DefinitionAutonomic neuropathy is a group of symptoms that occur when there is damage to the nerves that manage every day body functions such as blood pressure, heart rate, sweating, bowel and bladder emptying, and digestion.
Alternative NamesNeuropathy - autonomic; Autonomic nerve disease
Causes, incidence, and risk factorsAutonomic neuropathy is a group of symptoms, not a specific disease. There are many causes.Autonomic neuropathy involves damage to the nerves that carry information from the brain and spinal cord to the heart, bladder, intestines, sweat glands, pupils, and blood vessels.Autonomic neuropathy may be seen with:
Diabetes (diabetic neuropathy)Disorders involving scarring of tissues around the nervesGuillain Barre syndrome or other diseases that inflame nervesHIV and AIDSInherited nerve disordersMultiple sclerosisParkinson's diseaseSpinal cord injury Surgery or injury involving the nerves
SymptomsSymptoms vary depending on the nerves affected. They usually develop gradually over years. Symptoms may include:Stomach and intestinesConstipation (hard stools)Diarrhea (loose stools)Feeling full after only a few bites (early satiety)Nausea after eatingProblems controlling bowel movementsSwallowing problemsSwollen abdomenVomiting of undigested foodHeart and lungsAbnormal heart rate or rhythmBlood pressure changes with position and causes dizziness when standingHigh blood pressureShortness of breath with activity or exerciseBladderDifficulty beginning to urinateFeeling of incomplete bladder emptyingLeaking urine Other Sweating too much or not enoughHeat intolerance brought on with activity and exerciseSexual problems including erection problems in men and vaginal dryness and orgasm difficulties in womenSmall pupil in one eyeWeight loss without trying
Signs and testsSigns of autonomic nerve damage are not always seen when yourdoctor or nurse examines you. Your blood pressure or heart rate may change when lying down, sitting, and standing. Special tests to measure sweating and heart rate may be done. This is called "autonomic testing."Other tests depend on what type of symptoms you have.
TreatmentTreatment to reverse nerve damage is most often not possible. As a result, treatment and self-care are focused on managing your symptoms and preventing further problems.Your doctor or nurse may recommend: Extra salt in the diet or taking salt tablets to increase fluid volume in blood vesselsFludrocortisone or similar medications to help your body retain salt and fluidMedicines to treat irregular heart rhythmsPacemakerSleeping with the head raisedWearing elastic stockingsThe following may help your intestines and stomach work better:Daily bowel care programMedications that increase gastric motility (such as Reglan)Sleeping with the head raisedSmall, frequent mealsMedicines and self-care programs can help you if you have: Urinary incontinenceNeurogenic bladderErection problems
Expectations (prognosis)How well you do depends on the cause of the problem and if it can be treated.
ComplicationsFluid or electrolyte imbalance such as low blood potassium (if excessive vomiting or diarrhea)Injuries from falls (with postural dizziness)Kidney failure (from urine backup)MalnutritionPsychological/social effects of impotence
Calling your health care providerCall for an appointment with your health care provider if you have symptoms of autonomic neuropathy. Early symptoms might include:Becoming faint or lightheaded when standingChanges in bowel, bladder, or sexual functionUnexplained nausea and vomiting when eatingEarly diagnosis and treatment increases the likelihood of controlling symptoms.Autonomic neuropathy may hide the warning signs of a heart attack. They are sudden fatigue, sweating, shortness of breath, nausea, and vomiting.
PreventionPreventing or controlling disorders associated with autonomic neuropathy may reduce the risk. For example, people with diabetes should closely control blood sugar levels.
ReferencesShy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 446.Benarroch E, Freeman R, Kaufman H. Autonomic nervous system. In: Goetz CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 21.Chelimsky T, Robertson D, Chelimsky G. Disorders of the Autonomic Nervous System. In: Daroff: Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia,Pa; Elsevier; 2012: chap 77.