An autonomic neuropathy affects the nerves that control involuntary body functions such as heartbeat, blood pressure, digestion, sweating, and bladder function, among others. As part of the autonomic nervous system, these nerves help maintain homeostasis and regulate the body's response to stress.
Autonomic neuropathy can be caused by various factors, such as:
Diabetes, which is the most common cause of autonomic neuropathy. High blood sugar levels can damage the nerves over time, especially if the diabetes is poorly controlled.
Autoimmune diseases, such as lupus, Sjogren’s syndrome, rheumatoid arthritis, and Guillain-Barre syndrome, which can cause inflammation and damage to the nerves.
Infections, such as HIV, Lyme disease, botulism, and syphilis, which can affect the nerves directly or indirectly.
Medications, such as chemotherapy drugs, antiviral drugs, and blood pressure drugs, which can have side effects on the nerves.
Genetic disorders, such as familial amyloid polyneuropathy, Fabry disease, and hereditary sensory and autonomic neuropathy, which can affect the structure and function of the nerves.
Trauma, such as surgery, injury, or radiation, which can injure the nerves or disrupt the blood supply to the nerves.
Alcohol abuse, which can cause nerve damage due to nutritional deficiencies, toxicity, or direct effects on the nerves.
The symptoms of autonomic neuropathy can vary depending on the nerves and organs involved, and they can be mild or severe. Some of the common symptoms are:
Orthostatic hypotension, which is a sudden drop in blood pressure when standing up, causing dizziness, fainting, or blurred vision.
Gastroparesis, which is a delay in stomach emptying, causing nausea, vomiting, bloating, loss of appetite, or weight loss.
Erectile dysfunction, which is the inability to achieve or maintain an erection, or ejaculatory dysfunction, which is the inability to ejaculate or have an orgasm.
Urinary problems, such as difficulty starting or stopping urination, urinary incontinence, urinary retention, or urinary tract infections.
Constipation, diarrhea, or fecal incontinence, which are changes in bowel movements, frequency, or consistency.
Anhidrosis, which is the inability to sweat, or hyperhidrosis, which is excessive sweating, affecting the body’s ability to regulate temperature and prevent overheating.
Abnormal heart rate or rhythm, such as tachycardia, bradycardia, or arrhythmia, which can affect the blood flow and oxygen delivery to the organs.
Pupillary dysfunction, such as fixed or dilated pupils, or abnormal responses to light, which can affect the vision and eye health.
The diagnosis of autonomic neuropathy can be challenging, as the symptoms can be nonspecific, intermittent, or overlapping with other conditions. The diagnosis usually involves a combination of:
Symptom history, including onset, duration, frequency, and severity of symptoms, as well as the presence of any risk factors, including diabetes, autoimmune diseases, infections, medications, genetic disorders, trauma, or alcohol abuse.
A physical examination consists of checking blood pressure, heart rate, reflexes, sensations, and skin temperature, as well as eye, mouth, abdomen, genitals, and anus functions.
Infection, inflammation, diabetes, and other metabolic disorders can be detected through laboratory tests, such as blood, urine, and stool tests.
Tests of autonomic function measure the response of the autonomic nervous system to various stimuli, including deep breathing, tilting, cold, heat, and stress. As a result of these tests, cardiovascular, gastrointestinal, genitourinary, and sudomotor functions can be assessed.
The structure and function of the organs and tissues affected by autonomic neuropathy can be visualized with imaging tests such as ultrasound, X-ray, CT scan, MRI, or PET scan.
Tests to evaluate electrical activity, muscle response, or nerve tissue damage, such as nerve conduction studies, electromyography, or nerve biopsy.
The treatment of autonomic neuropathy depends on the cause, severity, and type of the symptoms, and it may involve:
Controlling blood sugar levels, managing autoimmune diseases, curing infections, changing or stopping medication, or correcting genetic disorders are all examples of treating the underlying condition.
Alpha-blockers, beta-blockers, fludrocortisone, midodrine, erythropoietin, or octreotide are used to treat orthostatic hypotension, gastroparesis, erectile dysfunction, urinary problems, or abnormal heart rhythms.
To relieve the symptoms and prevent complications, non-pharmacological interventions include wearing compression stockings, drinking more fluids, eating smaller and more frequent meals, avoiding alcohol and caffeine, using a heating pad or a fan, or applying lubricants or moisturizers.
Various devices are available to regulate the heart rate or rhythm, improve stomach emptying, or restore sexual function, such as pacemakers, implantable cardioverter-defibrillators, gastric stimulators, or penile implants.
Surgery, such as a sympathectomy, a vagotomy, or a colectomy, to cut or remove the nerves or organs that are causing the symptoms or complications.
The prevention of autonomic neuropathy mainly involves reducing the risk factors, such as:
Maintaining a healthy lifestyle, such as eating a balanced diet, exercising regularly, quitting smoking, and limiting alcohol intake.
Managing chronic conditions, such as diabetes, autoimmune diseases, infections, or genetic disorders, by following the doctor’s advice and taking the prescribed medications.
Avoiding or minimizing exposure to trauma, such as surgery, injury, or radiation, by taking precautions and seeking medical attention when needed.
Monitoring the symptoms and seeking medical help when they worsen or interfere with the daily activities or quality of life.
