Autonomic Neuropathy: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Prevention

Autonomic neuropathy is the outcome of damage to the nerves that control the body's autonomic functions. There may be effects on blood pressure, digestion, temperature control, bladder function, and even sexual function.

The damage to the nerves affects the signals that leave the brain and go to different organs and areas of the autonomic nervous system. Among these areas are the heart, blood arteries, and sweat glands.

Diabetes is the most common cause of autonomic neuropathy. Possible causes include drug interactions, microbial or viral infections, and other illnesses. Symptoms and treatment vary depending on the damaged nerve.

Causes Of Autonomic Neuropathy

Several medical conditions might cause autonomic neuropathy. It might also arise as an adverse reaction to other illnesses, such as cancer. Autonomic neuropathy frequently occurs for the following reasons:

• Autonomic neuropathy is most commonly caused by diabetes, especially if it is not properly managed. Diabetes may eventually cause damage to every nerve in the body.
• An abnormal protein accumulation in the tissues that impacts the nervous system and the organs is called amyloidosis.
• Autoimmune illnesses are disorders where your body's defenses attack and damage certain body parts, such as your nerves. Examples include systemic lupus erythematosus, rheumatoid arthritis, celiac disease, and Sjogren syndrome. An autoimmune disorder called Guillain-Barre syndrome can affect autonomic nerves and proceed swiftly.
• Autonomic neuropathy can also be caused by an immunological response to some cancers (paraneoplastic disease).
• Certain pharmaceuticals are drugs, like the ones used in cancer chemotherapy.
• A few bacteria and viruses, such as HIV and those that cause botulism and Lyme disease.
• Some inherited diseases can also cause autonomic neuropathy.

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Symptoms Of Autonomic Neuropathy

Autonomic neuropathy symptoms and indicators are determined by damaged nerves. They could include:

• Standing lightheadedness and syncope brought on by a sudden drop in blood pressure.
• Difficulties urinating, loss of control, difficulty feeling full in the bladder, and incomplete bladder emptying are examples of urinary issues. When the bladder cannot be completely emptied, urinary tract infections may result.
• Sexual dysfunction, including problems with ejaculation and obtaining and maintaining an erection. Dry vagina, low libido, and difficulty having an orgasm are problems that women encounter.
• Problems with food digestion, such as feeling full after a small amount of food, appetite loss, constipation, diarrhea, abdominal bloating, nausea, vomiting, trouble swallowing, and heartburn. These problems are all caused by changes in the way the digestive system functions.
• Failure to recognise hypoglycemia, or low blood sugar, due to the absence of warning symptoms like shaking.
• Problems with sweating, such as too much or too little sweating. These problems affect how well the body regulates its temperature.
• Delayed pupil response, which makes changing from light to dark and driving at night difficult.
• If your heart rate does not change in response to your activity level, you may develop exercise intolerance.

Also Read: Everything You Need To Know About Diabetic Nephropathy

Risk Factors of Autonomic Neuropathy

A few factors may increase your risk of developing autonomic neuropathy:

• Diabetes: People with diabetes are more likely to develop autonomic neuropathy and other nerve damage, particularly if their condition is not effectively treated. The largest risk is if you are unable to regulate your blood sugar.
• Different medical conditions: Many illnesses, including amyloidosis, porphyria, and hypothyroidism, can raise the risk of autonomic neuropathy. Cancer can also occur, typically as a result of therapy side effects.

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Diagnosis Of Autonomic Neuropathy

Autonomic neuropathy is a potential side effect of several illnesses. Which testing you need depends on your symptoms and risk factors for autonomic neuropathy.

When you are aware of the risk factors for autonomic neuropathy

If you have diabetes or another condition that increases your risk of autonomic neuropathy, your doctor will examine you physically and ask about your symptoms.

If you are using a medicine known to cause nerve damage as part of your cancer treatment, your healthcare provider will check for indications of neuropathy.

In the absence of risk factors for autonomic neuropathy

A more complicated diagnosis could be made if there are symptoms of autonomic neuropathy but no risk factors. Your doctor will probably examine you physically, go over your medical history, and have a conversation with you about your symptoms.

The following tests to evaluate autonomic functions may be recommended by your healthcare provider:

• Evaluation of autonomic processes: These tests measure your heart rate and blood pressure in reaction to breathing exercises like the Valsalva maneuver, which is inhaling deeply and exhaling forcefully.
• Tilt table test: This test measures how the heart rate and blood pressure respond to variations in posture and position. It simulates what occurs when you raise yourself from a lying position. You lie flat on a tilting table that raises your upper body. To compensate for the drop in blood pressure, the heart rate typically increases and the blood vessels constrict. This response may take longer if you have autonomic neuropathy. To measure this response more simply, take your blood pressure after three minutes while sitting, standing, and reclined. In an additional test, the subject's blood pressure and pulse rate are tracked as they stand for one minute, squat for another, and then stand again.
• Examinations of the digestive system: Gastroparesis, or the gastric-emptying test, is the most widely used diagnostic tool for digestive issues, including delayed stomach emptying and sluggish digestion. The person who usually does these tests is a gastroenterologist, a doctor who specializes in digestive disorders.
• Quantitative sudomotor axon reflex test: This examination assesses how your sweat glands respond to stimulation of their nerves. You have capsules on your foot, upper and lower thigh, and forearm that are filled with a little electrical current. A computer analyzes your sweat glands and nerve responses. You can feel warm or tingly throughout the test.
• Thermoregulation test using sweat: When you perspire, the powder coating that has been applied to you changes color. As you lie in a room that is progressively getting hotter, digital photographs capture the results as you start perspiring. Your pattern of perspiration may help corroborate an autonomic neuropathy diagnosis or point to other causes of decreased or excessive perspiration.
• Urinalysis tests that measure bladder function (urodynamics): If you experience bladder-related symptoms or urinary signs and symptoms, a battery of urine and bladder tests can evaluate bladder function.
• Ultrasound: If some signs and symptoms point to your bladder, your doctor can recommend an ultrasound of your urinary system. In this investigation, high-frequency sound waves are utilized to present an overview of the bladder and other urinary tract organs.

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Treatment Of Autonomic Neuropathy

Treatment options for autonomic neuropathy are numerous.

• Treating the underlying disease: Treating autonomic neuropathy primarily aims to manage the disease or condition that is damaging your nerves. If your nerve damage is being caused by diabetes, you will need to regularly monitor your blood sugar levels to prevent further damage. In around half of instances, the underlying cause of autonomic neuropathy remains unknown.
• Regulating specific symptoms: Certain medicines have the potential to mitigate the symptoms of autonomic neuropathy. How you are treated will depend on whatever part of your body has the most obvious nerve damage.

Gastrointestinal symptoms 

Your healthcare provider may recommend:

• Changes to the diet: You could need more water and fiber in your diet. Supplements with fiber, such as Citrucel or Metamucil, could also be helpful. Gradually increase your fiber consumption to avoid gas and bloating.
• Medicine that helps in emptying the stomach: With the help of a prescription drug called metoclopramide (Reglan), your stomach will empty more quickly by contracting more fully. Because this medicine can cause sleepiness, it is not advised to use it for longer than 12 weeks.
• Medications used for constipation: You can treat constipation with over-the-counter laxatives. Find out from your physician how often laxatives are recommended.
• Medications to treat diarrhea: Antibiotics can help treat diarrhea by reducing the proliferation of bacteria in the intestines. Anti-diarrhea over-the-counter drugs might be helpful.

Urinary Symptoms

Your doctor may suggest:

• Bladder control: Developing and maintaining a schedule for when to consume fluids and when to urinate can help your bladder become more capable and taught to empty at the appropriate times.
• Medicine to treat problems with the bladder: Your healthcare provider may recommend medications to lessen an overactive bladder. Other medications may help with voiding the bladder.
• Catheterization: A tube is inserted into your urethra to empty your bladder.

Sexual Disorders Symptoms

When treating male erectile dysfunction, doctors may recommend:

• Medications that help get an erection: Drugs including vardenafil, tadalafil, avanafil, and sildenafil can help you achieve and maintain an erection. Possible side effects include flushing, upset stomach, low blood pressure, mild headaches, and changes in color vision. If you have a history of arrhythmia, high blood pressure, heart disease, or stroke, use these medications with caution. Furthermore, avoid taking these medications if you are taking any form of organic nitrate. Seek immediate medical attention if your erection lasts longer than four hours.
• External source of Vacuum: This device helps to draw blood into the penis by using a hand pump. A tension ring helps keep the blood in for up to 30 minutes.

When women experience symptoms related to sexuality, doctors may recommend:

• Vaginal lubricants to lessen dryness and enhance comfort and satisfaction during intercourse.
• One of the few medications approved for use in premenopausal women with low libido.

Cardiac rhythm and blood pressure symptoms

Autonomic neuropathy can cause issues with heart rate and blood pressure. Your physician might advise:

• A diet high in salt and liquids: If your blood pressure drops when you stand up, eating a diet high in salt and water can help keep it from falling too low. This medicine may cause edema in the feet, ankles, or legs. It may also cause elevated blood pressure. It is usually only recommended in cases of severe hypertension as a result. Furthermore, patients with heart failure should not receive this medication.
• Compression Stockings: Enhancing blood flow can be helped by wearing a binder around the waist or thigh-high compression stockings.
• Medications that raise blood pressure: If you feel dizzy or faint when standing up, your doctor might prescribe medicine. Fludrocortisone reduces blood pressure by helping your body retain salt. Both midodrine (Orvaten) and droxidopa (Northera) can elevate blood pressure. However, these drugs can cause an increase in blood pressure when you're in a lying position. Octreotide, also known as sandostatin, can help diabetics with hypotension raise their blood pressure when taken with food; however, there may be negative effects as well. Pyridostigmine (Mestinon) may help keep blood pressure steady while standing.
• Drug designed to regulate heart rate: A class of medications called beta blockers can assist in regulating your heart rate during physical activity if it rises too high.

Sweating

If you sweat too much, your doctor could prescribe medication to lessen your sweating. Glycopyrrolate can reduce perspiration. Side effects include things like headaches, taste loss, dry mouth, dizziness, retention of urine, visual problems, and tiredness. Glycopyrrolate can increase the risk of heat-related diseases, such as heatstroke, because of its reduced ability to sweat.

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