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Autonomic Neuropathy

Last updated Dec. 15, 2019

Approved by: Krish Tangella MD, MBA, FCAP

The brain, through autonomic nerves, controls the heart rate, blood pressure, bladder and bowel movement, sweating, digestion, and many other functions. Any damage to these autonomic nerves leads to Autonomic Neuropathy, and this condition generally affects older adults.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Autonomic Nerve Disease

What is Autonomic Neuropathy? (Definition/Background Information)

  • The brain, through autonomic nerves, controls the heart rate, blood pressure, bladder and bowel movement, sweating, digestion, and many other functions
  • Any damage to these autonomic nerves leads to Autonomic Neuropathy, and this condition generally affects older adults
  • Nerve injury or damage due to a variety of conditions and treatments could potentially cause Autonomic Neuropathy. These include autoimmune disorders, such as systemic lupus and rheumatoid arthritis, Parkinson’s disease, multiple sclerosis, radiation treatment for certain cancers, etc.
  • The nerve damage may affect the transmission of signals to the heart, blood vessels, stomach and intestines, bladder, or eye depending on the specific set of nerves that are involved. This could lead to specific sets of symptoms such as constipation, diarrhea, nausea, heart rate abnormalities, light headedness, urination, and erectile dysfunction
  • The risk factors for Autonomic Neuropathy include diabetes, obesity, high blood pressure, and the development of conditions such as cancer, hypothyroidism, and amyloidosis
  • Autonomic Neuropathy is diagnosed based on physical examination and a number of tests depending on the specific set of nerves that may be affected as suspected by the physician). The tests may include checking for movement of food in the stomach, heart function, and urinary bladder function
  • The treatment for Autonomic Neuropathy usually includes medications that are meant to correct the specific condition the individual is facing. Leading a healthy lifestyle, responsible drinking, maintaining good glycemic status, and the treatment of underlying conditions to prevent nerve damage are some preventive options for Autonomic Neuropathy
  • Several complications could arise from Autonomic Neuropathy, because the nerve damage can be irreversible. This may range from the inability to stand without support to psychological trauma. Therefore, the prognosis for Autonomic Neuropathy depends on the severity of nerve damage

Who gets Autonomic Neuropathy? (Age and Sex Distribution)

  • Autonomic Neuropathy generally tends to occur in elderly adults
  • Both males and females and susceptible to the condition
  • It is observed worldwide; all racial and ethnic groups may be affected

What are the Risk Factors for Autonomic Neuropathy? (Predisposing Factors)

The risk factors for Autonomic Neuropathy include:

  • Uncontrolled diabetes; particularly diabetics who are overweight or have high blood pressure
  • Certain diseases and disorders, such as poorly-functioning thyroid (hypothyroidism) or amyloidosis (in which there is an abnormal accumulation of protein damaging the tissues), and cancers (may also be a side effect of treatment)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Autonomic Neuropathy? (Etiology)

Autonomic Neuropathy may be caused by:

  • Poorly-controlled diabetes
  • Autoimmune diseases, where the body’s immune system turns against itself, such as systemic lupus erythematosus, rheumatoid arthritis, celiac disease, and other similar conditions
  • Amyloidosis - abnormal accumulation of protein leading to tissue damage
  • Infections such as HIV, Lyme disease, or botulism
  • Nerve injury during radiation treatment for cancers in the neck or surgery
  • Parkinson’s disease
  • Multiple sclerosis

What are the Signs and Symptoms of Autonomic Neuropathy?

The signs and symptoms of Autonomic Neuropathy depend on the nerves which are affected. These may include:

  • Constipation, diarrhea, nausea, vomiting, bloating or feeling of fullness after eating small portions, when nerves to the stomach and intestine are damaged
  • Abnormalities of heart rate and blood pressure, or feeling of light-headedness when standing up from a sitting position, when the nerves supplying the heart or blood vessels are involved
  • Excessive or reduced sweating
  • Urination-related difficulties
  • Difficulty in getting or maintaining erections (in men)
  • Vaginal dryness or difficulties with orgasm (in women)
  • Impairment of the eye pupil size; the adjustment function according to brightness of environment may be impaired

How is Autonomic Neuropathy Diagnosed?

Autonomic Neuropathy is diagnosed with a detailed history and physical examination. The following tests might help a physician to arrive at an accurate diagnosis:

  • Gastric emptying tests to check for any delay in movement of food through the stomach
  • Assessment of changes in heart rate and blood pressure with changes in posture or with forceful exhalation
  • Thermoregulatory sweat test to look for increased or decreased sweating
  • Quantitative sudomotor axon reflex test (QSART): The response of nerves to sweat glands and the glands themselves is studied after applying mild electrical stimulation
  • Urine and bladder function tests

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Autonomic Neuropathy?

Autonomic Neuropathy may lead to the following complications:

  • Excessive diarrhea or vomiting may lead to fluid or electrolyte imbalance in the body
  • Sudden decrease in blood pressure on standing from sitting posture may lead to dizziness and falls
  • Kidney abnormalities
  • Abnormalities of nutritional status or weight
  • Impotence can cause psychological issues

How is Autonomic Neuropathy Treated?

Autonomic Neuropathy is managed by treating any underlying cause such as maintenance of blood sugar in diabetes. Further management depends on the presenting symptoms:

  • Gastrointestinal symptoms: Medications to improve gastrointestinal motility (metoclopramide), high-fiber diet, medications to ease diarrhea or constipation, and daily bowel care program 
  • Urinary symptoms: Medications to improve bladder emptying (bethanechol), medications to decrease bladder overactivity (tolterodine, oxybutynin)
  • Heart rate and blood pressure: High salt and high fluid diet, medication to promote retention of salt and fluid by the body (fludrocortisone), medication to control heart rate
  • Sexual dysfunction: Vaginal lubricants in women and drugs, such as sildenafil or tadalafil, for men with erection problems

How can Autonomic Neuropathy be Prevented?

Some of the possible preventive measures for Autonomic Neuropathy include:

  • Adequate control of blood sugar levels in diabetes
  • Proper maintenance of body weight and blood pressure
  • Appropriate treatment of alcoholism, autoimmune disorders, or other predisposing conditions

What is the Prognosis of Autonomic Neuropathy? (Outcomes/Resolutions)

  • Nerve damage in Autonomic Neuropathy is most often irreversible and requires long-term treatment of symptoms
  • The prognosis is linked to the underlying cause and extent of autonomic nerve damage

Additional and Relevant Useful Information for Autonomic Neuropathy:

Early research has shown that alpha-lipoic acid, an antioxidant, may be beneficial in treating neuropathy causing blood pressure or heart rate disturbances.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 28, 2015
Last updated: Dec. 15, 2019