Autonomic Neuropathy

Overview

Autonomic neuropathy is a condition that occurs when there is damage to the nerves that control automatic body functions. These nerves regulate blood pressure, temperature control, digestion, bladder function, and other essential bodily processes. The nerve damage affects the communication between the brain and other organs and areas of the autonomic nervous system, such as the heart, blood vessels, and sweat glands. The most common cause of autonomic neuropathy is diabetes, but it can also be caused by other health conditions, viral or bacterial infections, or certain medications. Symptoms vary depending on which nerves are damaged, but they may include dizziness, fainting, excessive sweating, changes in blood pressure, and gastrointestinal problems. It is essential to see a healthcare provider if you experience weakness, tingling, numbness, or a loss of feeling in a limb, as early treatment of peripheral nerve injuries is crucial. Causes of peripheral nerve damage include injuries, medical conditions like diabetes, autoimmune diseases, and certain medications. Prevention of autonomic neuropathy involves taking care of your overall health, managing medical conditions, and following your healthcare provider's advice on healthy living.

Understanding the disease

Symptoms

The symptoms of autonomic neuropathy depend on which nerves are damaged. They might include dizziness and fainting when standing, heat intolerance, excessive sweating or not being able to sweat, bowel, bladder or digestive problems, drops in blood pressure causing dizziness or lightheadedness, exercise intolerance, and more.

Risk Factors

Risk factors for developing autonomic neuropathy include:

1. Diabetes, especially when poorly controlled, which increases the risk of nerve damage throughout the body.
2. Other diseases, such as amyloidosis, porphyria, hypothyroidism, and cancer, which can increase the risk of autonomic neuropathy.
3. Certain inherited disorders that can cause autonomic neuropathy.
4. Poorly controlled blood sugar levels in people with diabetes.
5. Excessive alcohol consumption and smoking. It's important to manage these risk factors by following your healthcare provider's advice on maintaining a healthy lifestyle, controlling blood sugar levels (if you have diabetes), avoiding alcohol and smoking, and getting appropriate treatment for any underlying health conditions.

Development

Autonomic neuropathy can develop as a result of damage to the nerves that control automatic body functions. This damage can be caused by several factors, including:

1. Diabetes: Poorly controlled diabetes is the most common cause of autonomic neuropathy. High blood sugar levels over an extended period can cause nerve damage, leading to various symptoms.
2. Other health conditions: Conditions like amyloidosis, porphyria, hypothyroidism, and cancer can increase the risk of autonomic neuropathy.
3. Medications: Certain medications, including chemotherapy drugs used in cancer treatment, can cause autonomic neuropathy as a side effect. Infections like HIV, botulism, and Lyme disease can also lead to nerve damage.
4. Autoimmune diseases: Autoimmune diseases, such as Sjogren syndrome, systemic lupus erythematosus, rheumatoid arthritis, and celiac disease, can damage nerves, including those involved in autonomic functions. Guillain-Barre syndrome, an autoimmune disease, can also affect autonomic nerves.
5. Inherited disorders: Some inherited disorders can cause autonomic neuropathy, such as familial amyloidotic polyneuropathy. In summary, autonomic neuropathy can develop due to various health conditions, medications, and inherited disorders, with diabetes being the most common cause.

Assessment and Diagnosis

Triage

You should see a doctor if autonomic neuropathy is suspected, particularly if you have diabetes that's poorly controlled. The American Diabetes Association recommends annual autonomic neuropathy screening beginning when you receive your diabetes diagnosis. If you have type 1 diabetes, the association advises annual screening beginning five years after diagnosis. It's important to seek medical care promptly if you start experiencing any signs and symptoms of autonomic neuropathy to prevent potential complications.

Diagnosis

To diagnose autonomic neuropathy, a healthcare professional will typically perform a physical exam and review the patient's medical history, symptoms, and risk factors. If the patient has known risk factors for autonomic neuropathy, such as diabetes, the examination and discussion of symptoms may be sufficient for diagnosis. However, if the patient has symptoms of autonomic neuropathy without known risk factors, additional tests may be recommended to evaluate autonomic functions. These tests may include urinalysis and bladder function (urodynamic) tests, ultrasound, and other tests to assess autonomic functions.

Management and Treatment

Prevention

Autonomic neuropathy can be prevented to some extent by taking care of your overall health and managing any underlying medical conditions. Prevention measures include controlling blood sugar levels if you have diabetes, avoiding alcohol and smoking, getting appropriate treatment for autoimmune diseases, managing high blood pressure, maintaining a healthy weight, and exercising regularly. However, certain inherited diseases that increase the risk of autonomic neuropathy cannot be prevented. If you have diabetes, it's crucial to follow your healthcare provider's advice on healthy living to minimize the risk of developing autonomic neuropathy. Remember to consult a healthcare professional if you experience any symptoms related to autonomic neuropathy.

Home Remedies

It is important to consult a healthcare professional for proper diagnosis and treatment of autonomic neuropathy. They can provide advice on managing underlying conditions and recommend appropriate lifestyle changes and treatments.

Treatment

The answer depends on the underlying cause of the autonomic neuropathy. If an underlying cause is found, the focus of treatment is to manage that specific condition. Additionally, managing specific symptoms associated with autonomic neuropathy is important. Treatments vary based on the area of the body most affected by nerve damage. For digestive (gastrointestinal) symptoms, treatment may include:

• Diet changes: Increasing dietary fiber and fluids. Fiber supplements like Metamucil or Citrucel can be helpful. Gradually increase fiber intake to avoid gas and bloating.
• Medication to help with stomach emptying: Metoclopramide (Reglan) can be prescribed to increase digestive tract contractions, promoting faster stomach emptying. However, it should not be used for longer than 12 weeks due to its potential side effects.
• Medications for constipation: Over-the-counter laxatives can be used to ease constipation. Consult with a healthcare provider for guidance on laxative usage. For urinary symptoms, tests such as urinalysis, urodynamic tests, and bladder function tests can evaluate bladder function. Ultrasound of the urinary tract may also be recommended if bladder signs and symptoms are present. In general, the primary goal is to manage the underlying disease or condition causing the nerve damage. If no underlying cause is identified, the focus remains on managing specific symptoms. Consult with a healthcare provider for personalized advice and treatment options.

Preparing for medical consultation

To prepare for an appointment for autonomic neuropathy, you should:

1. Gather information: Note down your symptoms, when they began, and any other relevant details. Include key personal information, such as recent stresses, family medical history, and alcohol use.
2. Make a list of medications: Compile a list of all medications, vitamins, or supplements you're taking, including doses.
3. Prepare questions: Write down a list of questions to ask your healthcare provider, such as the likely cause of your symptoms, available treatments, potential side effects, alternatives, and how to manage other health conditions alongside autonomic neuropathy.
4. Bring a support person: Consider bringing a friend or family member to the appointment to help you remember the information you receive and to learn how to support you.
5. Discuss restrictions and necessary preparations: Inquire with your healthcare provider if there are any pre-appointment restrictions, such as fasting before certain tests, and follow their instructions. By being well-prepared and informed, you can make the most of your appointment and ensure that you receive the information and guidance you need to manage your autonomic neuropathy effectively.