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
    • 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, blood vessels, bladder, intestines, sweat glands, and pupils.

      Autonomic neuropathy may be seen with:

  • Symptoms
    • Symptoms vary depending on the nerves affected. They usually develop gradually 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:

      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 doctor 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 elastic 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:

  • 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 for an appointment with your doctor 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, you may only feel sudden fatigue, sweating, shortness of breath, nausea, and vomiting during a heart attack.

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

  • References
    • 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.

      Cheshir WP. Autonomic disorders and their management. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 427.