Autonomic Neuropathy: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Autonomic Neuropathy?
A neurologist, a nerve doctor, treats autonomic neuropathy. People with diabetes may also see an endocrinologist, a doctor who treats hormone problems such as diabetes. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is Autonomic Neuropathy?
Autonomic neuropathy is damage to nerves that control jobs your body does on its own. These jobs include blood pressure, heart rate, sweating, bladder and bowel emptying, and digestion. The hurt nerves are part of the autonomic nervous system. This condition is a group of symptoms, not one disease.
Symptoms
Symptoms depend on which nerves are hurt. They usually grow slowly over years. Common symptoms include:
- A drop in blood pressure when you stand up, which causes dizziness.
- Abnormal heart rate or rhythm.
- Constipation or diarrhea, nausea, or feeling full after a few bites.
- Gastroparesis, which slows or stops food moving out of the stomach.
- Trouble starting to urinate, leaking urine, or a feeling that the bladder did not empty.
- Sweating too much or too little, such as a lot at night or while eating.
- Sexual problems, such as erection problems in men and vaginal dryness in women.
- Weight loss without trying.
Damaged nerves can also keep you from feeling the warning signs of low blood sugar or a heart attack.
Causes and who gets it
High blood sugar and high blood fats called triglycerides can hurt nerves over time. They can also hurt the small blood vessels that feed the nerves. Other causes include alcohol overuse, HIV/AIDS, multiple sclerosis, Parkinson disease, spinal cord injury, Guillain-Barre syndrome and other diseases that inflame nerves, inherited nerve disorders, and surgery or injury that harms the nerves.
How doctors diagnose it
Doctors look at your symptoms, your medical history, and a physical exam. Your blood pressure and heart rate may change when you lie down, sit, or stand. Tests can include checking your heart rate while you breathe deeply or stand. Blood pressure can be checked lying down, then after standing up. Doctors may also test how you sweat. Other tests depend on your symptoms, such as stomach emptying tests or bladder ultrasound exams.
Treatment
In most cases the nerve damage cannot be reversed. So treatment and self-care focus on easing symptoms and preventing new problems. For blood pressure drops, doctors may suggest extra salt, more liquids, raising the head of the bed, or compression stockings. Standing up slowly helps too. Some medicines, such as fludrocortisone, help the body keep salt and fluid. For stomach problems, small frequent meals and daily bowel care may help. Other medicines can speed the stomach. Medicines and self-care can also help with bladder, erection, and bowel control problems. Keeping your blood sugar, blood pressure, and cholesterol near your goal numbers can keep the damage from getting worse.
When to see a doctor
Contact your doctor if you feel lightheaded when standing, notice changes in bowel, bladder, or sexual function, or have unexplained nausea and vomiting when eating. Early diagnosis and treatment may control symptoms. Autonomic neuropathy can hide the chest pain of a heart attack. Call 911 for sudden fatigue, sweating, shortness of breath, or nausea and vomiting. If low blood sugar makes someone pass out, they need a glucagon shot and a 911 call right away.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can run first checks for dizziness, digestive changes, or bladder changes. Either can also watch your blood pressure over time and refer you to a neurologist or diabetes doctor.
Common questions
Can nerve damage from autonomic neuropathy be reversed?
Most often it cannot. Treatment and self-care focus on managing symptoms and preventing new problems. How well you do depends on the cause and whether it can be treated.
Why does diabetes cause autonomic neuropathy?
Over time, high blood sugar and high blood fats called triglycerides can damage the nerves and the small blood vessels that feed them. Keeping blood sugar, blood pressure, and cholesterol near your goals can keep the damage from getting worse.
Why is a drop in blood pressure when standing a warning sign?
It can mean the nerves that control blood pressure are damaged. Standing up slowly and drinking more liquids can help. Tell your doctor about this symptom.
Can autonomic neuropathy hide a heart attack?
Yes. It can hide the warning signs, so you may not feel chest pain. Instead you may have only sudden fatigue, sweating, shortness of breath, or nausea and vomiting during a heart attack. Call 911 right away for those symptoms.
Sources
- MedlinePlus - Autonomic neuropathy: MedlinePlus Medical Encyclopedia
- National Institute of Diabetes and Digestive and Kidney Diseases - Autonomic Neuropathy
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
