Autonomic Neuropathy

When the nerves that regulate automatically occurring bodily activities are damaged, autonomic neuropathy develops. Blood pressure, temperature regulation, digestion, bladder function, and even sexual function can all be impacted.

The autonomic nervous system's ability to communicate with other organs and regions of the body is impacted by nerve injury. The heart, blood vessels, and sweat glands are some of these regions.

Autonomic Neuropathy: Causes

Autonomic neuropathy can be brought on by several medical disorders. It may also be a side effect of medications used to treat other conditions, such as cancer. The following are some typical causes of autonomic neuropathy −

  • The most frequent cause of autonomic neuropathy is diabetes, particularly when it is not well managed. Diabetes has the potential to harm the body's nerves over time.

  • Amyloidosis is an abnormal protein deposition in organs that has an impact on both the neurological system and the organs.

  • Disorders where your immune system assaults and damages various bodily tissues, including your nerves. Examples include celiac illness, rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome. Rapidly developing autoimmune illness Guillain-Barre syndrome can harm autonomic nerves.

  • Another factor that might contribute to autonomic neuropathy is an immunological response brought on by some malignancies (paraneoplastic syndrome).

  • Some pharmaceuticals, including some used in the treatment of cancer (chemotherapy).

  • HIV, the germs that cause botulism and Lyme disease, and other viruses and bacteria.

  • Autonomic neuropathy may also be caused by certain hereditary diseases.

Autonomic Neuropathy: Symptoms

Which nerves are destroyed determines the autonomic neuropathy signs and symptoms.

  • Standing dizziness and fainting brought on by a sharp decrease in blood pressure

  • Urinary issues, including failure to empty the bladder, inability to start urinating, lack of bladder control, and difficulties recognizing a full bladder. Urinary tract infections can result from the bladder not being able to drain entirely.

  • Difficulty with ejaculation or obtaining or keeping an erection are examples of sexual difficulties. Vaginal dryness decreased libido, and difficulties in inducing orgasm are issues that affect women.

  • Food digestion issues include feeling full after only a few bites, losing appetite, experiencing diarrhea or constipation, abdominal bloating, experiencing nausea or vomiting, having trouble swallowing, and experiencing heartburn. All of these issues are brought on by alterations in digestive function.

  • Not being able to detect hypoglycemia since there are no warning signs, such as being unsteady.

  • Difficulties with perspiration, such as excessive or insufficient sweating. The capability to control body temperature is impacted by these issues.

  • Slow pupil responsiveness makes it harder to transition from light to dark and impairs nighttime driving vision.

  • Exercise intolerance might develop if your heart rate doesn't change with your amount of activity but rather remains constant.

Autonomic Neuropathy: Risk Factors

The major risk factors include −

  • Diabetes  Your risk of autonomic neuropathy and other nerve damage increases if you have diabetes, especially if it is poorly managed. If you have trouble keeping your blood sugar under control, you're most at risk.

  • Various illnesses  The likelihood of developing autonomic neuropathy can be boosted by several medical diseases, such as amyloidosis, porphyria, and hypothyroidism. Cancer can also, typically as a result of negative effects from therapy.

Autonomic Neuropathy: Diagnosis

To diagnose autonomic neuropathy −

  • Tests of autonomic function  These exams assess how your heart rate and blood pressure change in response to activities like aggressively exhaling and deep breathing (Valsalva maneuver).

  • Table tilt test  This test tracks how the body reacts to changes in posture and position by measuring blood pressure and heart rate. It mimics what happens when you get out of a lying-down position. You lie flat on a surface that is later inclined to elevate your upper body. The normal response to a decline in blood pressure is for blood vessels to constrict and the heart rate to rise. If you have autonomic neuropathy, this reaction could be delayed.

  • Intestinal examinations  The most frequent tests to look for digestive problems, such as sluggish digesting and delayed stomach emptying, are gastric-emptying tests (gastroparesis).

  • Test of the quantitative sudomotor axon reflex  This test evaluates how your sweat glands' control neurons react to stimulus. Your forearm, upper and lower legs, and foot all have capsules that are subjected to a very modest electrical current. Your nervous system and sweat glands' reaction is analyzed by a computer. During the test, you can experience warmth or a tingling feeling.

  • Test for thermoregulatory sweat  A powder that is applied to you changes color as you perspire. Digital pictures capture the outcomes when you start to perspire while you lay in a room that gradually warms up. Your sweat pattern may point to additional reasons for reduced or increased sweating or assist in confirming the diagnosis of autonomic neuropathy.

  • Ultrasound  Your doctor might advise having an ultrasound of your urinary system if you have symptoms and signs of bladder problems.

Autonomic Neuropathy: Treatment

Autonomic neuropathy can be treated in the following ways −

  • Treating the primary illness  Managing the illness or condition that is causing your nerves to suffer is the first step in treating autonomic neuropathy. You must maintain strict blood sugar management if diabetes is the root cause of your nerve damage if you want to stop the damage from becoming worse.

  • Controlling particular symptoms  The signs and symptoms of autonomic neuropathy can be treated. The best course of action depends on which body area has the most nerve damage.

  • Food choices  You could require additional water and dietary fiber. Fiber supplements may also be beneficial.

  • Medication that facilitates stomach emptying  Metoclopramide, a prescription medication, increases the contractions of the digestive tract so that your stomach empties more quickly. Use of this drug shouldn't go beyond 12 weeks because it may make you sleepy.

  • Medications that alleviate constipation  Constipation can be alleviated by over-the-counter laxatives. Find out from your doctor how frequently you should take a laxative.

  • Drugs to treat diarrhea  By limiting the development of bacteria in the intestines, antibiotics can alleviate diarrhea. Anti-diarrheal drugs that are over-the-counter may be beneficial.

  • Bladder-training exercises  Increasing the capacity of your bladder and retraining it to empty at the proper times can both be accomplished by adhering to a timetable for when to drink fluids and when to pee.

  • Medication for treating bladder discomfort  Medication to reduce an overactive bladder may be recommended by your doctor. Your bladder may be helped to drain by other drugs.

Autonomic Neuropathy: Prevention

It is impossible to avoid some genetic illnesses that increase your chance of getting autonomic neuropathy. But by treating your medical problems and your overall health, you can delay the development or spread of symptoms.

Follow your doctor's recommendations for a healthy lifestyle to help reduce illnesses and disorders. The following suggestions might be part of the advice −

  • If you have diabetes, control your blood sugar levels.

  • Don't drink or smoke.

  • If you have an autoimmune condition, get the right therapy.

  • Take measures to lower or avoid high blood pressure.

  • Obtain and keep a healthy weight.

  • Regular exercise


Dysautonomia or autonomic dysfunction are other names for autonomic neuropathy. These names include a wide range of ailments that impair the autonomic nervous system (ANS). The ANS regulates a variety of bodily processes, including breathing, controlling blood pressure, digestion, regulating body temperature, and more. In addition to being a side effect of some drugs, autonomic neuropathy can be a consequence of many illnesses and ailments.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 03-Mar-2023


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