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Autonomic Neuropathy - Causes, Symptoms, Diagnosis, and Treatment

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Autonomic neuropathies are diseases that affect the peripheral nerves that control body functions. Continue reading the article below to learn more.

Written by

Dr. Shikha

Medically reviewed by

Dr. Prakashkumar P Bhatt

Published At September 27, 2022
Reviewed AtSeptember 27, 2022

What Is Autonomic Neuropathy?

Autonomic neuropathy is also known as autonomic dysfunction or dysautonomia. These refer to a variety of ailments that cause the autonomic nervous system or ANS to malfunction. The signals are exchanged between the brain and various organs, and parts of the autonomic nervous system are disrupted by nerve injury. The autonomic nervous system regulates biological functions such as breathing, temperature, blood pressure, digestion, and more. Autonomic neuropathy is a side effect of various drugs and can be a complication of several diseases.

What Is the Autonomic Nerve System’s Anatomy?

The blood vessels, liver, stomach, kidneys, heart, intestine, bladder, digestive glands, lungs, genitals, pupils, salivary glands, and sweat glands are all supplied by the autonomic nervous system. The autonomic nervous system is divided into two parts: sympathetic and parasympathetic. When the autonomic nervous system gets signals about the body and external environment, it reacts by inhibiting the body processes by the parasympathetic division of the autonomic nervous system and responds when the sympathetic division of the autonomic nervous system is activated.

What Is the Cause of Autonomic Neuropathy?

Autonomic neuropathy can be caused by a variety of medical disorders, and it can also happen to be a side effect of other disorders, such as cancer treatment. The following are some of the most common causes of autonomic neuropathy:

  • The most prevalent cause of autonomic neuropathy known is diabetes, especially when it is poorly controlled. Diabetes can lead to nerve damage throughout the body over time.

  • The immune system targets and damages components of the body, including the nerves, in autoimmune illnesses such as systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis, and celiac disease. Guillain-Barre syndrome is an autoimmune disease that affects the autonomic nervous system.

  • Amyloidosis is an abnormal protein deposition in tissues that damages the organs and neurological system.

  • Another probable reason is an immune system attack that happens as a result of some tumors, such as paraneoplastic syndrome.

  • Certain treatments, including chemotherapy for cancer and anticholinergic drugs, viruses and bacteria that cause HIV, Lyme disease and botulism, and hereditary disorders, can all be the reason behind autonomic neuropathy.

What Are the Symptoms of Autonomic Neuropathy?

The symptoms of autonomic neuropathy differ depending on which nerves are impacted. They usually take years to develop.

Symptoms of the heart and lungs include:

  • An abnormal heart rhythm or heart rate.

  • The blood pressure is too high. Standing induces dizziness because the blood pressure changes with position.

  • With exertion or exercise, individuals may experience shortness of breath.

Symptoms of the stomach and intestines include:

  • Constipation or hard stool (a common complaint among people).

  • Diarrhea or loose stool is a common problem.

  • Problem controlling bowel motions.

  • Nausea and early satiety after eating.

  • Swelling in the abdomen.

  • Problem experienced when swallowing and vomiting the undigested food.

Symptoms seen in the bladder include:

  • Urine dripping.

  • Having trouble when starting to urinate.

  • Getting the feeling as if the bladder is not emptying completely.

Other signs and symptoms could include:

  • Sweating excessively or insufficiently.

  • Heat intolerance develops as a result of physical exertion and exercise.

  • Erection problems in males, as well as vaginal dryness and orgasm issues in females.

  • One eye has a small pupil.

  • Weight loss without putting any effort.

How to Diagnose Autonomic Neuropathy?

The treatment process begins with a precise diagnosis of the signs and symptoms. A comprehensive history and physical examination focusing on the autonomic nervous system is needed to accomplish this. To aid with the diagnosis, specific testing of the autonomic nervous system is frequently required.

  • The autonomic nerves that control sweating are measured with the quantitative sudomotor axon reflex test (QSART). The sweat glands are stimulated, and the volume of sweat produced is measured in this test. The QSART can be used to diagnose a variety of autonomic illnesses, including autonomic and small-fiber neuropathies, as well as various pain syndromes. The QSART is also useful in determining if the autonomic dysfunction is located in the peripheral or central neural systems.

  • The cardiovascular autonomic test with tilt evaluates a patient's autonomic nervous system's ability to manage blood pressure and heart rate through several movements, including deep breathing, the Valsalva maneuver, and head-up tilt. These tests are very useful in evaluating people who have syncope or fainted.

  • The thermoregulatory sweat test is a test that determines a patient's ability to sweat in a warm, humid environment. This exam evaluates the control of sweating and body temperature regulation by the central and peripheral autonomic nervous systems. This test's detection of abnormal sweating patterns can aid in the diagnosis of a range of neurological and autonomic illnesses.

  • Gastric motility and muscular activity are assessed using gastric emptying assays.

  • Urine testing to determine how well the bladder is working and abdominal X-rays to analyze the digestive tract.

How To Treat Autonomic Neuropathy?

The disease that produced the nerve damage will be the primary focus of the doctor's treatment. For example, if a patient has diabetes, they will need to keep their blood sugar under control through food, exercise, and potentially medication. They will be given drugs to manage the immune system and reduce inflammation in the body if the patient has an autoimmune condition like Sjogren's syndrome.

To relieve intestinal symptoms:

  • Alter your eating habits. Smaller meals will keep the patients from feeling overly full.

  • To avoid bloating and constipation, increase hydration, and fiber intake.

  • Constipation can be relieved with laxatives, and diarrhea and stomach pain can be treated with additional medications.

To get rid of excessive sweating:

  • Botulinum toxin and Glycopyrrolate are two medications that can help the patient sweat less.

  • When it is hot outside, stay indoors if the patient does not sweat enough.

To treat urinary symptoms:

  • Throughout the day, at regular intervals, drink fluids and empty the bladder. This can aid in the retention of fluid in the bladder.

  • A catheter can be put into the bladder to aid in its emptying.

To alleviate blood pressure and heart symptoms:

  • Control the heart rate with medication. Beta-blockers can assist in restoring your heart's regular rhythm.

  • Take blood pressure medication.

  • Slowly get up to avoid becoming dizzy.

  • To assist in enhancing the blood pressure, include more salt and fluid in the diet, but only if advised by the doctor.

To relieve sexual discomfort:

  • Medications can assist men in achieving and maintaining an erection.

  • To make sex more comfortable, women can use a water-based lubricant.

  • Flibanserin is a medication that can help premenopausal women with reduced sexual drive.


Autonomic dysfunction can have a negative impact on daily activities, for example, exercise, generate bothersome symptoms, and even result in death. Because the patient's history and physical examination are poor in detecting early signs of autonomic nerve dysfunction, noninvasive diagnostics with proven efficacy should be used. Reduce the likelihood of neuropathy by preventing or controlling related illnesses. People with diabetes, for example, should keep a tight eye on their blood sugar levels.

Frequently Asked Questions


What Causes Autonomic Neuropathy to Begin?

The communication between the brain and the organs is impacted by nerve damage. Several nerve-related illnesses and therapies may bring it on. The most frequent cause of autonomic neuropathy (which develops when the nerves that regulate automatic bodily processes are damaged) is diabetes. Other medical disorders, bacterial or viral infections (diseases transmitted by viruses), and some drugs may also be responsible. The injured nerves determine the symptoms and course of therapy.


Does Autonomic Neuropathy Have a Treatment?

Yes, autonomic neuropathy has treatment. Addressing the underlying illness, the first step in treating autonomic neuropathy is to control the illness or condition causing the nerves to weaken. If diabetes is causing nerve damage, one must closely maintain the blood sugar to stop the damage from increasing. In around 50 % of cases, autonomic neuropathy has no underlying cause. Dealing with certain symptoms, the signs of autonomic neuropathy can sometimes be treated. The type of treatment depends on the area of the body where the nerve damage is most severe.


What Are the Causes of Autonomic Neuropathy?

Diabetes is the most prevalent condition that can cause it, although other nerve-related illnesses and medications also can do so. Various other options are
- Spinal cord (lower back) injuries.
- Surgery.
- Pharmaceuticals are used to treat cancer, such as certain chemotherapy medications (a cancer treatment that includes one or more anti-cancer medications within a set chemotherapy schedule).


How to Diagnose Autonomic Neuropathy?

It may be more difficult to diagnose if one has autonomic neuropathy symptoms but no risk factors. The doctor will review the entire medical history, talk with the patient about the symptoms, and do a physical examination. The healthcare practitioner could suggest the following tests to assess autonomic functions:
- Autonomic function tests.
- Tilt-table test.
- Gastrointestinal tests.
- Quantitative sudomotor axon reflex test.
- Thermoregulatory sweat test.
- Urinalysis and bladder function test.
- Ultrasound.


What Is the Rate of Progression of Autonomic Neuropathy?

Testing of their autonomic systems showed high heart rate variability as their autonomics continued to fail. Diabetic autonomic neuropathy (DAN) and cardiac autonomic neuropathy (CAN), which have a 50 % five-year death risk, are the most advanced autonomic test patterns indicating poor parasympathetic function. The danger of sudden cardiac death is increased because the person's autonomic functions are severely inhibited at times, such as when unconscious from sedation.


What Type of Autoimmune Illness Is Autonomic Neuropathy?

Rapidly developing autoimmune illness Guillain-Barre syndrome (an uncommon condition when the body's immune system targets the nerves) can harm autonomic nerves. Another factor that might contribute to autonomic neuropathy is an immunological response (how the body detects and fights off germs, viruses, and other things that seem strange and dangerous) brought on by some malignancies (the presence of a cancerous tumor). Some medicines, including chemotherapy, are used in the treatment of cancer.


How Common Is Autonomic Neuropathy?

Even though severe chronic kidney disease (a disorder when the kidneys are harmed and are unable to filter the blood as effectively as they must) is frequently brought on by diabetes, autonomic neuropathy is also quite prevalent in people with this condition. Due to reduced glucose filtration, hyperglycemia (elevated blood sugar) may be harder to manage in chronic kidney disease. Autonomic neuropathy is related to amyloidosis (an uncommon illness brought on by the accumulation of amyloid protein in organs), a less frequent chronic kidney disease etiology.


Does Autonomic Neuropathy Have an Impact on the Heart?

Cardiovascular autonomic neuropathy (CAN), which includes damage to the autonomic nerve fibers that primarily affect the heart and blood vessels and results in abnormalities in heart rate regulation and vascular dynamics, is one of the most commonly ignored serious complications of diabetes.


What Can Be Done to Repair the Autonomic Nervous System?

When an underlying illness is addressed, certain autonomic nervous system diseases improve. The following treatments can be done to repair the autonomic nervous system:
- Use medicine to control blood pressure.
- Take medicine to manage additional symptoms, such as bladder control, digestive problems, and sensitivity to heat.
- Take electrolyte-fortified fluids.
- Exercise regularly.


How Can Autonomic Neuropathy Impact Blood Pressure?

Heart rate and blood pressure can be impacted by autonomic neuropathy, which affects the cardiovascular system's nerves (including the heart, blood, and blood vessels). When one sits or stands up, blood pressure may drop suddenly, leaving one feeling unwell. Instead of varying with bodily processes and movement, the heart rate may stay high or excessively low.


Which Organ Is Under the Autonomic Nervous System’s Control?

The autonomic nervous system subconsciously controls the internal and exterior environments of the body's hundred trillion cells to maintain continuous hemostasis (the process that causes bleeding from a blood vessel to stop) and overall health and well-being. It also governs and regulates nearly all of the major organs.


What Are the Effects of Autonomic Neuropathy on the Bladder?

The autonomic nerves, which regulate the bladder, gastrointestinal system (the mouth, throat, esophagus, stomach, small intestine, large intestine, rectum, and anus are among these organs), and genitalia (the reproductive system's organs), among other organs, are impacted by autonomic neuropathy. Bladder paralysis (when a person cannot regulate their bladder because of a spinal cord, brain, or nerve issue) is typical of this kind of neuropathy. When this occurs, as the bladder fills with urine, the nerves inside it stop responding properly to pressure.


How to Reset Autonomic Nervous System?

Use deep breathing exercises to restore the nervous system organically. Box breathing, deep breathing, and alternate nose breathing are all excellent techniques that provide calm while in a frightening situation. Even if one has five or ten minutes, one may practice deep breathing while doing yoga or meditation.
Dr. Prakashkumar P Bhatt
Dr. Prakashkumar P Bhatt



dysautonomiaautonomic neuropathy
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