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Autonomic neuropathy

Neuropathy - autonomic; Autonomic nerve disease

 

Autonomic neuropathy is a group of symptoms that occur when there is damage to the nerves that manage every day body functions. These functions include blood pressure, heart rate, sweating, bowel and bladder emptying, and digestion.

Causes

 

Autonomic neuropathy is a group of symptoms. It is not a specific disease. There are many causes.

Autonomic neuropathy involves damage to the nerves that carry information from the brain and spinal cord. The information is then carried to the heart, blood vessels, bladder, intestines, sweat glands, and pupils.

Autonomic neuropathy may be seen with:

  • Alcohol abuse
  • Diabetes (diabetic neuropathy)
  • Disorders involving scarring of tissues around the nerves
  • Guillain Barré syndrome or other diseases that inflame nerves
  • HIV/AIDS
  • Inherited nerve disorders
  • Multiple sclerosis
  • Parkinson disease
  • Spinal cord injury
  • Surgery or injury involving the nerves

 

Symptoms

 

Symptoms vary, depending on the nerves affected. They usually develop slowly over years.

Stomach and intestine symptoms may include:

  • Constipation (hard stools)
  • Diarrhea (loose stools)
  • Feeling full after only a few bites (early satiety)
  • Nausea after eating
  • Problems controlling bowel movements
  • Swallowing problems
  • Swollen abdomen
  • Vomiting of undigested food

Heart and lungs symptoms may include:

  • Abnormal heart rate or rhythm
  • Blood pressure changes with position that causes dizziness when standing
  • High blood pressure
  • Shortness of breath with activity or exercise

Bladder symptoms may include:

  • Difficulty beginning to urinate
  • Feeling of incomplete bladder emptying
  • Leaking urine

Other symptoms may include:

  • Sweating too much or not enough
  • Heat intolerance brought on with activity and exercise
  • Sexual problems, including erection problems in men and vaginal dryness and orgasm difficulties in women
  • Small pupil in one eye
  • Weight loss without trying

 

Exams and Tests

 

Signs of autonomic nerve damage are not always seen when your doctor examines you. Your blood pressure or heart rate may change when lying down, sitting, or 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 health care provider may recommend:

  • Extra salt in the diet or taking salt tablets to increase fluid volume in blood vessels
  • Fludrocortisone or similar medicines to help your body retain salt and fluid
  • Medicines to treat irregular heart rhythms
  • Pacemaker
  • Sleeping with the head raised
  • Wearing compression stockings

The following may help your intestines and stomach work better:

  • Daily bowel care program
  • Medicines that help the stomach move food through faster
  • Sleeping with the head raised
  • Small, frequent meals

Medicines and self-care programs can help you if you have:

  • Urinary incontinence
  • Neurogenic bladder
  • Erection problems

 

Outlook (Prognosis)

 

How well you do will depend on the cause of the problem and if it can be treated.

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of autonomic neuropathy. Early symptoms might include:

  • Becoming faint or lightheaded when standing
  • Changes in bowel, bladder, or sexual function
  • Unexplained nausea and vomiting when eating

Early diagnosis and treatment may control symptoms.

Autonomic neuropathy may hide the warning signs of a heart attack. Instead of feeling chest pain, if you have autonomic neuropathy, during a heart attack you may only have:

  • Sudden fatigue
  • Sweating
  • Shortness of breath
  • Nausea and vomiting

 

Prevention

 

Prevent or control associated disorders to reduce the risk of neuropathy. For example, people with diabetes should closely control blood sugar levels.

 

 

References

Katirji B. Disorders of peripheral nerves. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 107.

Shy ME. Peripheral neuropathies. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 420.

 
  • Autonomic Nerves

    Autonomic Nerves - illustration

    Autonomic nerves are concerned with muscular functions which are reflexive, such as breathing, heartbeats and peristalsis (rhythmic movements of the intestines).

    Autonomic Nerves

    illustration

  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

    • Autonomic Nerves

      Autonomic Nerves - illustration

      Autonomic nerves are concerned with muscular functions which are reflexive, such as breathing, heartbeats and peristalsis (rhythmic movements of the intestines).

      Autonomic Nerves

      illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

    A Closer Look

     

    Self Care

     

      Tests for Autonomic neuropathy

       

         

        Review Date: 10/24/2016

        Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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