Damage to the nerves that control involuntary body functions, such as blood pressure and digestion, results in autonomic neuropathy.
Autonomic neuropathy occurs when there is damage to the nerves that control automatic body functions. It can affect blood pressure, temperature control, digestion, bladder function and even sexual function.
The nerve damage affects the messages sent between the brain and other organs and areas of the autonomic nervous system. These areas include the heart, blood vessels and sweat glands.
Diabetes is the most common cause of autonomic neuropathy. It can also be caused by other health conditions, viral or bacterial infections, or some medications. Symptoms and treatment vary based on which nerves are damaged.
Signs and symptoms of autonomic neuropathy depend on which nerves are damaged. They might include:
Seek medical care promptly if you begin having any of the signs and symptoms of autonomic neuropathy, particularly if you have diabetes that's poorly controlled.
If you have type 2 diabetes, the American Diabetes Association recommends annual autonomic neuropathy screening beginning when you receive your diagnosis. For people with type 1 diabetes, the association advises annual screening beginning five years after diagnosis.
Many health conditions can cause autonomic neuropathy. It can also be a side effect of treatments for other diseases, such as cancer. Some common causes of autonomic neuropathy include:
Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren 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 immune system attack triggered by some cancers (paraneoplastic syndrome).
Factors that might increase your risk of autonomic neuropathy include:
Certain inherited diseases that put you at risk of developing autonomic neuropathy can't be prevented. But you can slow the onset or progression of symptoms by taking care of your health in general and managing your medical conditions.
To control diseases and conditions, follow your health care provider's advice on healthy living. That advice might include these recommendations:
Autonomic neuropathy is a possible complication of some diseases. The tests you'll need depend on your symptoms and risk factors for autonomic neuropathy.
If you have diabetes or another condition that increases your risk of autonomic neuropathy and have symptoms of neuropathy, your health care provider will perform a physical exam and ask about your symptoms.
If you are undergoing cancer treatment with a drug known to cause nerve damage, your provider will check for signs of neuropathy.
If you have symptoms of autonomic neuropathy but no risk factors, the diagnosis can be more involved. Your health care provider will probably review your medical history, discuss your symptoms and do a physical exam.
Your provider might recommend tests to evaluate autonomic functions, including:
Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position. It simulates 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. Typically, blood vessels narrow and heart rate increases to compensate for the drop in blood pressure. This response may be slowed if you have autonomic neuropathy.
A simpler test for this response involves checking your blood pressure when lying, sitting and standing after three minutes. Another test involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.
Treatment of autonomic neuropathy includes:
Your health care provider may recommend:
Your health care provider may suggest:
For men with erectile dysfunction, health care providers might recommend:
Medications that enable erections. Drugs such as sildenafil (Viagra), vardenafil, tadalafil (Cialis) and avanafil (Stendra) can help you achieve and maintain an erection. Possible side effects include low blood pressure, mild headache, flushing, upset stomach and changes in color vision.
If you have a history of heart disease, arrhythmia, stroke or high blood pressure, use these medications with caution. Also avoid taking these medications if you are taking any type of organic nitrates. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
For women with sexual symptoms, health care providers might recommend:
Autonomic neuropathy can cause heart rate and blood pressure problems. Your health care provider might prescribe:
Medications to raise your blood pressure. If you feel faint or dizzy when you stand up, your health care provider might suggest medications. Fludrocortisone helps your body retain salt, which helps regulate your blood pressure.
Midodrine (Orvaten) and droxidopa (Northera) can help raise blood pressure. But these drugs can cause high blood pressure when you're lying down. Octreotide (Sandostatin) can help raise blood pressure in people with diabetes who have low blood pressure after eating, but it can cause some side effects. Pyridostigmine (Mestinon) may help keep blood pressure stable when standing.
If you sweat too much, your health care provider might prescribe a medication that decreases sweating. Glycopyrrolate (Cuvposa, Robinul, others) can decrease sweating. Side effects can include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headache, loss of taste and drowsiness. Glycopyrrolate can also increase the risk of heat-related illness, such as heatstroke, from a reduced ability to sweat.
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 up. Flex your feet and make fists with 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.
Several alternative medicine treatments might help people with autonomic neuropathy. Talk with your health care provider about any treatments you want to try. This can help make sure that they won't interfere with your medical treatments or be harmful.
Research suggests this antioxidant might improve the measures of autonomic nerve function. More study is needed.
This therapy involves placing thin needles in specific points in the body. It might help treat slow stomach emptying and erectile dysfunction. More studies are needed.
This therapy sends low-energy electrical waves through electrodes placed on the skin. Some studies have found that it might help ease pain associated with diabetic neuropathy.
Living with a chronic condition presents daily challenges. Here are some suggestions to help you cope:
First, you'll probably see your primary care provider. If you have diabetes, you might see your diabetes doctor (endocrinologist). However, you might be referred to a doctor specializing in nerve disorders (neurologist).
You might see other specialists, depending on the part of your body affected by neuropathy, such as a cardiologist for blood pressure or heart rate problems or a gastroenterologist for digestive difficulties.
Here are some tips to help you prepare for your appointment.
Ask if you should do anything before your appointment, such as fasting before certain tests. Make a list of:
Take a friend or family member with you to help you remember the information you receive and to learn how to support you. For example, if you pass out from low blood pressure, people around you need to know what to do.
Questions to ask your health care provider about autonomic neuropathy include:
Don't hesitate to ask other questions.
Your health care provider is likely to ask you questions, such as: