Friday, 5 January 2018

Autonomic Neuropathy: The Nerve Damage You Least Want To Have

Today's post from (see link below) is an extensive and thorough description of autonomic neuropathy, which is the form of neuropathy you least want to have because of its all-encompassing effects on your body and system. It's rare that you see such a comprehensive breakdown of what it is and how it's treated and this is an excellent resource. If you don't already know; autonomic neuropathy, is when the nerves controlling your involuntary daily functions are damaged and leads to a wide variety of depressing symptoms. Reading this article will help you understand what's going on if you've received this diagnosis and how best to learn to live with it. It will also form an excellent basis for discussions with your doctor.

Autonomic Neuropathy: Symptoms, Causes, and Treatment [Complete]
Last updated on January 2, 2018


Autonomic neuropathy affects the part of your nervous system that controls your heart, lungs, bladder, digestive tract, sex organs, and eyes. It also goes after your blood vessels and can increase blood flow to your limbs, which could result in swelling and weakened bones.

Autonomic neuropathy affects the part of your nervous system, and could result in swelling and weakened bones.Click To Tweet

The nerve damage interferes with the messages sent between the brain and other organs and areas of the autonomic nervous system, such as the heart, blood vessels and sweat glands.
While diabetes is generally the most common cause of autonomic neuropathy, other health conditions — even an infection — may be to blame. Some medications also may cause nerve damage. Symptoms and treatment will vary based on which nerves are damaged.

Injured autonomic nerves can affect your:

blood pressure
heart rate
perspiration patterns
bowel movements
bladder emptying

AN is often associated with other medical conditions and diseases and certain medications. Your symptoms may vary based on the cause of your neuropathy and the location of your nerve damage.


Signs and symptoms of autonomic neuropathy vary based on the nerves affected. They may include:

Dizziness and fainting when standing caused by a sudden drop in blood pressure.
Urinary problems, such as difficulty starting urination, incontinence, difficulty sensing a full bladder and inability to completely empty the 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, low libido and difficulty reaching orgasm in women.
Difficulty digesting food, such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn, all due to changes in digestive function.
Sweating abnormalities, such as sweating too much or too little, which affects the ability to regulate body temperature.
Sluggish pupil reaction, making it difficult to adjust from light to dark and seeing well when driving at night.
Exercise intolerance, which may occur if your heart rate stays the same instead of adjusting in response to your activity level.

Other symptoms may affect the functioning of specific organs and organ systems:


The symptoms affecting your bladder may include frequent urinary tract infections and urinary incontinence or an inability to empty your bladder.

Digestive system

The symptoms of AN that affect your digestive system can include:

frequent indigestion or heartburn
vomiting undigested food
swollen abdomen
feeling full after eating a small quantity of food
poor appetite
Reproductive organs

The symptoms of AN that affect your reproductive organs can include:

erectile dysfunction
premature ejaculation
in women, difficulty achieving an orgasm
vaginal dryness
Heart and blood vessels

The symptoms of AN that affect your heart and blood vessels can include:

dizziness when rising or standing
difficulty breathing during exercise
rapid heart rate at rest
heart attack without any warning signs

The symptoms of AN that affect your eyes can include slow pupil adjustment from dark to light and difficulty driving at night.

Sweat glands

The symptoms of AN that affect your sweat glands can include dry skin on your feet and excessive sweating or lack of sweating.

Other symptoms

Other symptoms of AN can include unexplained weight loss and low blood glucose without warning signals, such as shakiness.

When to see a doctor

Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy, particularly if you have diabetes and it’s poorly controlled.

If you have type 2 diabetes, the American Diabetes Association (the Association) recommends annual autonomic neuropathy screening for people with type 2 diabetes as soon as you’ve received your diabetes diagnosis. For people with type 1 diabetes, the Association advises annual screening beginning five years after diagnosis. 

Causes of autonomic neuropathy

Many health conditions can cause autonomic neuropathy. It may also be a side effect of treatments for other diseases, such as cancer. Factors that might cause injury to the autonomic nerves include:

chronic illnesses, such as HIV or Parkinson’s disease
chemotherapy drugs
nerve trauma, such as a bruise, burn, or cut
degenerative disorders, such as multiple system atrophy
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, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. Guillain-Barre syndrome is an autoimmune disease that happens rapidly and can affect autonomic nerves.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.
Other chronic illnesses, such as Parkinson’s disease, multiple sclerosis and some types of dementia.
Certain infectious diseases. Some viruses and bacteria, such as botulism, Lyme disease and HIV, can cause autonomic neuropathy.
Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy.

Risk factors

Factors that may increase your risk of autonomic neuropathy include:

Diabetes. Diabetes, especially when poorly controlled, increases your risk of autonomic neuropathy and other nerve damage. You’re at greatest risk if you have had the disease for more than 25 years and have difficulty controlling your blood sugar, according to the National Institute of Diabetes and Digestive and Kidney Diseases.Additionally, people with diabetes who are overweight or have high blood pressure or high cholesterol have a higher risk of autonomic neuropathy.
Other diseases. Amyloidosis, porphyria, hypothyroidism and cancer (usually due to side effects from treatment) may also increase the risk of autonomic neuropathy.
Parkinson’s disease

The following people have an increased risk of Autonomic Neuropathy:

older people
people with high blood pressure
individuals with high cholesterol
humans who are overweight


Autonomic neuropathy is a possible complication of a number of diseases, and the tests you’ll need often depend on your symptoms and risk factors for autonomic neuropathy.
When you have known risk factors for autonomic neuropathy

If you have conditions that increase your risk of autonomic neuropathy (such as diabetes) and have symptoms of the condition, extensive testing may not be necessary. Your doctor may perform a physical exam and ask about your symptoms.

If you are undergoing cancer treatment with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.

When you don’t have risk factors for autonomic neuropathy

If you have symptoms of autonomic neuropathy but don’t have risk factors, the diagnosis may be more involved. Your doctor will probably review your medical history, discuss your symptoms and do a physical exam.

Your doctor may perform tests to evaluate autonomic functions, which may include:

Breathing tests. These tests measure how your heart rate and blood pressure respond during exercises such as forcefully exhaling (Valsalva maneuver).
Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.A simpler way test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.
Gastrointestinal tests. Gastric-emptying tests are the most common tests to check for digestive abnormalities such as slow digestion and delayed emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in digestive disorders (gastroenterologist).
Quantitative sudomotor axon reflex test. This test evaluates how the nerves that regulate your sweat glands respond to stimulation. A small electrical current passes through four capsules placed on your forearm, foot and leg, while a computer analyzes the response of your nerves and sweat glands. You may feel warmth or a tingling sensation during the test.
Thermoregulatory sweat test. During this test, you’re coated with a powder that changes color when you sweat. While lying in a chamber with slowly increasing temperature, digital photos document the results as you begin to sweat. Your sweat pattern may help confirm a diagnosis of autonomic neuropathy or suggest other causes for decreased or increased sweating.
Urinalysis and bladder function (urodynamic) tests. If you have bladder or urinary symptoms, a series of urine tests can evaluate bladder function.
Ultrasound. If you have bladder symptoms, your doctor may do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract.


Treatments for AN target the damaged nerves and any underlying condition causing injury to the nerves. Different treatments are available depending on your symptoms.

Digestive and gastrointestinal treatments include:

taking prescription medications to help with digestion
taking laxatives for constipation
consuming frequent, small meals
increasing your fiber and fluid intake
taking tricyclic antidepressants for stomach pain or loose stools

Bladder and urinary treatments include:

taking prescription medication to empty your bladder
taking prescription medication to reduce symptoms of overactive bladder
scheduling your drinking and urinating to retrain your bladder
threading a catheter through your urethra to drain the bladder

Sexual dysfunction treatments include:

taking medication to help bring about an erection
using a vacuum pump to force blood into the penis to cause an erection
using vaginal lubricants to combat dryness

Heart and blood pressure treatments include:

a high-sodium and high-fluid diet to sustain blood pressure
prescription medication to reduce dizziness when rising or standing
prescription medication to increase your blood pressure to combat faintness
beta blockers to regulate your heart rate with differing activity levels
changes in posture, flexing your feet, and slowing your speed when rising or standing to decrease dizziness
sleeping with your head elevated to reduce dizziness

Abnormal sweating treatment includes:
taking prescription medication to reduce excessive sweating


While certain inherited diseases that put you at risk of developing autonomic neuropathy can’t be prevented, you can slow the onset or progression of symptoms by taking good care of your health in general and managing your medical conditions.

Follow your doctor’s advice on healthy living to control diseases and conditions, which may include these recommendations:

Control your blood sugar if you have diabetes.
Seek treatment for alcoholism.
Get 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.

Lifestyle and home remedies

Posture changes. Stand up slowly, in stages, to decrease dizziness. Sit with your legs dangling over the side of the bed for a few minutes before getting out of bed. Flex your feet and grip your hands for a few seconds before standing up, to increase blood flow.Once standing, try tensing your leg muscles while crossing one leg over the other a few times to increase blood pressure.
Elevate the bed. If you have low blood pressure, it may also help to raise the head of your bed by about 4 inches by placing blocks or risers under the legs at the head of the bed.
Digestion. Eat small, frequent meals to combat digestive problems. Increase fluids, and opt for low-fat, high-fiber foods, which may improve digestion. You may also want to try restricting foods that contain lactose and gluten.
Diabetes management. Try to keep your blood sugar as close to normal as possible. Tight blood sugar control can help lessen symptoms and help to prevent or delay the onset of new problems.

Alternative medicine

Several alternative medicine treatments may help people with autonomic neuropathy. Remember to discuss any new treatments with your doctor to ensure that they won’t interfere with treatments you’re already receiving or cause you any harm.

Alpha-lipoic acid

Preliminary research suggests this antioxidant may be helpful in slowing or even reversing neuropathy that’s causing blood pressure or heart rate problems, but more study is needed.


This therapy, which uses numerous thin needles placed in specific points in the body, may help treat slow stomach emptying. More studies are needed to confirm what acupuncture’s role is in treating autonomic neuropathy.

Electrical nerve stimulation

Some studies have found that this therapy, which uses low-energy electrical waves transmitted through electrodes placed on the skin, may help ease pain associated with diabetic neuropathy.

Coping and support

Living with a chronic condition presents daily challenges. Some of these suggestions may make it easier for you to cope:
Set priorities. Accomplish the most important tasks, such as paying bills or grocery shopping, and save less important tasks for another day. Stay active, but don’t overdo it.
Seek and accept help from friends and family. Having a support system and a positive attitude can help you cope with the challenges you face. Ask for or accept help when you need it. Don’t shut yourself off from loved ones.
Talk to a counselor or therapist. Depression and impotence are possible complications of autonomic neuropathy. Seek help from a counselor or therapist in addition to your primary care doctor to discuss possible treatments.
Consider joining a support group. Ask your doctor about support groups in your area. If there isn’t a specific group for people with neuropathies, you may find that there’s a support group for your underlying condition, such as diabetes.Some people find it helpful to talk to other people who truly understand what they’re going through. Support group members can offer camaraderie, as well as tips or tricks to make living with autonomic neuropathy easier.

Preparing for your appointment

First, you’ll probably see your primary care physician. If you have diabetes, you may see your diabetes specialist (endocrinologist). However, you may be referred to a specialist in nerve disorders (neurologist).

You may need to see other specialists depending on the part of your body affected by neuropathy: for example, a cardiologist for problems with your blood pressure or heart rate, or a gastroenterologist for digestive difficulties.

Arrive at your appointment well-prepared. Here are some tips to help you prepare yourself and know what to expect from your doctor.

What you can do

Ask about any restrictions before the appointment. Find out if you should do anything in advance, such as fasting before certain tests.
Write down any symptoms you’re experiencing, even those that may seem unrelated to autonomic neuropathy.
Make a list of all medications (including over-the-counter), vitamins or supplements that you take.
Ask a family member or friend to come with you. Bring someone who can help you remember the information you and your doctor discuss. Family members can learn more about autonomic neuropathy if they attend appointments with you. For example, if you don’t know when your blood pressure is too low, you may pass out (faint). Your family members will need to know what to do.

Write down questions to ask your doctor.

Since appointments can be short, prepare a list of questions before you go. Some basic questions to ask your doctor about autonomic neuropathy may include:

Why did I develop autonomic neuropathy?
Could anything else cause my symptoms?
What kinds of tests do I need? Will I need to do anything to prepare?
Is autonomic neuropathy temporary or chronic?
What are the available and recommended treatments for autonomic neuropathy?
What are the treatment side effects?
Are there any alternatives to the treatment that you’re suggesting?
Is there anything I can do on my own to help manage autonomic neuropathy?
I have other health conditions. How can I best manage those with autonomic neuropathy?
Do I need to follow a special diet?
Are there any activity restrictions that I need to follow?
Do you have any printed materials or recommended websites that you can share with me?

Don’t hesitate to ask additional questions that may come up during your appointment.
What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be prepared to answer these types of questions to allow more time for your own:

When did you first begin experiencing symptoms?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
Does anything seem to improve your symptoms?
What, if anything, appears to worsen your symptoms?

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