Autonomic neuropathy

Causes

Autonomic neuropathy is a group of symptoms, not a specific disease. There are many causes.

Autonomic neuropathy involves damage to the nerves that carry information from the brain and spinal cord to the heart, bladder, intestines, sweat glands, pupils, and blood vessels.

Autonomic neuropathy may be seen with:

• Alcohol abuse
• Diabetes (diabetic neuropathy)
• Disorders involving scarring of tissues around the nerves
• Guillain Barre syndrome or other diseases that inflame nerves
• HIV and AIDS
• Inherited nerve disorders
• Multiple sclerosis
• Parkinson's disease
• Spinal cord injury   
• Surgery or injury involving the nerves

Symptoms

Symptoms vary depending on the nerves affected. They usually develop gradually over years. Symptoms may include:

Stomach and intestines

• Constipation (hard stools)
• Diarrhea (loose stools)
• Feeling full after only a few bites (early satiety)
• Nausea after eating
• Problems controlling bowel movements
• Swallowing problems
• Swollen abdomen
• Vomiting of undigested food

Heart and lungs

• Abnormal heart rate or rhythm
• Blood pressure changes with position and causes dizziness when standing
• High blood pressure
• Shortness of breath with activity or exercise

Bladder

• Difficulty beginning to urinate
• Feeling of incomplete bladder emptying
• Leaking urine 

Other

• Sweating too much or not enough
• Heat intolerance brought on with activity and exercise
• Sexual problems including erection problems in men and vaginal dryness and orgasm difficulties in women
• Small pupil in one eye
• Weight loss without trying

Exams and Tests

Signs of autonomic nerve damage are not always seen when yourdoctor or nurse examines you. Your blood pressure or heart rate may change when lying down, sitting, and standing.

Special tests to measure sweating and heart rate may be done. This is called "autonomic testing."

Other tests depend on what type of symptoms you have.

Treatment

Treatment to reverse nerve damage is most often not possible. As a result, treatment and self-care are focused on managing your symptoms and preventing further problems.

Your doctor or nurse may recommend:

• Extra salt in the diet or taking salt tablets to increase fluid volume in blood vessels
• Fludrocortisone or similar medications to help your body retain salt and fluid
• Medicines to treat irregular heart rhythms
• Pacemaker
• Sleeping with the head raised
• Wearing elastic stockings

The following may help your intestines and stomach work better:

• Daily bowel care program
• Medications that increase gastric motility (such as Reglan)
• Sleeping with the head raised
• Small, frequent meals

Medicines and self-care programs can help you if you have:

• Urinary incontinence
• Neurogenic bladder
• Erection problems

Outlook (Prognosis)

How well you do depends on the cause of the problem and if it can be treated.

Possible Complications

• Fluid or electrolyte imbalance such as low blood potassium (if excessive vomiting or diarrhea)
• Injuries from falls (with postural dizziness)
• Kidney failure (from urine backup)
• Malnutrition
• Psychological/social effects of impotence

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms of autonomic neuropathy. Early symptoms might include:

• Becoming faint or lightheaded when standing
• Changes in bowel, bladder, or sexual function
• Unexplained nausea and vomiting when eating

Early diagnosis and treatment increases the likelihood of controlling symptoms.

Autonomic neuropathy may hide the warning signs of a heart attack.  They are sudden fatigue, sweating, shortness of breath, nausea, and vomiting.

Prevention

Preventing or controlling disorders associated with autonomic neuropathy may reduce the risk. For example, people with diabetes should closely control blood sugar levels.

Alternative Names

Neuropathy - autonomic; Autonomic nerve disease

References

Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 446.

Benarroch E, Freeman R, Kaufman H. Autonomic nervous system. In: Goetz CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 21.

Chelimsky T, Robertson D, Chelimsky G. Disorders of the Autonomic Nervous System. In: Daroff: Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia,Pa; Elsevier; 2012: chap 77.

Update Date: 10/3/2012

Updated by: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.