Disease

Autonomic neuropathy

Definition

Autonomic 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 Names

Neuropathy - autonomic; Autonomic nerve disease

Causes, incidence, and risk factors

Autonomic 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: Alcohol abuse 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

Symptoms

Symptoms 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 tests

Signs 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.

Treatment

Treatment 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.

Complications

Fluid 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 provider

Call 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.

Prevention

Preventing or controlling disorders associated with autonomic neuropathy may reduce the risk. For example, people with diabetes should closely control blood sugar levels.

References

Shy 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.

Review Date: 10/3/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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