Disease: Autonomic neuropathy

Autonomic neuropathy occurs when the nerves that control involuntary bodily functions are damaged. This may affect blood pressure, temperature control, digestion, bladder function and even sexual function.

The nerve damage interferes with the messages sent between the brain and other organs and areas of the autonomic nervous system, such as the heart, blood vessels and sweat glands.

While diabetes is generally the most common cause of autonomic neuropathy, other health conditions — even an infection — may be to blame. Some medications also may cause nerve damage. Symptoms and treatment will vary based on which nerves are damaged.

Source: http://www.mayoclinic.com

Signs and symptoms of autonomic neuropathy vary based on the nerves affected. They may include:

  • Dizziness and fainting when standing caused by a sudden drop in blood pressure.
  • Urinary problems, such as difficulty starting urination, incontinence, difficulty sensing a full bladder and inability to completely empty the bladder, which can lead to urinary tract infections.
  • Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men and vaginal dryness, low libido and difficulty reaching orgasm in women.
  • Difficulty digesting food, such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn, all due to changes in digestive function.
  • Sweating abnormalities, such as sweating too much or too little, which affects the ability to regulate body temperature.
  • Sluggish pupil reaction, making it difficult to adjust from light to dark and seeing well when driving at night.
  • Exercise intolerance, which may occur if your heart rate stays the same instead of adjusting in response to your activity level.

When to see a doctor

Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy, particularly if you have diabetes and it's poorly controlled.

If you have type 2 diabetes, the American Diabetes Association (the Association) recommends annual autonomic neuropathy screening for people with type 2 diabetes as soon as you've received your diabetes diagnosis. For people with type 1 diabetes, the Association advises annual screening beginning five years after diagnosis.

Source: http://www.mayoclinic.com

Many health conditions can cause autonomic neuropathy. It may also be a side effect of treatments for other diseases, such as cancer. Some common causes of autonomic neuropathy include:

  • Abnormal protein buildup in organs (amyloidosis), which affects the organs and the nervous system.
  • Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren's syndrome, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. Guillain-Barre syndrome is an autoimmune disease that happens rapidly and can affect autonomic nerves.

    Autonomic neuropathy may also be caused by an abnormal attack by the immune system that occurs as a result of some cancers (paraneoplastic syndrome).

  • Diabetes, which is the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.
  • Injury to nerves caused by surgery or radiation to the neck.
  • Treatment with certain medications, including some drugs used in cancer chemotherapy.
  • Other chronic illnesses, such as Parkinson's disease, multiple sclerosis and some types of dementia.
  • Certain infectious diseases. Some viruses and bacteria, such as botulism, Lyme disease and HIV, can cause autonomic neuropathy.
  • Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy.

Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren's syndrome, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. Guillain-Barre syndrome is an autoimmune disease that happens rapidly and can affect autonomic nerves.

Autonomic neuropathy may also be caused by an abnormal attack by the immune system that occurs as a result of some cancers (paraneoplastic syndrome).

Source: http://www.mayoclinic.com

Autonomic neuropathy is a possible complication of a number of diseases, and the tests you'll need often depend on your symptoms and risk factors for autonomic neuropathy.

When you have known risk factors for autonomic neuropathy

If you have conditions that increase your risk of autonomic neuropathy (such as diabetes) and have symptoms of the condition, extensive testing may not be necessary. Your doctor may perform a physical exam and ask about your symptoms.

If you are undergoing cancer treatment with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.

When you don't have risk factors for autonomic neuropathy

If you have symptoms of autonomic neuropathy but don't have risk factors, the diagnosis may be more involved. Your doctor will probably review your medical history, discuss your symptoms and do a physical exam.

Your doctor may perform tests to evaluate autonomic functions, which may include:

  • Breathing tests. These tests measure how your heart rate and blood pressure respond during exercises such as forcefully exhaling (Valsalva maneuver).
  • Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.

    A simpler way test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.

  • Gastrointestinal tests. Gastric-emptying tests are the most common tests to check for digestive abnormalities such as slow digestion and delayed emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in digestive disorders (gastroenterologist).
  • Quantitative sudomotor axon reflex test. This test evaluates how the nerves that regulate your sweat glands respond to stimulation. A small electrical current passes through four capsules placed on your forearm, foot and leg, while a computer analyzes the response of your nerves and sweat glands. You may feel warmth or a tingling sensation during the test.
  • Thermoregulatory sweat test. During this test, you're coated with a powder that changes color when you sweat. While lying in a chamber with slowly increasing temperature, digital photos document the results as you begin to sweat. Your sweat pattern may help confirm a diagnosis of autonomic neuropathy or suggest other causes for decreased or increased sweating.
  • Urinalysis and bladder function (urodynamic) tests. If you have bladder or urinary symptoms, a series of urine tests can evaluate bladder function.
  • Ultrasound. If you have bladder symptoms, your doctor may do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract.

Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.

A simpler way test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.

Source: http://www.mayoclinic.com

While certain inherited diseases that put you at risk of developing autonomic neuropathy can't be prevented, you can slow the onset or progression of symptoms by taking good care of your health in general and managing your medical conditions.

Follow your doctor's advice on healthy living to control diseases and conditions, which may include these recommendations:

  • Control your blood sugar if you have diabetes.
  • Seek treatment for alcoholism.
  • Get appropriate treatment for any autoimmune disease.
  • Take steps to prevent or control high blood pressure.
  • Achieve and maintain a healthy weight.
  • Stop smoking.
  • Exercise regularly.

Source: http://www.mayoclinic.com

Several alternative medicine treatments may help people with autonomic neuropathy. Remember to discuss any new treatments with your doctor to ensure that they won't interfere with treatments you're already receiving or cause you any harm.

Alpha-lipoic acid

Preliminary research suggests this antioxidant may be helpful in slowing or even reversing neuropathy that's causing blood pressure or heart rate problems, but more study is needed.

Acupuncture

This therapy, which uses numerous thin needles placed in specific points in the body, may help treat slow stomach emptying. More studies are needed to confirm what acupuncture's role is in treating autonomic neuropathy.

Electrical nerve stimulation

Some studies have found that this therapy, which uses low-energy electrical waves transmitted through electrodes placed on the skin, may help ease pain associated with diabetic neuropathy.

Source: http://www.mayoclinic.com

  • Posture changes. Stand up slowly, in stages, to decrease dizziness. Sit with your legs dangling over the side of the bed for a few minutes before getting out of bed. Flex your feet and grip your hands for a few seconds before standing up, to increase blood flow.

    Once standing, try tensing your leg muscles while crossing one leg over the other a few times to increase blood pressure.

  • Elevate the bed. If you have low blood pressure, it may also help to raise the head of your bed by about 4 inches by placing blocks or risers under the legs at the head of the bed.
  • Digestion. Eat small, frequent meals to combat digestive problems. Increase fluids, and opt for low-fat, high-fiber foods, which may improve digestion. You may also want to try restricting foods that contain lactose and gluten.
  • Diabetes management. Try to keep your blood sugar as close to normal as possible. Tight blood sugar control can help lessen symptoms and help to prevent or delay the onset of new problems.

Posture changes. Stand up slowly, in stages, to decrease dizziness. Sit with your legs dangling over the side of the bed for a few minutes before getting out of bed. Flex your feet and grip your hands for a few seconds before standing up, to increase blood flow.

Once standing, try tensing your leg muscles while crossing one leg over the other a few times to increase blood pressure.

Source: http://www.mayoclinic.com

Living with a chronic condition presents daily challenges. Some of these suggestions may make it easier for you to cope:

  • Set priorities. Accomplish the most important tasks, such as paying bills or grocery shopping, and save less important tasks for another day. Stay active, but don't overdo it.
  • Seek and accept help from friends and family. Having a support system and a positive attitude can help you cope with the challenges you face. Ask for or accept help when you need it. Don't shut yourself off from loved ones.
  • Talk to a counselor or therapist. Depression and impotence are possible complications of autonomic neuropathy. Seek help from a counselor or therapist in addition to your primary care doctor to discuss possible treatments.
  • Consider joining a support group. Ask your doctor about support groups in your area. If there isn't a specific group for people with neuropathies, you may find that there's a support group for your underlying condition, such as diabetes.

    Some people find it helpful to talk to other people who truly understand what they're going through. Support group members can offer camaraderie, as well as tips or tricks to make living with autonomic neuropathy easier.

Consider joining a support group. Ask your doctor about support groups in your area. If there isn't a specific group for people with neuropathies, you may find that there's a support group for your underlying condition, such as diabetes.

Some people find it helpful to talk to other people who truly understand what they're going through. Support group members can offer camaraderie, as well as tips or tricks to make living with autonomic neuropathy easier.

Source: http://www.mayoclinic.com

Factors that may increase your risk of autonomic neuropathy include:

  • Diabetes. Diabetes, especially when poorly controlled, increases your risk of autonomic neuropathy and other nerve damage. You’re at greatest risk if you have had the disease for more than 25 years and have difficulty controlling your blood sugar, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

    Additionally, people with diabetes who are overweight or have high blood pressure or high cholesterol have a higher risk of autonomic neuropathy.

  • Other diseases. Amyloidosis, porphyria, hypothyroidism and cancer (usually due to side effects from treatment) may also increase the risk of autonomic neuropathy.

Diabetes. Diabetes, especially when poorly controlled, increases your risk of autonomic neuropathy and other nerve damage. You’re at greatest risk if you have had the disease for more than 25 years and have difficulty controlling your blood sugar, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Additionally, people with diabetes who are overweight or have high blood pressure or high cholesterol have a higher risk of autonomic neuropathy.

Source: http://www.mayoclinic.com

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