathing exercises such as Valsalva.

Test table. This test monitors blood pressure and heart rate in response to changes in posture and position, simulating what happens when standing up after lying down. Lie flat on the board, then lean to lift your upper body. Normally, the body compensates for the drop in blood pressure that occurs when standing up by constricting blood vessels and increasing heart rate. This response may be slowed or abnormal if autonomic neuropathy is present.

Check the digestive tract. The gastric emptying test is the most common test to check for slow movements of food through the stomach system and other abnormalities. Tests can take different forms. The test can measure the rate at which food leaves the stomach, while testing stomach muscles to relax after eating. These tests are usually done by a doctor who specializes in digestive disorders.

Quantitative sweat gland stimulation, axonal reflex test (QSART). This test evaluates the nerves that regulate sweat glands in response to stimulation. A small electric current is passed through the feet, forearms, and legs, and the computer analyzes the response of the nerves and sweat glands. You may feel a warm, tingling sensation during the test.

Sweat test. This test, coated with a powder that changes color when perspiration. Then enter a room with a slowly rising temperature, which will eventually make you sweat. Sweat patterns can help confirm a diagnosis of autonomic neuropathy or other causes of decreased or increased sweating.

Urinalysis and bladder function (urodynamic). If you have a bladder disorder or urinary symptoms, a series of urinalysis can evaluate bladder function.

Supersonic. If bladder symptoms are present, your doctor may do an ultrasound, a high-frequency sound wave that creates images of the bladder and other parts of the urinary tract.

Treatments and drugs

Treatment for autonomic neuropathy includes:

Treatment of underlying diseases. The first goal of autonomic neuropathy treatment is to manage the disease or problem that is damaging the nerve. For example, if the underlying cause is diabetes, blood sugar needs to be controlled to keep it as close to normal as possible. In some cases, treating the underlying disease stops autonomic neuropathy from progressing, and damaged nerves can even repair or regenerate on their own.

Manage specific symptoms. In addition to managing the underlying disease, other treatments can relieve symptoms of autonomic neuropathy. Treatment is based on the organ system most affected by nerve damage.

Digestive symptoms

Dietary changes may include increasing fiber intake and fluid intake. Fiber supplements, such as Metamucil or Citrucel, may also help. Be sure to increase fiber in your diet slowly to avoid gas and bloating.

Metoclopramide (REGLAN). Prescription drugs help the stomach digest faster by increasing gastrointestinal contractions. This medicine may cause drowsiness, and its effectiveness wears off over time.

Medicines to relieve constipation. Laxatives can help ease constipation. Additionally, increasing the amount of fiber in the diet can help relieve constipation.

Antidepressants. Tricyclic antidepressants, such as imipramine (Tofranil), nortriptyline (Pamelor), can help treat diarrhea and abdominal pain. Dry mouth and low urine output are side effects of these medications.

Urinary symptoms

Bladder function training. Following a schedule of watering and urinating, it may be possible to help increase bladder capacity and retrain bladder function to empty completely at the appropriate time.

Bethanechol (Urecholine). This medication helps facilitate bladder emptying. Side effects include headache, abdominal cramps, bloating, nausea, and flushing.

Continuous urinary catheterization. In this procedure, a tube is threaded through the urethra into the bladder.

Medicines that relieve an overactive bladder. These include (Detrol) or oxybutynin (Ditropan). Side effects may include dry mouth, headache, fatigue, constipation, and abdominal pain.

Sexual dysfunction

For men with erectile dysfunction, your doctor may recommend:

Medicines for erection. Medicines such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) can help achieve and maintain an erection. Side effects may include mild headache, facial flushing, abdominal pain, and altered color vision. Men with a history of heart disease, stroke, or high blood pressure should use these medications with caution and medical supervision. Seek immediate medical help if an erection lasts more than four hours.

The external vacuum pump. This device helps draw blood into the penis using a hand pump. A stretch ring will help keep the blood in place, maintaining an erection for up to 30 minutes.

For women with sexual symptoms, your doctor may recommend:

Vaginal lubricant. If vaginal dryness is a problem, vaginal lubricants can make sex more comfortable and enjoyable.

Heart rate and blood pressure symptoms

Autonomic neuropathy can cause some problems with heart rate and blood pressure. Your doctor may prescribe:

Fludrocortisone acetate (Florinef). If you get dizzy or feel tired when you stand up, this medicine helps your body retain salt.

Midodrine (ProAmatine) or pyridostigmine (Mestinon). This medicine may increase blood pressure if you experience dizziness when standing up. High blood pressure when lying down is a possible side effect of midodrine.

Beta-blockers. This medication helps to regulate the heart rhythm if the heart rate does not respond to changes in normal activity levels.

Diet high in salt and fluids. If blood pressure drops when standing up, a diet high in salt and fluids can help maintain blood pressure.


If you experience excessive sweating, your doctor may prescribe:

Drugs that reduce sweating. Glycopyrrolate (Robinul, Robinul Forte) might reduce sweating. Side effects may include dry mouth, urinary retention, blurred vision, changes in heart rate, loss of taste, and drowsiness.

There is no medication to increase sweating if you have an inability to sweat.

Lifestyle and remedies

Change posture. To reduce dizziness when standing, try standing slowly in stages. You can also flex your feet and hold onto your hands for a few seconds before standing up to increase blood flow. After standing up, try to stretch the calf muscles while taking a few steps to increase the blood pressure.

Raise the head of the bed. Elevate your legs (30 cm) and sit with your legs dangling by the side of the bed for a few minutes before getting out of bed.

Digest. If you have digestive symptoms, try eating small, frequent meals. Increase water intake, and choose foods low in fat and fiber, which improve digestion.

Diabetes management. Try to keep your blood sugar as close to normal as possible if you have diabetes. Tight control of blood sugar will relieve symptoms, and may also prevent or delay new problems from developing.

Alternative medicine

Some alternative medicine treatments can help people with autonomic neuropathy. However, because autonomic neuropathy is a serious condition, discuss any new treatments with your doctor to make sure that they don't interfere with already received treatments or cause any problems. harmful period.

Alpha-lipoic acid. Preliminary research suggests that this antioxidant may be helpful in slowing or even reversing neuropathy that causes problems with blood pressure or heart rate. However, more research is needed.

Acupuncture. Therapy, which uses needles placed at specific points in the body, has been found to help slow gastric emptying. More and more research is needed to confirm these findings.

Coping and supporting

Living with a chronic condition will present daily challenges. Some of these suggestions may make it easier to deal with:

Priority setting. Decide what to do by a certain day, such as paying bills or shopping, and maybe wait until another time. Be active, but don't overdo it.

Seek and accept help from friends and family. Having a support system and a positive attitude can help cope with the challenges faced. Ask for or accept help when you need it. Do not alienate family and friends.

Talk to a counselor or treating doctor. Depression and impotence are possible complications of autonomic neuropathy. If you have either, you may find it helpful to talk to a counselor or treating physician other than your primary care physician.

Consider joining a support group. Ask your doctor about support groups in your area. Some people find it helpful to talk to others who truly understand what they are going through. In addition to being close, members of a support group may also have tricks to make life easier with autonomic neuropathy.


While some genetic diseases carry a risk of developing autonomic neuropathy that cannot be prevented, it is possible to slow the onset or progression of symptoms by taking good care of your general health and managing the symptoms. medical problem. Follow your doctor's advice on leading a healthy life to control disease and health problems, which may include these recommendations:

Control your blood sugar if you have diabetes.

Seek treatment for alcoholism.

Appropriate treatment for any autoimmune disease.

Take steps to prevent or control high blood pressure.

Achieve and maintain a healthy weight.

Stop smoking.

Exercise regularly.