Autonomic Neuropathy

Causes of Autonomic Neuropathy

Certain diseases and treatments related to your nerves can cause autonomic neuropathy. Diabetes is the most common cause. Other possibilities include:

• Abnormal protein buildup, called amyloidosis
• Autoimmune diseases such as rheumatoid arthritis, Guillain-Barré syndrome, lupus, and Sjögren's syndrome
• Lyme disease
• HIV
• Parkinson's disease
• Inherited diseases such as Riley-Day syndrome
• Spinal cord injury
• Surgery
• Medicines, including some chemotherapy drugs used to treat cancer
• Chemicals such as acrylamide and heavy metals
• Heavy alcohol use
• Multiple sclerosis
• Botulism

Autonomic Neuropathy Diagnosis

There's no one test for autonomic dysfunction. Your doctor will ask about your symptoms and do a physical exam. They also might recommend blood tests to check for causes such as:

• Diabetes
• Sjögren's syndrome and other autoimmune diseases
• Infections such as HIV or Lyme disease

While additional testing isn't always needed, other tests you might have include:

Tilt-table test. You’ll lie on a table, and it will tilt to raise part of your body as if you were standing. Your doctor will watch your blood pressure and heart rate as your position changes.

Quantitative sudomotor axon reflex test. This uses a small electrical current to see how your sweat glands are working.

Urodynamic tests. These check how well your bladder stores and releases urine.

Ultrasound. This uses high-frequency sound waves to make images of your bladder so your doctor can get a better look at what’s happening.

X-rays. This test, which uses radiation to get pictures of the inside of your body, might be used to look at parts of your digestive system. CTs, MRIs, or other scans might also be used to look at your gut.

Gastric emptying test. This test checks you for signs of irregular digestion, such as slow digestion or slower stomach emptying (gastroparesis).

Thermoregulatory sweat test. This test looks for any irregular patterns in how you sweat. Your body is covered in powder that changes colors as the temperature slowly rises inside a special chamber.

Autonomic Neuropathy Treatment

Your doctor will mainly treat the disease that caused your nerve damage. For example, if you have diabetes, you'll need to control your blood sugar with diet, exercise, and possibly medicine. For autoimmune diseases, such as Sjögren's syndrome, you'll get medicine to control your immune system and lower inflammation in your body.

Your doctor also might recommend other things to ease specific symptoms.

To treat digestive symptoms, you might:

• Eat smaller meals so you don’t feel too full.
• Add fluid and fiber to your diet to prevent bloating and constipation.
• Take laxatives to help with constipation.
• Take medicines to treat diarrhea and belly pain.
• Raise the head of your bed when you sleep to help prevent heartburn.

To treat urinary symptoms, you might:

• Drink fluids and empty your bladder at set times during the day.
• Take medications such as oxybutynin (Ditropan XL) and tolterodine (Detrol) to stop your bladder muscle from squeezing too often.
• Take a medicine called bethanechol to help you empty your bladder all the way.
• Use a catheter, a tube that goes into your bladder to help empty it.

To treat sweating problems, you might:

• Try drugs that help you make less sweat, such as glycopyrrolate (Robinul, Robinul Forte) and botulinum toxin.
• Stay inside when it's hot outdoors.

To treat heart and blood pressure symptoms, such as dizziness when you stand up, you might:

• Take a medicine that raises your blood pressure, such as fludrocortisone or midodrine and pyridostigmine (Mestinon).
• Take medicine to control your heart rate, such as beta-blockers.
• Stand up more slowly so you don't get dizzy.
• Get extra salt and fluid in your diet to help raise your blood pressure (but only if your doctor recommends it since you don't want to raise your blood pressure too high or cause swelling).

To treat sexual symptoms, you might:

• Try drugs such as sildenafil (Revatio, Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxyn) to get and keep an erection.
• Use an external vacuum pump to pull blood into the penis to have an erection.
• Use a water-based lubricant to make vaginal sex more comfortable.
• Try the drug flibanserin (Addyl) if you are a premenopausal woman with low sexual desire.

How to Prevent Autonomic Neuropathy

The best way to protect your autonomic nervous system is to prevent or manage the conditions that can damage it. Some ways to do that:

• Control your blood sugar if you have diabetes.
• Follow treatment plans for any autoimmune condition you have.
• Maintain a healthy weight.
• Avoid alcohol and smoking.
• Stay physically active.
• Use appropriate safety equipment (such as helmets and seatbelts) when you work, play, or drive. 

Takeaways

When you have autonomic neuropathy, symptoms such as feeling faint when you stand, having sluggish digestion, or sweating too much or too little might seem mysterious or unrelated. But they happen because you have damage to nerves that control automatic processes in your body. Diabetes is the most common cause, but other conditions can also be involved. So, it's important to work with your doctor to figure out what's going on so you can limit further damage and feel better.

Autonomic Neuropathy FAQs 

What's the difference between neuropathy and autonomic neuropathy?

Autonomic neuropathy is a type of neuropathy, which just means any kind of nerve damage. It's also a form of peripheral neuropathy, which means nerve damage outside the brain and spinal cord. However, peripheral neuropathy more commonly refers to nerve damage in the feet, legs, hands, and arms that causes numbness, tingling, and other symptoms.

Can you recover from autonomic neuropathy?

In some cases, yes. Most notably, if you have diabetes, strict blood sugar control might slow down the nerve damage and sometimes reverse it. In most cases, the damage can't be reversed. But treatments can help relieve many of the symptoms.

What is diabetic autonomic neuropathy?

That's how your doctor might describe autonomic dysfunction caused by diabetes.

Does exercise help autonomic neuropathy?

Exercise might help autonomic neuropathy in many ways. For example, it might help control your blood sugar, blood pressure, and weight, which might help with both the underlying causes and the symptoms.

How long can you live with autonomic neuropathy?

That depends on the cause of your nerve damage. Some conditions affect your lifespan more than others. In people with diabetes, autonomic neuropathy might contribute to a shorter life through heart and kidney damage, but controlling your diabetes can help.