Autonomic Neuropathy

Autonomic neuropathy may develop as a complication of several diseases. The tests required depend on your symptoms and risk factors.

For people with risk factors:

If you have diabetes or another condition that increases your risk, your healthcare provider will do a physical exam and review your symptoms.
If you are undergoing cancer treatment with a drug known to cause nerve damage, your provider will monitor for signs of neuropathy.

For people without risk factors:

Diagnosis may require a more detailed assessment. Your provider will review your medical history, discuss symptoms, and perform a physical exam.
Tests may include:
- Autonomic function tests: Measure heart rate and blood pressure response during exercises like deep breathing or the Valsalva maneuver.
- Tilt-table test: Monitors blood pressure and heart rate as your position changes. A simple version measures blood pressure lying, sitting, and standing; another involves standing, squatting, and standing again while monitoring cardiovascular responses.
- Gastrointestinal tests: Gastric-emptying tests evaluate digestive issues such as gastroparesis.
- Quantitative sudomotor axon reflex test: Measures how nerves controlling sweat glands respond to stimulation using small electrical currents.
- Thermoregulatory sweat test: Powder changes color when you sweat. Photos track sweat patterns in a heated chamber to confirm diagnosis.
- Urinalysis and urodynamic tests: Evaluate bladder function if urinary symptoms are present.
- Ultrasound: High-frequency sound waves create images of the bladder and urinary tract.

Treatment aims to manage the underlying disease and relieve symptoms based on which parts of the body are affected.

Managing underlying disease:

Control the disease causing nerve damage, such as tight blood sugar control in diabetes.
About 50% of cases may have no identifiable cause.

Digestive (gastrointestinal) symptoms:

Diet changes: Increase fiber and fluid intake. Fiber supplements like Metamucil or Citrucel may help.
Medications to aid stomach emptying: Metoclopramide (Reglan) increases digestive contractions. Short-term use is recommended.
Constipation relief: Over-the-counter laxatives as advised by your provider.
Diarrhea management: Antibiotics or anti-diarrheal medications may help.

Urinary symptoms:

Bladder retraining: Scheduled fluid intake and urination to improve bladder control.
Medications: Drugs to manage overactive bladder or aid complete emptying.
Catheterization: Tube inserted through the urethra to empty the bladder.

Sexual dysfunction:

For men:
- Medications: Sildenafil (Viagra), Vardenafil, Tadalafil (Cialis), Avanafil (Stendra). Caution in heart disease, arrhythmia, stroke, high blood pressure, or nitrate use. Seek immediate care for erections lasting over 4 hours.
- External vacuum pump: Hand pump pulls blood into the penis, maintained by a tension ring.
For women:
- Vaginal lubricants: Reduce dryness for more comfortable intercourse.
- Medications for low sexual desire: Approved options exist for premenopausal women.

Heart rhythm and blood pressure symptoms:

High-salt, high-fluid diet: Helps maintain blood pressure when standing; use cautiously in heart failure.
Compression garments: Waist binders or thigh-high stockings improve blood flow.
Medications to raise blood pressure:
- Fludrocortisone: Retains salt to regulate blood pressure.
- Midodrine (Orvaten), Droxidopa (Northera): Raise standing blood pressure but may cause high pressure when lying down.
- Octreotide (Sandostatin): For postprandial low blood pressure in diabetes.
- Pyridostigmine (Mestinon): Helps maintain stable standing blood pressure.
Medications to regulate heart rate: Beta blockers control high heart rate during activity.

Sweating abnormalities:

Excess sweating: Medications like Glycopyrrolate (Cuvposa, Robinul) reduce sweat. Side effects may include diarrhea, dry mouth, blurred vision, heart rate changes, headache, loss of taste, drowsiness. Reduced sweating can increase heat-related illness risk.

Overview