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:

• Dizziness and fainting when standing, caused by a sudden drop in blood pressure.
• Urinary problems, such as difficulty starting urination, loss of bladder control, difficulty sensing a full bladder and inability to completely empty the bladder. Not being able to completely empty the bladder can lead to urinary tract infections.
• Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems. In women, problems include vaginal dryness, low libido and difficulty reaching orgasm.
• Difficulty digesting food, such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn. These problems are all due to changes in digestive function.
• Inability to recognize low blood sugar (hypoglycemia), because the warning signals, such as getting shaky, aren't there.
• Sweating problems, such as sweating too much or too little. These problems affect the ability to regulate body temperature.
• Sluggish pupil reaction, making it difficult to adjust from light to dark and seeing well when driving at night.
• Exercise intolerance, which can occur if your heart rate stays the same instead of adjusting to your activity level.

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:

• Diabetes, especially when poorly controlled, is the most common cause of autonomic neuropathy. Diabetes can gradually cause nerve damage throughout the body.
• Irregular protein buildup in organs (amyloidosis), which affects the organs and the nervous system.

• 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).

• Certain medications, including some drugs used in cancer treatment (chemotherapy).
• Some viruses and bacteria, such as human immunodeficiency virus (HIV) and those that cause botulism and Lyme disease.
• Certain inherited disorders also can cause autonomic neuropathy.

Factors that might increase your risk of autonomic neuropathy include:

• Diabetes. Diabetes, especially when poorly controlled, increases your risk of autonomic neuropathy and other nerve damage. You're at greatest risk if you have difficulty controlling your blood sugar.
• Other diseases. Some health conditions including amyloidosis, porphyria and hypothyroidism can increase the risk of autonomic neuropathy. Cancer can too, usually due to side effects from treatment.

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:

• Control your blood sugar if you have diabetes.
• Avoid alcohol and smoking.
• Get appropriate treatment if you have an autoimmune disease.
• Take steps to prevent or control high blood pressure.
• Achieve and maintain a healthy weight.
• Exercise regularly.