Autonomic neuropathy

Description

Autonomic neuropathy occurs when there is damage to the nerves that control automatic functions of the body. It can affect blood pressure, temperature control, digestion, bladder function and even sexual function.

The damage to the nerves affecting the messages sent between the brain and other organs and areas of the autonomic nervous system. These areas include the heart, blood vessels and sweat glands.

Diabetes is the most common cause of autonomic neuropathy. It can also be caused by other health conditions, bacterial or viral infections, or some medications. The symptoms and treatment vary depending on which nerves are damaged.

Symptoms

The signs and symptoms of autonomic neuropathy depend on which nerves are damaged. These could include:

  • Dizziness and fainting upon standing, caused by a sudden drop in blood pressure.
  • Urinary problems, such as difficulty starting urination, loss of bladder control, difficulty for the detection of the full bladder and the inability to empty the bladder completely. Not being able to completely empty the bladder can lead to urinary tract infections.
  • Sexual difficulties, including problems getting or keeping an erection (erectile dysfunction) or ejaculation problems. In women, the problems include vaginal dryness, decreased libido and difficulty reaching orgasm.
  • Difficulty digesting food, such as the feeling of being full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal distention, nausea, vomiting, difficulty swallowing, and heartburn. All of these problems are due to the changes in digestive function.
  • The inability to recognize low blood sugar (hypoglycemia), because the warning signs, such as tremor, does not exist.
  • Sweating problems, such as sweating too much or too little. These issues affect the ability to regulate the temperature of the body.
  • Sluggish pupil reaction, making it more difficult to adjust the light to the darkness and see well while driving at night.
  • Intolerance to exercise, what can happen to you if your heart rate stays the same in place to adapt to your activity level.

When to see a doctor

Seek immediate medical attention if you start to have any of the signs and symptoms of autonomic neuropathy, especially if you have diabetes poorly controlled.

If you have type 2 diabetes, the American Diabetes Association recommends annual autonomic neuropathy screening from the time you receive your diagnosis. For people with type 1 diabetes, the association advises an annual evaluation that begins five years after diagnosis.

Causes

Many health conditions can cause autonomic neuropathy. It can also be a side effect of treatments for other diseases, such as cancer. Some of the common causes of autonomic neuropathy include:

  • Diabetes, especially when poorly controlled, is the most common cause of autonomic neuropathy. Diabetes can gradually cause damage to the nerves throughout the body.
  • Spot the accumulation of protein in the organs (amyloidosis), which affects the organs and the nervous system.
  • Autoimmune diseases,in which your immune system attacks and damages the parts of your body, including your nerves. Examples include sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, and celiac disease. Guillain-Barré syndrome is an autoimmune disease that occurs rapidly and can affect the autonomic nerves. Autonomic neuropathy can also be caused by an attack of the immune system triggered by some types of cancer (paraneoplastic syndrome).
  • Certain medications, including some drugs used in the treatment of cancer (chemotherapy).
  • Some viruses and bacteria, such as the human immunodeficiency virus (HIV) and those that cause botulism and Lyme disease.
  • Certain inherited disorders can also cause autonomic neuropathy.

Autoimmune diseases, in which your immune system attacks and damages the parts of your body, including your nerves. Examples include sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, and celiac disease. Guillain-Barré syndrome is an autoimmune disease that occurs rapidly and can affect the autonomic nerves.

Autonomic neuropathy can also be caused by an attack of the immune system triggered by some types of cancer (paraneoplastic syndrome).

Risk factors

The factors that could increase the risk of autonomic neuropathy include:

  • Diabetes. Diabetes, especially when poorly controlled, increases the risk of autonomic neuropathy and other nerve damage. You're at higher risk if you have trouble controlling your blood sugar.
  • Other diseases. Some health conditions such as amyloidosis, porphyria and hypothyroidism can increase the risk of autonomic neuropathy. The cancer may also, usually due to the side effects of the treatment.

Prevention

Certain inherited diseases that put you at risk of developing autonomic neuropathy can't be prevented. But you can delay the onset or progression of symptoms for the care of your overall health and the management of their medical conditions.

For the control of diseases and conditions, follow the recommendations of your doctor about a healthy life. The advice may include the following recommendations:

  • Control your blood sugar if you have diabetes.
  • Avoid the consumption of alcohol and smoking.
  • To receive the proper treatment if you have an autoimmune disease.
  • Take measures to prevent or control high blood pressure.
  • Achieve and maintain a healthy weight.
  • Exercise regularly.

Autonomic neuropathy

Diagnosis

Autonomic neuropathy is a possible complication of some diseases. The tests that you need will depend on your symptoms and risk factors for autonomic neuropathy.

When you have known risk factors for autonomic neuropathy

If you have diabetes or another condition that increases the risk of autonomic neuropathy and you have symptoms of neuropathy, your health care provider will perform a physical exam and ask about your symptoms.

If you are receiving cancer treatment with a medication known to cause damage to the nerves, your doctor will examine you for signs of neuropathy.

When you do not have risk factors for autonomic neuropathy

If you have symptoms of autonomic neuropathy, but without risk factors, the diagnosis can be more complicated. Your doctor will likely review your medical history, discuss your symptoms and do a physical exam.

Your doctor may recommend tests to assess autonomic functions, including:

  • The autonomic function tests. These tests measure how your heart rate and blood pressure respond during the exercises, such as deep breathing and strongly to the breath (Valsalva maneuver).
  • Tilt-table Test.This test monitors the response of the blood pressure and heart rate to changes in posture and position. Simulates what happens when you stand up after lying down. You will lie on a table, which then bends to lift the upper part of your body. Normally, the blood vessels narrow and your heart rate increases to compensate for the drop in blood pressure. This response can be slow if you have autonomic neuropathy. A simple test for this response involves checking your blood pressure when lying down, sitting and standing after three minutes. Another test is to walk for a minute, then squatting for a minute and then stand up again, while the blood pressure and heart rate are monitored.
  • Gastrointestinal tests. Gastric emptying tests are the most common tests to check digestive problems such as slow digestion and the delay in the emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in disorders of the digestive system (gastroenterologist).
  • Quantitative sudomotor axon reflex test. This test checks to see how the nerves that manage to sweat glands respond to the stimulation. A small electric current is passed through the capsule placed in your forearm, the upper part and the lower part of the leg and the foot. A computer that analyses the response of the nerves and the sweat glands. You may feel warmth or a tingling sensation during the test.
  • Thermoregulatory sweat test. It is coated with a powder that changes color when you sweat. While you lie on a camera with a slow increase of the temperature, digital photos, document the results as you begin to sweat. Your sweat pattern could help to confirm a diagnosis of autonomic neuropathy or suggest other causes of decreased or increased sweating.
  • The analysis of urine and bladder function (urodynamics) tests. If you have a bladder or urinary tract signs and symptoms, a series of urine and bladder tests can evaluate the function of the bladder.
  • Ultrasound. If you have the bladder signs and symptoms, your doctor may recommend an ultrasound scan of the urinary tract. In this test, high-frequency sound waves to create an image of the bladder and other parts of the urinary tract.

Tilt-table Test. This test monitors the response of the blood pressure and heart rate to changes in posture and position. Simulates what happens when you stand up after lying down. You will lie on a table, which then bends to lift the upper part of your body. Normally, the blood vessels narrow and your heart rate increases to compensate for the drop in blood pressure. This response can be slow if you have autonomic neuropathy.

A simple test for this response involves checking your blood pressure when lying down, sitting and standing after three minutes. Another test is to walk for a minute, then squatting for a minute and then stand up again, while the blood pressure and heart rate are monitored.

Treatment

Treatment of autonomic neuropathy includes:

  • The treatment of the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. If diabetes is the cause of your nerve damage, you'll need a tight control of blood sugar to prevent the damage from progressing. About half of the time, no underlying cause of autonomic neuropathy was found.
  • The management of specific symptoms. Some treatments may relieve the symptoms of autonomic neuropathy. The treatment is based on what part of your body is most affected by damage to the nerves.

Digestive (gastrointestinal) symptoms

Your health care provider may recommend:

  • Changes in the diet. You might need more fiber in your diet and liquids. Fiber supplements such as Metamucil or Citrucel, could also help. Gradually increase the amount of fiber you get to avoid gas and bloating.
  • Medicines to help your stomach empty. The prescription of a drug called metoclopramide (Reglan) to help your stomach empty faster by increasing the contractions of the digestive tract. This medication can cause drowsiness and should not be used for longer than 12 weeks.
  • Medications to relieve constipation. Laxatives that you can buy without a prescription, can help to relieve constipation. Ask your doctor how often you should use a laxative.
  • Medications to relieve diarrhea. Antibiotics can help treat diarrhea by preventing the excessive growth of bacteria in the intestines. The Anti-diarrheal medication available without a prescription may be helpful.

Urinary symptoms

Your health care provider may suggest:

  • Bladder retraining. After a schedule of when to drink liquids and urination can help to increase the bladder capacity, and retraining the bladder empties completely, at the appropriate time.
  • Medication to control the symptoms of the bladder. Your health care provider may prescribe medications that decrease the overactivity of the bladder. Other medicines can help to empty the bladder.
  • Urinary support (catheterization). A tube is guided through the urethra to drain your bladder.

Sexual dysfunction

For men with erectile dysfunction, health care providers may recommend:

  • Medications that allow the erections.Medications like sildenafil (Viagra), vardenafil, tadalafil (Cialis), and avanafil (Stendra) can help you to achieve and maintain an erection. Possible side effects include low blood pressure, mild headache, flushing, stomach pain, and changes in color vision. If you have a history of heart disease, arrhythmia, stroke or high blood pressure, the use of these medications with caution. Also avoid taking these medications if you are taking any kind of organic nitrates. Seek immediate medical assistance if you have an erection that lasts more than four hours.
  • External vacuum pump. This device helps draw blood into the penis using a hand pump. A tension ring helps to keep the blood in place, to maintain the erection for up to 30 minutes.

Medications that allow the erections. Medications like sildenafil (Viagra), vardenafil, tadalafil (Cialis), and avanafil (Stendra) can help you to achieve and maintain an erection. Possible side effects include low blood pressure, mild headache, flushing, stomach pain, and changes in color vision.

If you have a history of heart disease, arrhythmia, stroke or high blood pressure, the use of these medications with caution. Also avoid taking these medications if you are taking any kind of organic nitrates. Seek immediate medical assistance if you have an erection that lasts more than four hours.

For the women with the sexual activity of the symptoms, health care providers may recommend:

  • Vaginal lubricants to decrease dryness and sexual relationships, more comfortable and enjoyable.
  • One of the few drugs approved for premenopausal women with low sexual desire.

The heart rate and the blood pressure symptoms

Autonomic neuropathy can cause the heart rate and blood pressure problems. Your health care provider may prescribe:

  • A high salt content, high-liquid diet. If your blood pressure drops when you stand up, a diet high in salt and fluid can help to maintain your blood pressure. This treatment can cause high blood pressure or swelling of the feet, ankles, or legs. So that is usually recommended only for severe cases of blood pressure problems. And this treatment should not be used in people with heart failure.
  • The compression garments. A notebook worn around the waist or thigh-high compression stockings may help to improve the flow of blood.
  • Medications to increase blood pressure.If you feel faint or dizzy when you stand up, your health care provider may suggest medications. The medicine helps your body to retain salt, which helps to regulate the blood pressure. Midodrine (Orvaten) and droxidopa (Northera) can help you to raise the blood pressure. But these medicines can cause high blood pressure when you are lying. Octreotide (Sandostatin) can help you to raise the blood pressure in people with diabetes who have low blood pressure after eating, but can cause some side effects. Pyridostigmine (Mestinon) may help keep the blood pressure stable when standing.
  • Medicines to regulate your heart rhythm. A class of medications called beta-blockers helps to regulate the rhythm of your heart if it goes too high during physical activity.

Medications to increase blood pressure. If you feel faint or dizzy when you stand up, your health care provider may suggest medications. The medicine helps your body to retain salt, which helps to regulate the blood pressure.

Midodrine (Orvaten) and droxidopa (Northera) can help you to raise the blood pressure. But these medicines can cause high blood pressure when you are lying. Octreotide (Sandostatin) can help you to raise the blood pressure in people with diabetes who have low blood pressure after eating, but can cause some side effects. Pyridostigmine (Mestinon) may help keep the blood pressure stable when standing.

Sweating

If you sweat too much, your health care provider may prescribe a medication that decreases sweating. Glycopyrrolate (Cuvposa, Robinul, others) can decrease sweating. Side effects may include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headache, loss of taste, and sleepiness. This drug may also increase the risk of heat-related illnesses, such as heat stroke, from a reduction of the ability to sweat.

Self-care

  • Posture changes.Stand slowly, in stages, to reduce the dizziness. Sit with legs dangling over the side of the bed for a few minutes before getting up. Flex the foot and make fists with your hands for a few seconds before standing up, to increase the flow of blood. Once standing up, tries to tighten the muscles of the legs, while crossing one leg over the other a couple of times to increase the blood pressure.
  • Elevate the bed. If you have low blood pressure, could help to elevate the head of your bed by about 4 inches (10 centimeters). You can do this by placing blocks or risers under the legs of the headboard of the bed.
  • Digestion. Eat small, frequent meals to combat digestive problems. Increase fluids and opt for low-fat, high-fiber foods, which can improve the digestion.
  • The management of Diabetes. Tight blood sugar control can help to relieve the symptoms and help to prevent or delay the emergence of new problems.

Posture changes. Stand slowly, in stages, to reduce the dizziness. Sit with legs dangling over the side of the bed for a few minutes before getting up. Flex the foot and make fists with your hands for a few seconds before standing up, to increase the flow of blood.

Once standing up, tries to tighten the muscles of the legs, while crossing one leg over the other a couple of times to increase the blood pressure.

Alternative medicine

Several treatments of alternative medicine can help people with autonomic neuropathy. Talk with your health care provider about any treatment you want to try. This can help to make sure that they are not going to interfere with your medical treatment, or to be harmful.

Alpha-lipoic acid

The research suggests that this antioxidant may improve measures of autonomic nerve function. More studies are needed.

Acupuncture

This therapy involves the placement of thin needles into specific points on the body. Could help treat slow the emptying of the stomach, and erectile dysfunction. More studies are needed.

Transcutaneous electrical nerve stimulation

This therapy sends low-energy electrical waves through electrodes placed on the skin. Some studies have found that could help relieve the pain associated with diabetic neuropathy.

Coping and support

Living with a chronic illness presents daily challenges. Here are some suggestions to help you cope:

  • Set priorities. Accomplish the most important tasks, such as paying bills or shopping at the supermarket, when you have more energy. Save the less important tasks for later. Stay active, but don't overdo it.
  • Seek and accept the help of friends and family. Having a support system and a positive attitude can help address their challenges. Ask for what you need. Do not close yourself from loved ones.
  • Talk with a counselor or therapist. Depression is a possible complication of autonomic neuropathy. Seek help from a counselor or therapist in addition to your primary care provider to discuss the possible treatments.
  • Consider joining a support group. Ask your doctor about support groups in your area. If there is a local group of people with neuropathies, you can find a support group for his underlying condition, such as diabetes, or a support group online.

Preparing for your appointment

In the first place, it is likely that you see your primary care provider. If you have diabetes, you can see your diabetes doctor (endocrinologist). However, you may be referred to a doctor specializing in disorders of the nerves (neurologist).

You can see other specialists, depending on the part of the body affected by neuropathy, such as a cardiologist for high blood pressure or heart rate problems, or a gastroenterologist for digestive difficulties.

Here are some tips to help you prepare for your appointment.

What you can do

Ask if you should do something before your appointment, such as fasting before certain tests. Make a list of:

  • Their symptoms, and when they began
  • All the medications, vitamins, or other supplements you are taking, including dose
  • Questions to ask your health care provider

Bring a friend or family member with you to help you remember the information you receive and to learn of your support. For example, if you pass out from low blood pressure, the people around you need to know what to do.

Questions to ask your health care provider about the autonomic neuropathy include:

  • Why should I develop autonomic neuropathy?
  • Could anything else cause of my symptoms?
  • What tests do I need?
  • What treatments are available?
  • There are alternatives to the treatment you are suggesting?
  • Is there anything I can do to help control autonomic neuropathy?
  • I have other health conditions. How can I better manage with autonomic neuropathy?
  • How should I follow a special diet?
  • There are activities that I need to restrict?
  • Do you have printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Autonomic neuropathy