Autonomic Neuropathy

Damage to the nerves that control automatic body functions is called autonomic neuropathy. These nerves handle important tasks like regulating blood pressure, temperature, digestion, bladder control, and even sexual function.

Imagine your body as a complex machine. These nerves are like the communication system, sending messages back and forth between your brain and your organs. They tell your heart to beat, your blood vessels to constrict or dilate, and your sweat glands to work. When these nerves are damaged, the messages get mixed up or don't get through properly.

One of the most common reasons for this nerve damage is diabetes. Other causes can include various health problems, infections (like viruses or bacteria), or certain medications.

The symptoms and treatment for autonomic neuropathy depend on which nerves are affected. For example, if the nerves controlling blood pressure are damaged, someone might experience dangerously low or high blood pressure. If the nerves that manage digestion are harmed, problems like nausea, vomiting, or diarrhea could occur. The specific symptoms and best approach to treatment will depend on the affected nerves and the overall health of the individual.

Autonomic neuropathy happens when nerves that control automatic body functions are damaged. The symptoms depend on which nerves are affected. Here are some common signs:

• Feeling dizzy or faint when standing up: This is often because your blood pressure drops suddenly when you change positions.
• Problems with urination: This can include trouble starting to urinate, leaking urine, not feeling your bladder filling, or not being able to empty your bladder completely. If you can't empty your bladder completely, you're more likely to get urinary tract infections (UTIs).
• Sexual problems: Men might have trouble getting or keeping an erection (erectile dysfunction) or problems with ejaculation. Women might experience vaginal dryness, less interest in sex (low libido), or difficulty reaching orgasm.
• Digestive issues: These can range from feeling full quickly after eating a few bites to loss of appetite, diarrhea, constipation, bloating, nausea, vomiting, trouble swallowing, and heartburn. These are all related to changes in how your body processes food.
• Not recognizing low blood sugar (hypoglycemia): The typical warning signals, like shakiness, might not be there. This is dangerous because you might not know your blood sugar is low.
• Sweating problems: You might sweat too much or too little. This affects your body's ability to regulate its temperature.
• Vision problems: Your pupils might not react normally to changes in light. This can make it harder to adjust from bright to dim light, especially while driving at night.
• Trouble exercising: Your heart rate might not increase or decrease as it should when you're active. This makes exercise more difficult and can be dangerous.

These are just some of the possible symptoms. If you experience any of these, it's important to talk to a doctor to determine the cause and get appropriate treatment.

If you're experiencing any symptoms of autonomic neuropathy, see a doctor right away. This is especially important if you have diabetes that isn't well managed.

For people with type 2 diabetes, the American Diabetes Association suggests checking for autonomic neuropathy every year, starting the moment they're diagnosed. If you have type 1 diabetes, the recommendation is to have these checks annually starting five years after you're diagnosed. This is a routine way to catch any problems early.

Autonomic neuropathy is a nerve problem that can stem from various health conditions. It can also happen as a result of treatments for other illnesses, like cancer. Here are some common causes:

• Diabetes: This is the most frequent reason for autonomic neuropathy, especially if blood sugar isn't well managed. High blood sugar levels over time can damage nerves throughout the body. Think of it like a slow, gradual wearing away of the pathways in your nervous system.

• Protein buildup (amyloidosis): Sometimes, abnormal proteins build up in organs. This buildup, called amyloidosis, can harm the organs and the nerves, leading to autonomic neuropathy.

• Immune system problems (autoimmune diseases): Your immune system is designed to protect your body from invaders, but sometimes it mistakenly attacks and damages your own tissues and nerves. Examples of autoimmune diseases that can cause autonomic neuropathy include:

  • Sjogren syndrome: This affects the glands that produce moisture in the body.
  • Systemic lupus erythematosus: This is a chronic inflammatory disease that can affect many parts of the body.
  • Rheumatoid arthritis: This causes inflammation in the joints and can spread to other tissues.
  • Celiac disease: This occurs when the immune system reacts to gluten, a protein found in wheat, barley, and rye.
  • Guillain-Barré syndrome: This is an example of a rapidly developing autoimmune disease that can quickly affect the nerves, including the autonomic nerves.

• Cancer and related problems (paraneoplastic syndrome): Sometimes, an immune response triggered by cancer can damage the autonomic nervous system.

• Certain medications: Some drugs, including those used to treat cancer (chemotherapy), can be a factor in autonomic neuropathy.

• Infections: Viruses and bacteria can also damage nerves. Examples include the human immunodeficiency virus (HIV), the bacteria that cause botulism, and the bacteria that cause Lyme disease.

• Inherited conditions: Some genetic disorders can lead to autonomic neuropathy.

Understanding the causes of autonomic neuropathy is important for diagnosis and treatment. If you have concerns about these symptoms, talk to your doctor.

Several things can raise your chances of getting autonomic neuropathy, a condition where nerves that control automatic body functions, like digestion and heart rate, are damaged.

• High Blood Sugar (Diabetes): If you have diabetes, especially if you have trouble keeping your blood sugar levels stable, you're more likely to develop autonomic neuropathy and other nerve problems. Uncontrolled blood sugar can damage the nerves over time.

• Other Medical Conditions: Beyond diabetes, several other health issues can increase your risk. These include:

  • Amyloidosis: This condition involves the buildup of abnormal proteins in organs and tissues, which can damage nerves.
  • Porphyria: This group of inherited disorders affects how your body makes certain substances, which can harm nerves.
  • Hypothyroidism: An underactive thyroid gland can disrupt the body's overall function, sometimes leading to nerve damage.
  • Cancer: In some cases, cancer treatments, like chemotherapy or radiation, can cause nerve damage as a side effect.

Essentially, if you have any of these conditions, or have a history of them, it's important to talk to your doctor about your risk of autonomic neuropathy. Early detection and management can often help prevent or slow the progression of the condition.

Some inherited conditions can increase your chances of getting autonomic neuropathy. Unfortunately, you can't prevent these inherited risks. However, you can definitely slow down how quickly the symptoms appear or get worse. This involves taking good care of your overall health and managing any existing medical conditions effectively.

To help manage your health and the potential for autonomic neuropathy, it's crucial to follow your doctor's advice. This might involve:

• Managing diabetes: If you have diabetes, carefully controlling your blood sugar levels is very important. This means following your doctor's instructions on diet, medication, and lifestyle changes. High blood sugar can damage nerves, and controlling it can significantly reduce the risk and progression of nerve damage.

• Avoiding harmful habits: Quitting smoking and limiting or avoiding alcohol consumption can help. Smoking and alcohol can damage nerves and increase the risk of various health problems.

• Managing autoimmune diseases: If you have an autoimmune disease, working closely with your doctor to get appropriate treatment is vital. Autoimmune diseases can contribute to nerve damage. Effective treatment can help slow the progression of the disease and its effects on your nerves.

• Controlling high blood pressure: High blood pressure can damage blood vessels, including those that supply the nerves. Following your doctor's advice on medication and lifestyle changes to manage high blood pressure is essential to protect your nerves.

• Maintaining a healthy weight: Being at a healthy weight can improve your overall health and reduce the strain on your body's systems, including your nerves. A healthy weight is often achieved through a balanced diet and regular exercise.

• Staying active: Regular exercise is beneficial for overall health and can help maintain a healthy weight. Exercise can also improve blood circulation, which is important for healthy nerve function. Aim for a combination of cardiovascular exercise and strength training, as advised by your doctor.

Diagnosing Autonomic Neuropathy

Autonomic neuropathy is a possible problem that can develop as a complication of certain medical conditions. The specific tests needed to diagnose it depend on your symptoms and whether you have risk factors.

If you have risk factors and symptoms:

If you have diabetes or another condition that increases your chances of autonomic neuropathy, and you're experiencing symptoms, your doctor will first do a physical exam and ask you about those symptoms. They'll want to know what's happening, how often, and how it affects your daily life. For example, are you having trouble with digestion, blood pressure changes, or sweating?

If you're undergoing cancer treatment with drugs that can harm nerves, your doctor will also check for signs of neuropathy as part of your routine care.

If you have symptoms but no known risk factors:

Diagnosing autonomic neuropathy can be more complex if you don't have clear risk factors. Your doctor will likely review your medical history, discuss your symptoms in detail, and perform a physical exam.

Tests to evaluate autonomic functions:

To confirm a diagnosis, your doctor might recommend specific tests to evaluate how your autonomic nervous system is working. These tests look at how your body responds to changes in position, exercise, and temperature.

• Blood pressure and heart rate tests: These tests measure how your blood pressure and heart rate change when you move from lying down to sitting up, or when you do activities like exercise. Your doctor might check your blood pressure in different positions (lying, sitting, standing) or have you do simple exercises like squatting and standing up, while monitoring your blood pressure and heart rate. These tests can show if your body isn't responding normally to position changes.

• Autonomic function tests: These tests look at how your heart rate and blood pressure respond to specific activities. One common test is the Valsalva maneuver, where you forcefully exhale against a closed airway, which can affect blood pressure and heart rate.

• Digestive system tests (gastrointestinal tests): If you're having digestive problems like slow digestion or difficulty emptying your stomach (gastroparesis), your doctor might order tests to check the function of your stomach and intestines. These tests are often performed by a gastroenterologist, a doctor specializing in digestive health.

• Sweating tests: These tests assess how your sweat glands respond to stimulation or temperature changes. A quantitative sudomotor axon reflex test uses electrical impulses to measure how your sweat glands react. A thermoregulatory sweat test measures your sweat response to increasing temperature in a controlled environment. These tests help determine if your body is sweating normally.

• Bladder function tests (urodynamic tests): If you have bladder or urinary problems, your doctor may recommend tests to evaluate your bladder function. These tests often include a urinalysis and potentially more specialized bladder function tests.

• Ultrasound: In some cases, an ultrasound of your urinary tract can be helpful in evaluating potential structural issues. This uses sound waves to create images of the bladder and surrounding areas.

These tests help your doctor understand if your autonomic nervous system is functioning correctly and whether there's a problem that might be autonomic neuropathy. They are helpful in diagnosing the cause of your symptoms and guiding treatment decisions.

Managing Autonomic Neuropathy: A Guide to Treatment

Autonomic neuropathy damages the nerves that control automatic body functions like heart rate, blood pressure, digestion, and bladder function. This damage can lead to a wide range of symptoms, and treatment focuses on managing the underlying cause, relieving symptoms, and adapting to the changes.

Treating the Underlying Cause:

The first step in managing autonomic neuropathy is addressing the root cause of the nerve damage. If diabetes is the culprit, strict blood sugar control is crucial to prevent further nerve damage. In about half of cases, no specific cause can be identified.

Managing Symptoms:

The treatment approach depends on the specific symptoms. For example, if nerve damage affects the digestive system, strategies to improve digestion and bowel function are employed.

Specific Treatments:

• Blood Pressure Issues: If blood pressure drops significantly when standing (orthostatic hypotension), doctors might prescribe medications. These include:

  • Fludrocortisone: This medication helps the body retain salt, which can help regulate blood pressure.
  • Midodrine (Orvaten) and droxidopa (Northera): These raise blood pressure but can sometimes cause high blood pressure when lying down.
  • Octreotide (Sandostatin): This medication is sometimes helpful for people with diabetes and low blood pressure after eating, but it can have side effects.
  • Pyridostigmine (Mestinon): This medication can help maintain stable blood pressure during standing.

• Sweating Problems: If excessive sweating is a concern, medications like glycopyrrolate (Cuvposa, Robinul, others) can help reduce it. However, these medications can have side effects like dry mouth, diarrhea, urinary retention, and blurred vision, and can increase the risk of heatstroke.

• Digestive Issues:

  • Slow Stomach Emptying: Metoclopramide (Reglan) can help the stomach empty faster. However, it's not recommended for long-term use due to potential drowsiness.
  • Constipation: Over-the-counter laxatives can help. Consult your doctor about appropriate usage frequency.
  • Diarrhea: Antibiotics can be used to reduce bacterial overgrowth, and over-the-counter anti-diarrheal medications may help.

• Bladder Problems:

  • Bladder Retraining: Establishing a regular schedule for fluid intake and urination can help the bladder function better.
  • Medications: Doctors may prescribe medications to manage an overactive bladder or to help empty the bladder.
  • Catheterization: A tube may be inserted to empty the bladder if other methods aren't effective.

• Sexual Dysfunction:

  • Erectile Dysfunction (Men): Medications like sildenafil (Viagra), vardenafil, tadalafil (Cialis), and avanafil (Stendra) can help achieve and maintain erections. Use with caution if you have heart conditions, stroke, or high blood pressure. Avoid use with organic nitrates. Seek immediate medical attention for erections lasting longer than four hours. Vacuum pumps may also be an option.
  • Sexual Symptoms (Women): Vaginal lubricants can ease dryness, and some medications may be helpful for women experiencing low sexual desire.

• Blood Pressure Management (Severe Cases): A high-salt, high-fluid diet might be recommended in severe cases of low blood pressure when standing, but this should be done under a doctor's supervision, as it can cause other issues. Compression garments (binders or stockings) can also help improve blood flow in some situations.

• Heart Rate Issues: Beta-blockers can help regulate rapid heart rates.

Important Considerations:

All medications have potential side effects. Talk to your doctor about the risks and benefits of any medication before starting it. If you experience any significant side effects, contact your doctor immediately. Managing autonomic neuropathy often involves a combination of treatments tailored to individual needs. Regular follow-up with your healthcare provider is essential to monitor progress and adjust the treatment plan as needed.

Getting Up Safely and Comfortably

Getting up quickly can sometimes cause dizziness or lightheadedness. Here are some simple tips to help you get up and around more easily and safely:

Gentle Transitions:

• Slow and Steady: When you get out of bed, stand up slowly, in stages. This helps your body adjust to the change in position and can prevent dizziness. Think of it like a ramp, not a jump. Give yourself a moment to adjust at each stage.

• Prepare Your Body: Before you stand, sit on the edge of the bed with your legs dangling for a few minutes. This allows your blood to redistribute more evenly. Also, flex your feet and make your hands into fists for a few seconds. This gently squeezes your muscles, helping to increase blood flow to your brain and body.

• Boosting Blood Pressure: Once you're standing, gently tense your leg muscles by crossing one leg over the other a few times. This helps to increase blood pressure, making you feel more stable and less likely to feel dizzy.

Other Helpful Tips:

• Elevated Bed: If you have low blood pressure, raising the head of your bed by about 4 inches (10 centimeters) can make a difference. You can use blocks or risers under the head of the bed to accomplish this. This helps your blood flow better when you first wake up.
• Improved Digestion: If you have digestive issues, eating small, frequent meals throughout the day can help. Drinking plenty of fluids is also important. Choosing foods that are low in fat and high in fiber can often improve digestion.
• Managing Diabetes: Good blood sugar control is crucial for people with diabetes. Keeping your blood sugar levels stable can significantly lessen symptoms and help prevent or delay new health problems. Working closely with your doctor is essential for managing diabetes effectively.