Autonomic Neuropathy

WHAT IS AUTONOMIC NEUROPATHY?

Autonomic neuropathy (AN) is a condition that occurs when there is damage to the nerves that help the body organs and systems to function. The resultant effect is a disturbance in signal processing between the brain and the autonomic nervous system.

The damaged autonomic nerves can affect the:

• Blood pressure
• Heart rate
• Perspiration patterns
• Bladder emptying
• Bowel emptying
• Digestion

Autonomic neuropathy is usually linked with other medical conditions, diseases, or drugs. Symptoms depend on the cause of the neuropathy and the site of nerve damage.

CAUSES OF AUTONOMIC NEUROPATHY

The following conditions cause damage to the autonomic nerves:

• Excessive alcohol intake
• Diabetes
• Chronic illnesses like HIV or Parkinson’s disease
• Drugs such as chemotherapy drugs
• Nerve trauma in the form of a bruise, cut, or burn
• Unusual accumulation of protein in the organs
• Autoimmune diseases such as Systemic lupus erythematosus
• Degenerative diseases such as multiple system atrophy

RISK FACTORS FOR AUTONOMIC NEUROPATHY

The likelihood of developing autonomic neuropathy is higher in these set of people:

• Older people
• Those who have hypertension
• Those with elevated cholesterol levels
• Those who are overweight

Additional factors that may increase the risk include:

• Diabetes
• Excessive alcohol consumption
• Parkinson’s disease
• HIV
• Botulism
• Cancer

SYMPTOMS OF AUTONOMIC NEUROPATHY

Autonomic neuropathy can affect different organs and cause a wide range of symptoms. The early presentation may be symptoms such as feeling dizzy, lightheadedness when rising or standing, nausea and vomiting even while eating. Disturbances could also affect bowel movements, bladder control, and even sexual functioning. 

Other symptoms are organ-specific and can affect the functioning of these systems.

BLADDER

The symptoms here are those of a urinary tract infection which include urinary frequency, urgency, incontinence, feeling of incomplete bladder emptying, poor urinary stream, etc.

DIGESTIVE SYSTEM

The symptoms here include:

• Heartburn or frequent indigestion
• Vomiting of undigested food
• Diarrhea
• Distended abdomen
• Constipation
• Early satiety
• Loss of appetite

REPRODUCTIVE ORGANS

Autonomic neuropathy can exert the following effects on the reproductive organs:

• Erectile dysfunction
• Premature ejaculation
• Difficulty achieving orgasm in women
• Vaginal dryness

HEART AND BLOOD VESSELS

The symptoms that result from affectation of the heart and blood vessels by AN include the following:

• Dizziness or lightheadedness when standing or rising
• Fainting
• Difficulty in breathing while exercising
• Racing heart rate at rest
• Heart attack devoid of warning signs

EYES

AN can manifest as slow pupil adjustment when moving from dark to light and makes it difficult to drive at night.

SWEAT GLANDS

When AN affects the sweat glands, it produces symptoms such as dry skin on the feet and excessive sweating or lack of sweating.

OTHER SYMPTOMS

Additional symptoms include unintentional weight loss and low blood sugar which does not show warning signals, such as tremor or dizziness.

DIAGNOSIS OF AUTONOMIC NEUROPATHY

If you experience symptoms of AN, speak to a doctor. You will get a better outcome is diagnosis is made early enough.

The diagnosis will be made by the doctor after recognizing some risk factors, results gotten from the examination, and test results.  The following tests may be requested:

• Breathing tests to evaluate the heart rate and blood pressure
• Gastric emptying tests to evaluate muscle activity and gastric motility
• Blood pressure in two positions, sitting and standing
• Tilt-table test to detect pressure changes when posture is changed
• Quantitative sudomotor axon reflex test (QSART), used to assess nerve reactions linked to sweat glands
• The thermoregulatory test used to check patterns of sweating during temperature changes
• Urine tests to check bladder functionality
• Abdominal X-rays to examine the digestive system

TREATMENT FOR AUTONOMIC NEUROPATHY

The treatment modalities for autonomic neuropathy are directed at the damaged nerves and any condition that may be causing the nerve injury. Treatments are given based on the symptoms experienced. 

Treatments were given for digestive and gastrointestinal symptoms

• prescription drugs that help with digestion
• laxatives are taken for constipation
• eating frequently but with small servings
• increasing the fiber and fluid intake
• taking tricyclic anti-depressants when a loose stool or stomach pain is experienced

Treatments for bladder and urinary tract

• taking drugs that assist in bladder emptying
• taking drugs that will reduce the symptoms of an overactive bladder
• carry out bladder retraining by scheduling your drink and urine
• using a catheter to drain the bladder

Treatments for sexual dysfunction

• taking drugs that will enhance erection
• using a vacuum pump to force the entrance of blood into the penis to bring about an erection
• using vaginal lubricants to manage dryness

Heart and blood pressure treatments

• to sustain the blood pressure, a high-sodium and a high-fluid meal is given
• drugs are prescribed to reduce dizziness when standing or rising
• drugs that increase the blood pressure are prescribed to handle faintness
• beta-blockers are given to control the heart rate
• being aware and carrying out some postural changes when standing from a sitting position to decrease dizziness
• sleeping with an elevated head to reduce dizziness

Treatment for abnormal sweating

• taking drugs that reduce excessive sweating

PREVENTION OF AUTONOMIC NEUROPATHY

You can prevent neuropathy from developing by taking care of conditions that can cause it. The suggestions include:

• Stabilizing your blood sugar level if you have diabetes. Consuming meals that are low in sugar and high in fiber will help to control diabetes.
• Cease smoking. Speak to your doctor about treatments that will assist in quitting
• Stop alcohol consumption. A counselor may be needed
• Daily exercise to boost the general health status and lose weight, when needed
• Preventing hypertension by drinking plenty of fluids, exercising regularly, and getting rid of stressors

LONG-TERM OUTLOOK

The outcome depends on the cause of the nerve damage and the potency of treatment. In some instances, the nerves can heal themselves. In others, the symptom remains static or even worsens with treatment. 

Tonika Bruce

Tonika Bruce, also known as The Network Nurse, is a multi-talented individual with a career spanning over 20 years. She’s a Registered Nurse, speaker, author, and advocate for change, excelling in business building and team development. Tonika holds two Master’s degrees in Nursing and Business Administration, (MSN & MBA) and is currently pursuing her Doctorate of Nursing Practice in Executive Leadership.

Her expertise extends to various fields such as nursing, entrepreneurship, business, basketball coaching, and executive leadership. She is a published author of “Relentless Pursuit: Proven Tips for Unlocking Your Potentials, Limitless Success and Post COVID Syndrome: A Guide to Repositioning the Nursing Profession for A Post COVID Era”. Currently, Tonika is working on Thrudemic, an anthology examining the impact of the coronavirus pandemic on medical professionals and patients.

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