Autonomic Neuropathy

Autonomic neuropathy refers to disorders caused by damage to autonomic nerves, which control the involuntary functions of the body including

• bladder,
• intestine,
• blood pressure,
• genitals.

The nerve damage affects the signal transmission between the autonomic nervous system and brain.

This may affect

• blood pressure,
• perspiration,
• bowel movements,
• bladder control,
• digestion,
• heartrate.

Diabetes is one of the most common causes of autonomic neuropathy.

Other health conditions, certain medications, and infections may also lead to this condition.

Symptoms of autonomic neuropathy depends on the location of nerve damage and cause of neuropathy.

Diagnosis is based on physical examination and tests.

Treatment depends on the symptoms. 

Symptoms of Autonomic neuropathy depend on the location of nerve damage and the cause of neuropathy.

Some common symptoms of the condition include

• Sudden drop of pressure that lead to fainting or dizziness

• Urinary problems like
  • difficulty in starting urination,
  • incontinence,
  • difficulty in completely emptying the bladder

• Sexual problems like erectile dysfunction in men, and vaginal dryness in women. Women with this condition may also have a low libido and difficulty in attaining orgasm

• Gastrointestinal issues like
  • difficulty in digestion,
  • feeling full even with little amount of food,
  • diarrhea,
  • constipation,
  • bloating,
  • nausea,
  • vomiting,
  • heartburn,
  • difficulty in swallowing,
  • loss of appetite

• Issues in controlling body temperature like too much or too little sweating

• Delay in pupil reaction while adjusting vision from light to dark and vice versa

• Exercise intolerance, caused by consistent heartrate even when the bodily activities increase

Autonomic neuropathy is caused by several factors including certain conditions, medications, and infections.

Some common causes of neuropathy include

• Amyloidosis or accumulation of protein

• Autoimmune diseases like Sjogren's syndrome, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. An autoimmune condition in which the immune system attacks the nerves may also result in autonomic neuropathy. This may be caused by certain forms of cancer like paraneoplastic syndrome.

• Diabetes is one of the most common cause of autonomic neuropathy as the disease gradually damages the nerves in different parts of the body

• Surgery or radiation may also cause nerve damage resulting in autonomic neuropathy

• Certain medications as in chemotherapy is also a cause of this neuropathy

• Other conditions like Parkinson’s disease, multiple sclerosis, and dementia are also implied in the development of this disease

• Many inherited disorders are also considered to be causative factors of autonomic neuropathy

Major risk factors for autonomic neuropathy are diabetes and other diseases like

• amyloidosis,
• hypothyroidism,
• cancer.

Diagnostic test recommended are based on the symptom and risk factors of Autonomic neuropathy.

When the major risk factors of the condition is present, extensive test may not be prescribed for the diagnosis of the condition.

When risk factors are absent, more comprehensive tests are recommended. Diagnostic tests evaluate the functioning of autonomic processes.

Breathing tests

Enable to measure the changes in heartrate and blood pressure during exercises

Tilt-table test

Measures the changes in heartrate and blood pressure with changes in posture and position. In this procedure, the table is tilted to raise the upper part of the body. A delay or abnormality in the response to the change in posture and position may indicate autonomic neuropathy.

Gastrointestinal symptoms

Are assessed using gastric-emptying tests. Slow digestion and delay in emptying the stomach are two indications of nerve damage in this region

Quantitative sudomotor axon reflex test

Is a method to evaluate the functioning of the sweat glands. In this procedure, the response of nerves to sweat glands is monitored by passing electric current through four capsules placed in different parts of the body.

Thermoregulatory sweat test

Helps to assess the sweat pattern. In this method, the body is covered with a powder which changes color with sweat. The person is then moved to a chamber where the temperature is increased gradually and the response visualized through images.

Urinalysis and urodynamic tests

Are recommended to evaluate the function of bladder. Ultrasound scan is also used to check the bladder function, particularly when the person has bladder symptoms.

Treatment of autonomic neuropathy focuses on controlling the symptoms and treating the underlying disease.

Gastrointestinal symptoms are managed by

• Having a diet rich in fiber and fluids. Fiber supplements are also suggested to ease bowel movements

• Medications like metoclopramide is recommended for faster emptying of the stomach.

• Laxatives are used to ease bowel movements and to control constipation

• Antibiotics are prescribed to treat diarrhea by preventing bacterial growth in the intestine. Diarrhea is also managed by medications normally used to treat high blood pressure and cholesterol

• Antidepressants are used to treat abdominal pain.

Urinary symptoms

Are treated by small lifestyle changes to improve functioning of bladder. Following a schedule to drink fluid and empty the bladder improves the capacity of bladder.

Medications are also helpful in controlling urinary symptoms. Catheterization is recommended in some cases. Medications are useful in decreasing the activity of bladder.

Erectile dysfunction

Is treated with medications that improve erections. Sildenafil and vardenafil are commonly used to achieve and maintain erection.

An external hand pump may be used to improve blood flow into the penis and maintain an erection for some time.

In women, vaginal lubricants control vaginal dryness.

Changes in blood pressure

Is controlled by medications that raise pressure by retaining salt. Medications like beta blockers are useful in regulating heartrate. Dietary changes with high salt and fluid content helps to maintain pressure.

Excessive sweating is controlled by medications like glycopyrrolate.

The best way to prevent Autonomic Neuropathy is to meet frequently with your physician to manage your health.

Managing medical conditions and improving health helps to control the progression of the disease.

Those who are diagnosed with diabetes should take measures to control blood pressure.

Managing autoimmune diseases also help to prevent the condition.

Controlling hypertension and maintaining a healthy body weight are also recommended.

Regular exercise and quitting smoking are also part of preventive measures. 

A few alternative and homeopathic remedies exist that can alleviate symptoms of Autonomic neuropathy.

Antioxidants are considered to be good supplements for reversing the effects of neuropathy.

Acupuncture is specifically used in controlling some of the gastrointestinal symptoms like slow emptying.

Pain is controlled by electrical nerve stimulation. 

Lifestyle modifications are necessary in order to cope with Autonomic neuropathy.

Changing the posture gradually, like standing slowly, helps to reduce dizziness.

Flexing the feet before standing helps to improve the blood flow.

Elevating or raising the head part of the cot helps to control blood pressure.

Eating small, frequent meals control the digestive symptoms.

Taking diabetes medications and managing the disease is also important in controlling autonomic neuropathy.

Having a supportive family helps to cope with the condition better. Joining a support group or talking to a counselor or therapist also is of help.

Autonomic neuropathy may result in a number of complications like

• Charcot joint,
• urinary tract infections,
• urinary incontinence,
• low blood pressure,
• digestive problems,
• sexual dysfunction,
• changes in sweating pattern.