Autonomic neuropathy
Definition:
Autonomic neuropathy is a nerve disorder that affects involuntary body functions, including heart rate, blood pressure, perspiration and digestion.
It isn't a specific disease. Autonomic neuropathy refers to damage to the autonomic nerves. This damage disrupts signals between the brain and portions of the autonomic nervous system, such as the heart, blood vessels and sweat glands. This can cause decreased or abnormal performance of one or more involuntary body functions.
Autonomic neuropathy can be a complication of a number of diseases and conditions. And some medications can cause autonomic neuropathy as a side effect. Signs, symptoms and treatment of autonomic neuropathy vary depending on the cause, and on which nerves are affected.
Symptoms:
Signs and symptoms of autonomic neuropathy vary, depending on which parts of your autonomic nervous system are affected. They may include:
Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy. If you have diabetes, a compromised immune system or another chronic medical condition, see your doctor regularly to be checked for nerve damage.
The American Diabetes Association (ADA) recommends that people with type 2 diabetes be screened every year for autonomic neuropathy starting as soon as they receive their diabetes diagnosis. For people with type 1 diabetes, the ADA advises annual screening beginning five years after being diagnosed with diabetes.
Causes:
Autonomic neuropathy can be caused by a large number of diseases and conditions or can be a side effect of treatment for diseases unrelated to the nervous system. Some common causes of autonomic neuropathy include:
Treatments and drugs:
Treatment of autonomic neuropathy includes:
Your doctor may recommend:
Your doctor may suggest:
For men with erectile dysfunction, your doctor may recommend:
Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor may prescribe:
If you experience excessive sweating, your doctor may prescribe:
Definition:
Autonomic neuropathy is a nerve disorder that affects involuntary body functions, including heart rate, blood pressure, perspiration and digestion.
It isn't a specific disease. Autonomic neuropathy refers to damage to the autonomic nerves. This damage disrupts signals between the brain and portions of the autonomic nervous system, such as the heart, blood vessels and sweat glands. This can cause decreased or abnormal performance of one or more involuntary body functions.
Autonomic neuropathy can be a complication of a number of diseases and conditions. And some medications can cause autonomic neuropathy as a side effect. Signs, symptoms and treatment of autonomic neuropathy vary depending on the cause, and on which nerves are affected.
Symptoms:
Signs and symptoms of autonomic neuropathy vary, depending on which parts of your autonomic nervous system are affected. They may include:
- Dizziness and fainting upon standing caused by a drop in blood pressure.
- Urinary problems, including difficulty starting urination, urinary incontinence and an inability to completely empty your bladder, which can lead to urinary tract infections.
- Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men, and vaginal dryness and difficulties with arousal and orgasm in women.
- Difficulty digesting food, due to abnormal digestive function and slow emptying of the stomach (gastroparesis). This can cause a feeling of fullness after eating little, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn.
- Sweating abnormalities, such as excessive or decreased sweating, which affects the ability to regulate body temperature.
- Sluggish pupil reaction, making it difficult to adjust from light to dark and causing problems with driving at night.
- Exercise intolerance, which may occur if your heart rate remains unchanged instead of appropriately increasing and decreasing in response to your activity level.
Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy. If you have diabetes, a compromised immune system or another chronic medical condition, see your doctor regularly to be checked for nerve damage.
The American Diabetes Association (ADA) recommends that people with type 2 diabetes be screened every year for autonomic neuropathy starting as soon as they receive their diabetes diagnosis. For people with type 1 diabetes, the ADA advises annual screening beginning five years after being diagnosed with diabetes.
Causes:
Autonomic neuropathy can be caused by a large number of diseases and conditions or can be a side effect of treatment for diseases unrelated to the nervous system. Some common causes of autonomic neuropathy include:
- Abnormal protein buildup in organs (amyloidosis), which affects the organs and the nervous system.
- Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren's syndrome and systemic lupus erythematosus. Autonomic neuropathy may also be caused by an abnormal attack by the immune system that occurs as a result of some cancers (paraneoplastic syndrome).
- Diabetes, which is the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.
- Injury to nerves caused by surgery or radiation to the neck.
- Treatment with certain medications, including some drugs used in cancer chemotherapy, some antidepressants and some heart medications.
- Other chronic illnesses, such as Parkinson's disease.
- Certain infectious diseases. Some viruses and bacteria, such as botulism, leprosy and diphtheria, can cause autonomic neuropathy.
- Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy.
Treatments and drugs:
Treatment of autonomic neuropathy includes:
- Treating the underlying disease. The first goal of
treating autonomic neuropathy is to manage the disease or condition
damaging your nerves. For example, if the underlying cause is diabetes,
you'll need to control your blood sugar to keep it as close to normal as
possible. Treating the underlying disease can help stop autonomic
neuropathy from progressing.
- Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.
Your doctor may recommend:
- Modifying your diet. This could include increasing
the amount of fiber you eat and fluids you drink. Supplements containing
fiber, such as Metamucil or Citrucel, also may help. Be sure to
increase the fiber in your diet slowly to avoid gas and bloating.
- Medication to help your stomach empty. A
prescription drug called metoclopramide (Reglan) helps your stomach
empty faster by increasing the contractions of the digestive tract. This
medication may cause drowsiness, and its effectiveness wears off over
time.
- Medications to ease constipation. Over-the-counter
laxatives may help ease constipation. Ask your doctor how often you
should use these medications. In addition, increasing the amount of
fiber in your diet may help relieve constipation.
- Antidepressants. Tricyclic antidepressants, such as imipramine (Tofranil) or nortriptyline (Pamelor), can help treat diarrhea and abdominal pain. Dry mouth and urine retention are possible side effects of these medications.
Your doctor may suggest:
- Retraining your bladder. Following a schedule of
when to drink fluids and when to urinate can help increase your
bladder's capacity and retrain your bladder to empty completely at the
appropriate times.
- Medication to help empty the bladder. Bethanechol
is a medication that helps ensure complete emptying of the bladder.
Possible side effects include headache, abdominal cramping, bloating,
nausea and flushing.
- Urinary assistance (catheterization). During this procedure, a tube is threaded through your urethra to empty your bladder.
- Medications that decrease overactive bladder. These include tolterodine (Detrol) or oxybutynin (Ditropan XL). Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.
For men with erectile dysfunction, your doctor may recommend:
- Medications that enable erections. Drugs such as
sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) can help
you achieve and maintain an erection. Possible side effects include
mild headache, flushing, upset stomach and altered color vision. Men
with a history of heart disease, stroke or high blood pressure need to
use these medications with caution and medical supervision. Seek
immediate medical assistance if you have an erection that lasts longer
than four hours.
- An external vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.
- Vaginal lubricants. If vaginal dryness is a problem, vaginal lubricants may make sexual intercourse more comfortable and enjoyable.
Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor may prescribe:
- Medications that help raise your blood pressure. If
you get dizzy or feel faint when you stand up, your doctor may suggest a
drug called fludrocortisone acetate. This medication helps your body
retain salt, which helps regulate your blood pressure. Other drugs that
can help raise your blood pressure include midodrine (ProAmatine) and
pyridostigmine (Mestinon). High blood pressure when lying down is a
possible side effect of midodrine.
- Medication that helps regulate your heart rate. A
class of medications called beta blockers helps to regulate your heart
rate if your heart rate doesn't respond normally to changes in activity
level.
- A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high fluid diet may help maintain your blood pressure.
If you experience excessive sweating, your doctor may prescribe:
- A medication that decreases perspiration. The drug glycopyrrolate (Robinul, Robinul Forte) can decrease sweating. Side effects may include dry mouth, urinary retention, blurred vision, changes in heart rate, loss of taste and drowsiness.
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