Dr-M-Shahadat-Hossain

Autonomic neuropathy is a type of nerve damage that affects the autonomic nervous system, which controls involuntary body functions such as blood pressure, heart rate, digestion, and temperature regulation. Symptoms include lightheadedness, fainting, constipation, diarrhea, and bladder dysfunction. Several underlying conditions, including diabetes, certain infections, and inherited disorders, can cause the condition. Treatment typically involves managing the underlying condition and addressing specific symptoms as they arise. It is important to see a doctor if you suspect you have autonomic neuropathy.

Symptoms of autonomic neuropathy

It can vary depending on which part of the autonomic nervous system is affected and the condition’s underlying cause. Some common symptoms[1] include:

  • Lightheadedness or fainting when standing up (orthostatic hypotension)
  • Constipation and diarrhea
  • Bladder dysfunction, such as difficulty starting or stopping urination or incontinence.
  • Sexual dysfunction, such as impotence or difficulty achieving orgasm
  • Difficulty swallowing
  • Gastroparesis, or delayed stomach emptying
  • Abnormal sweating or temperature regulation
  • Dry eyes and mouth
  • Rapid heartbeat or palpitations
  • Difficulty with coordination and balance

What are the causes of autonomic neuropathy?

Autonomic neuropathy is caused[2] by damage to the nerves that control the body’s involuntary functions, such as heart rate, blood pressure, digestion, and sweating. This damage can be caused by many factors, including:

  1. Diabetes – High blood sugar levels can damage the nerves over time, leading to autonomic neuropathy.
  2. Certain medications – Some drugs used to treat high blood pressure, cancer, and depression can cause autonomic neuropathy as a side effect.
  3. Infections – Certain infections, such as Lyme disease, shingles, and HIV, can damage the nerves and lead to autonomic neuropathy.
  4. Inherited disorders – Some inherited disorders, such as Charcot-Marie-Tooth disease, can damage the nerves and lead to autonomic neuropathy.
  5. Alcoholism – Chronic alcohol abuse can cause damage to the nerves and lead to autonomic neuropathy.
  6. Exposure to toxins – Certain chemicals and toxins can damage the nerves and lead to autonomic neuropathy.
  7. Certain cancers – Cancer can spread to the nerves and cause damage, leading to autonomic neuropathy.
  8. Idiopathic – In some cases, the cause of autonomic neuropathy may be unknown.

How dangerous autonomic neuropathy can be

Autonomic neuropathy can be a serious condition that can lead to many complications[3], some of which can be life-threatening. The severity and type of complications vary depending on the affected nerves and the underlying cause of the autonomic neuropathy. Some possible complications include the following:

  1. Cardiovascular problems – Autonomic neuropathy can affect the nerves that control the heart and blood vessels, leading to high blood pressure, irregular heartbeats, and an increased risk of heart attack and stroke.
  2. Gastrointestinal problems – Autonomic neuropathy can affect the nerves that control digestion, leading to constipation, diarrhea, and other digestive problems.
  3. Sexual dysfunction – Autonomic neuropathy can affect the nerves that control sexual function, leading to impotence or problems with ejaculation in men and vaginal dryness in women.
  4. Bladder problems – Autonomic neuropathy can affect the nerves that control the bladder, leading to difficulty urinating or urine retention.
  5. Foot and skin problems – Autonomic neuropathy can affect the nerves that control blood flow to the feet, leading to poor circulation and an increased risk of foot infections and skin ulcers.
  6. In severe cases, autonomic neuropathy can cause sudden drops in blood pressure upon standing or sitting up (orthostatic hypotension), which can cause fainting and falls.

Preventive technique of autonomic neuropathy

Preventing[4] autonomic neuropathy can be challenging as the underlying causes can be varied. Still, certain steps can be taken to reduce the risk of developing the condition. Some preventive techniques include:

  1. Managing diabetes – People with diabetes can reduce their risk of developing autonomic neuropathy by managing their blood sugar levels through diet, exercise, and medication.
  2. Avoiding alcohol – Avoiding or limiting alcohol consumption can help prevent nerve damage.
  3. Avoiding toxins – Avoiding exposure to certain chemicals and toxins can help prevent nerve damage.
  4. Managing other chronic illnesses – People with other chronic illnesses such as HIV/AIDS, cancer, and chronic inflammatory diseases may be at risk of developing autonomic neuropathy. Therefore, it’s important to have regular check-ups and follow a treatment plan to manage the underlying condition.
  5. Maintaining a healthy lifestyle – Eating a healthy diet, regular exercise, and not smoking can help prevent nerve damage and reduce the risk of developing autonomic neuropathy.
  6. Monitoring for symptoms – People at risk of developing autonomic neuropathy should be aware of the symptoms and see a doctor if they experience any of them.
  7. Monitoring medication side effects – Long-term use of certain medications, such as chemotherapeutic agents, can cause autonomic neuropathy. Therefore, discussing the potential risks and side effects with a doctor is important before starting any medication.

Diagnosis of automatic neuropathy

The diagnosis of autonomic neuropathy[5] typically involves a combination of medical history, physical examination, and diagnostic tests. Some of the methods used to diagnose autonomic neuropathy include:

  1. Medical history and physical examination – The doctor will ask about symptoms and conduct a physical examination to assess the function of the autonomic nervous system. For example, the doctor may check the patient’s blood pressure and heart rate while lying down and then again while standing to look for signs of orthostatic hypotension.
  2. Blood tests – Blood tests may be done to check for conditions that can cause autonomic neuropathy, such as diabetes or anemia.
  3. Nerve function tests – Tests that assess the function of the autonomic nerves can include heart rate variability tests, deep breathing tests, and tests of sweat production.
  4. Imaging studies – Imaging studies, such as an MRI or CT scan, may be done to check for tumors or other abnormalities causing autonomic neuropathy.
  5. Autonomic reflex screen (ARS) – Autonomic reflex screen is a test that can be used to evaluate the function of the autonomic nerves.
  6. Cardiovascular autonomic neuropathy (CAN) – Cardiovascular autonomic neuropathy can be diagnosed by measuring heart rate variability, blood pressure, and heart rate response to various stimuli.
  7. Gastrointestinal autonomic neuropathy – Gastrointestinal autonomic neuropathy can be diagnosed by measuring gastric emptying, colonic motility, and short bowel transit time.
  8. Genitourinary autonomic neuropathy – Genitourinary autonomic neuropathy can be diagnosed by measuring bladder and urethral function.

When an Autonomic Neuropathy patient needs to visit a doctor

Individuals with autonomic neuropathy should visit a doctor if they experience any symptoms or are at risk for developing the condition. Some symptoms that may indicate the need for a doctor’s visit[1][3] include:

  1. Dizziness or fainting – Autonomic neuropathy can affect the nerves that control blood pressure, leading to dizziness or fainting.
  2. Digestive problems – Autonomic neuropathy can affect the nerves that control digestion, leading to constipation, diarrhea, or other digestive problems.
  3. Sexual dysfunction – Autonomic neuropathy can affect the nerves that control sexual function, leading to impotence or problems with ejaculation in men and vaginal dryness in women.
  4. Sweating abnormalities – Autonomic neuropathy can affect the nerves that control sweating, leading to excessive or lack of sweating.
  5. Urine retention – Autonomic neuropathy can affect the nerves that control the bladder, leading to difficulty urinating or urine retention.
  6. Risk Factors – If the individual has a known risk factor like diabetes, alcoholism, or exposure to toxins and they have not been checked for autonomic neuropathy.

Treatment plan for automatic neuropathy

The overall treatment plan[2][4] for autonomic neuropathy will depend on the underlying cause and the specific symptoms experienced by the individual. However, some general principles of treatment include the following:

  1. Managing the underlying condition – If the autonomic neuropathy is caused by a condition such as diabetes, the first step in treatment is to manage the underlying condition to prevent further nerve damage.
  2. Medications – Medications can be used to treat the symptoms of autonomic neuropathy. For example, medications to increase blood pressure may be prescribed for individuals with orthostatic hypotension.
  3. Physical therapy – Physical therapy may be recommended to help individuals improve their balance and coordination.
  4. Lifestyle changes – Making lifestyle changes, such as avoiding alcohol, limiting exposure to toxins, and maintaining a healthy diet and exercise routine, can help reduce symptoms and prevent further nerve damage.
  5. Monitoring for complications – People with autonomic neuropathy are at risk for certain complications, such as foot ulcers, so regular monitoring is important to detect and treat any possible complications.
  6. Specialized care – If a particular condition causes autonomic neuropathy, the patient may need to be referred to a specialist such as a neurologist, endocrinologist, or internist.

Autonomic neuropathy is caused by damage to the nerves that control the body’s involuntary functions. Many factors, including diabetes, certain medications, infections, and inherited disorders, can cause it. Symptoms of autonomic neuropathy can vary depending on the affected nerves. Still, they can include dizziness or fainting, digestive problems, sexual dysfunction, sweating abnormalities, and urine retention.

Diagnosis is made through medical history, physical examination, and diagnostic tests. The treatment plan will depend on the underlying cause and the specific symptoms experienced by the individual. Still, it may include managing the underlying condition, taking medications, physical therapy, making lifestyle changes, monitoring for complications, and specialized care.

Reference

1. Autonomic Neuropathy

https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/autonomic-neuropathy

2. Autonomic Neuropathy

https://www.webmd.com/diabetes/autonomic-neuropathy-overview

3. Autonomic Neuropathy or Autonomic Dysfunction (Syncope): Information and Instructions

https://my.clevelandclinic.org/health/diseases/15631-autonomic-neuropathy-or-autonomic-dysfunction-syncope-information-and-instructions

4. Autonomic Neuropathy

https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/autonomic-neuropathy.html

5. Autonomic Neuropathies

https://www.msdmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/autonomic-nervous-system-disorders/autonomic-neuropathies

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