Treatment of autonomic neuropathy includes:
- Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you'll need to tightly control blood sugar to prevent autonomic neuropathy from progressing.
- Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.
Digestive (gastrointestinal) symptoms
Your doctor may recommend:
- Modifying your diet. You may need to increase dietary fiber and fluids. Fiber supplements, such as Metamucil or Citrucel, also may help. Slowly increase fiber to avoid gas and bloating.
- Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication may cause drowsiness, and its effectiveness wears off over time.
- Medications to ease constipation. Over-the-counter laxatives may help ease constipation. Ask your doctor how often you should use these medications. Increasing dietary fiber also may help relieve constipation.
- Medications to ease diarrhea. Antibiotics can help treat diarrhea by preventing excess bacterial growth in the intestines. Medications usually used to treat high blood pressure and cholesterol may also be prescribed for managing diarrhea.
- Antidepressants. Tricyclic antidepressants, such as imipramine (Tofranil), can help treat nerve-related abdominal pain. Dry mouth and urine retention are possible side effects of these medications.
Your doctor may suggest:
- Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder's capacity and retrain your bladder to empty completely at the appropriate times.
- Medication to help empty the bladder. Bethanechol is a medication that helps ensure complete emptying of the bladder. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
- Urinary assistance (catheterization). During this procedure, a tube is guided through your urethra to empty your bladder.
- Medications that decrease overactive bladder. These include tolterodine (Detrol) or oxybutynin (Ditropan XL). Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.
For men with erectile dysfunction, your doctor may recommend:
Medications that enable erections. Drugs such as sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) can help you achieve and maintain an erection. Possible side effects include 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 and medical discretion. 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.
- An external vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.
For women with sexual symptoms, your doctor may recommend:
- Vaginal lubricants. Vaginal lubricants may decrease dryness and make sexual intercourse more comfortable and enjoyable.
Heart rhythm and blood pressure symptoms
Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor may prescribe:
Medications that help raise your blood pressure. If you feel faint or dizzy when you stand up, your doctor may suggest a drug called fludrocortisone. This medication helps your body retain salt, which helps regulate your blood pressure.
Other drugs that can help raise your blood pressure include midodrine and pyridostigmine (Mestinon). Midodrine may cause high blood pressure when lying down.
- Medication that helps regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if it goes too high with an activity level.
- A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high fluid diet may help maintain your blood pressure. This is generally only recommended for very severe cases of blood pressure problems, as this treatment may cause blood pressure that is too high or swelling of the feet, ankles or legs.
If you experience excessive sweating, your doctor may prescribe:
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- A medication that decreases perspiration. The drug glycopyrrolate (Robinul, Robinul Forte) can decrease sweating. Side effects may include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headaches, loss of taste and drowsiness. Glycopyrrolate may also increase the risk of heat-related illness (such as heatstroke) from a reduced ability to sweat.
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