Wednesday, 9 January 2013

A Good Explanation Of Autonomic Neuropathy

Many people write to the blog worried that their peripheral neuropathy is turning into Autonomic neuropathy because essential involuntary functions in their bodies seem to be letting them down, alongside their normal neuropathic symptoms. Today's post from (see link below) provides a comprehensive description of possible features of autonomic neuropathy and will give you enough information to begin a constructive discussion with your doctor or specialist. It is tempting to believe that more of these symptoms apply to you than you think; or that they are all neuropathy-based when in fact they can be the result of aging or other conditions. It's important to have the experts assess your neuropathy. If you have idiopathic neuropathy (no apparent cause) then your account of the progression of symptoms becomes very important - try to keep a record of what's happening and when - it will help your doctor enormously. Remember, individual symptoms of autonomic neuropathy may well be individually treatable, so try not to let it get you down too much.


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Autonomic neuropathy
lodiseases | December 30, 2012 |
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.

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.

When to see a doctor
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.

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.

Digestive (gastrointestinal) symptoms
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.

Urinary symptoms
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.

Sexual dysfunction
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.

For women with sexual symptoms, your doctor may recommend:

Vaginal lubricants. If vaginal dryness is a problem, vaginal lubricants may make sexual intercourse more comfortable and enjoyable.

Heart rhythm and blood pressure symptoms
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.

There is no medication to increase sweating if you have lost the ability to sweat.

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