Autonomic Neuropathy in Context

There are other posts on the blog concerning autonomic neuropathy (see alphabetical list on the right) but today's article from h-b-f.info (see link below) gives a very good overview of how autonomic neuropathy relates to other neuropathies and other medical problems. It helps you understand why certain things not normally associated with peripheral neuropathy, may lead to a diagnosis of autonomic neuropathy. If you're not sure which nerves are affected by autonomic neuropathy, look at the diagram in the post of Thursday, 27th October.

Autonomic Neuropathy.

Autonomic neuropathy is a medical condition with multiple symptoms, depending on the tissues and organs affected. Autonomic neuropathy is a peripheral neuropathy and involves damage to the nerves supplying the autonomic portion of the peripheral nervous system that innerves the internal organs and blood vessels.

The disease may have an impact on the urinary track, gastrointestinal system, cardiovascular system, sweat glands, sex organs, eyes and nerves that regulate blood pressure. Autonomic neuropathy can also lead to unawareness of hypoglycemia.

Diabetes mellitus is perhaps the most common cause of the disease which is described as diabetic neuropathy. Alcoholism, surgical operations, accidental nerve injuries and anticholinergic medications can lead to autonomic neuropathy, as well. The condition may be accompanied by different forms of neuropathy and it seems to be associated with the Parkinson's disease and multiple sclerosis.

Symptoms of autonomic neuropathy.
Clinically autonomic neuropathy is considered a group of symptoms rather than a particular disease. These symptoms can be unstable blood pressure affected by the position of the body, postural dizziness, fainting, heat intolerance, unexpected or abnormal sweating, urinary incontinence, difficulty to urinate, sexual disorders, swollen abdomen, nausea or vomiting after meals, bloating, diarrhea or constipation and unintentional weight loss.
Not all of the above symptoms are necessary to occur, though.

Consequences and complications of autonomic neuropathy.
Consequences and complications of autonomic neuropathy may vary, since the condition affects a variety of organs and systems.
Unawareness of hypoglycemia due to autonomic neuropathy.
Normally, symptoms such as shakiness, sweating and palpitations occur as blood glucose level drops below 70mg/dL. In people with autonomic neuropathy, symptoms may not occur and hypoglycemia remains unnoticed. It has to be mentioned that other conditions can cause hypoglycemia unawareness too.

Cardiovascular system can be affected by autonomic neuropathy.
Damage to nerves in heart and circulatory system interferes with the body's ability to adjust blood pressure and heart rate. As a result, blood pressure may drop sharply after standing up. This is called postural or orthostatic hypotension and it causes dizziness or immediate loss of consciousness. Damage to the nerves that control heart rate can occur. In such a case, heart rhythm remains high, rather than fluctuating in response to normal body functions and physical activity.

Digestive system and autonomic neuropathy.
Nerve damage to the digestive system often causes constipation due to gastroparesis. The latest is a condition that leads to impaired stomach digestive performance. Severe gastroparesis, which may occur due to autonomic neuropathy, can lead to persistent nausea and vomiting, bloating, loss of appetite and eventually to malnutrition and unintentional weight loss. Excessive vomiting or diarrhea can lead to fluid or electrolyte imbalance such as hypokalemia. Gastroparesis can cause extreme blood glucose level fluctuations, including hypoglycemia due to abnormal food digestion.
Nerve damage to the esophagus may cause dysphagia which is difficulty in swallowing. Apart from gastroparesis, constipation can occur due to damage of the bowel nerves and may alternate with diarrhea, especially overnight.

Urinary track can get affected by autonomic neuropathy.
Diabetic autonomic neuropathy can affect the nerves that control urination and can lead to neurogenic bladder. In such a condition, the bladder retains some quantity of urine, allowing bacteria to grow in the bladder itself and the kidneys. Eventually, persistent urinary tract infections establish. When the bladder nerves are damaged, urinary incontinence may occur, since the individual may not be able to sense the fullness or control the muscles that release urine. Kidney failure can develop because of urine reflux.

Sex organs may present impaired function as a result of autonomic neuropathy.
Neuropathy can gradually decrease sexual response in both genders. A man may get unable to have erections or may reach sexual climax, without ejaculating normally. A woman may suffer a decreased vaginal lubrication, decreased sexual response or orgasm problems. You can find more information in the sexual health section on this site.

Sweat glands may work poorly because of autonomic neuropathy.
Autonomic neuropathy can affect the nerves that control sweating. When nerve damage restrains the sweat glands from working properly, the body cannot regulate its temperature adequately. Nerve damage can also cause profuse sweating at night or while eating.

Eyes can be affected by autonomic neuropathy.
Autonomic neuropathy may affect the eyes, making them less responsive to changes of light. As a result, a person may not be able to see well, when the light is turned on in a dark room or may have trouble driving at night.

Treatment of autonomic neuropathy.
If the cause of autonomic neuropathy can be diagnosed and treated, there is a small possibility for the affected nerves to regenerate. Otherwise, the treatment of autonomic neuropathy itself is supportive and it aims to reduce the symptoms.
The use of elastic stockings, sleeping with the head elevated and the use of medications may reduce postural hypotension.
Medications, small and frequent meals are means that can be used to treat reduced gastric motility.
Manual excretion of urine, occasional catheterization or medications may be necessary for bladder dysfunction treatment.
Medications are used to treat impotence, diarrhea and constipation.
A wide range of drugs are prescribed for medical treatment of diabetic neuropathy.

Prevention of autonomic neuropathy.
Prevention or control of diseases, which may be associated with autonomic neuropathy, can reduce the risk. For instance, diabetics should control blood sugar levels faithfully and alcoholics should seek for help and treatment.

http://www.h-b-f.info/health_autonomic_neuropathy.htm