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Autonomic Neuropathy: Symptoms, Causes, and Treatments Explained

Autonomic neuropathy is a medical condition that involves damage to the nerves that control automatic body functions. This type of neuropathy can impact various aspects of daily life, including blood pressure, temperature regulation, digestion, bladder function, and even sexual function. The nerve damage interferes with the messages sent between the brain and other organs, disrupting the autonomic nervous system's proper functioning Mayo Clinic.

This condition is a result of various underlying diseases and can also be a side effect of specific medications. Diabetic patients are at a higher risk for developing autonomic neuropathy due to persistently high blood sugar levels, which can damage the nerves over time NIDDK. Symptoms of autonomic neuropathy can range from mild to severe and may emerge gradually or suddenly at any age, affecting both women and men equally Cleveland Clinic.

Causes of Autonomic Neuropathy

Autonomic neuropathy is a condition caused by damage to the nerves that control the involuntary functions of the body. Factors leading to autonomic neuropathy can vary, with numerous distinct causes contributing to the development of this condition.

Diabetes and Blood Sugar

Diabetes is one of the primary causes of autonomic neuropathy. Prolonged high blood sugar levels can result in nerve damage, leading to neuropathy. Hence, maintaining proper blood sugar levels is crucial to preventing or controlling the progression of this condition.

Autoimmune Diseases

Autoimmune diseases can contribute to autonomic neuropathy, as the body's immune system mistakenly attacks healthy tissue, leading to nerve damage. Diseases like rheumatoid arthritis, lupus, Guillain-Barre syndrome, celiac disease, Sjogren's syndrome, and hypothyroidism can increase the risk of developing autonomic neuropathy.

Inherited Disorders

In some cases, autonomic neuropathy may result from inherited disorders such as familial dysautonomia (Riley-Day syndrome), idiopathic orthostatic hypotension (progressive autonomic failure), and Charcot-Marie-Tooth disease.

Cancer and Chemotherapy

Cancer and chemotherapy can also lead to autonomic neuropathy. In some cases, the immune system might attack nerves due to the presence of cancer, resulting in a paraneoplastic syndrome. Additionally, some chemotherapy drugs used in cancer treatment can cause nerve damage.

Viral and Bacterial Infections

Viral and bacterial infections, such as HIV and those that cause botulism and Lyme disease, can contribute to autonomic neuropathy. These infections may attack nerves directly or cause inflammation leading to nerve damage.

Alcohol and Smoking

Excessive alcohol consumption has been linked to autonomic neuropathy, as it can lead to nerve damage. Similarly, smoking can damage the nerves and blood vessels, increasing the risk of developing autonomic neuropathy.

In conclusion, multiple factors can contribute to the development of autonomic neuropathy. Understanding these factors can help individuals manage their risk and take appropriate preventative measures.

Symptoms and Effects of Autonomic Neuropathy

Cardiovascular Issues

Autonomic neuropathy can impact the cardiovascular system by affecting heart rate and blood pressure. Patients may experience postural hypotension, which is characterized by dizziness, lightheadedness, fainting, and unsteady gait due to a sudden drop in blood pressure when standing 1.

Digestive Problems

The autonomic nervous system (ANS) plays a crucial role in the digestive process. Damage to the nerves within the digestive system can cause a variety of symptoms such as bloating, fullness, nausea, constipation, diarrhea, and gastroparesis2. Autonomic neuropathy may also lead to difficulties swallowing and vomiting in some cases2.

Urinary and Bladder Dysfunction

Urinary problems are common in autonomic neuropathy patients. Symptoms can include urinary frequency, excessive urination at night, urgency, hesitancy, and urinary retention3. Furthermore, patients may experience a loss of bladder control, difficulty in sensing a full bladder, and inability to completely empty the bladder1. These problems increase the risk of urinary tract infections4.

Sexual Dysfunction

Autonomic neuropathy can lead to sexual dysfunction in both men and women. Erectile dysfunction is a common issue for men, while women may experience vaginal dryness and difficulty achieving orgasm5. These symptoms can negatively impact sexual function and relationships.

Sweating and Temperature Regulation

The ANS plays a vital role in regulating body temperature and controls the function of sweat glands. Damage to these nerves can result in problems with sweating, leading to issues with temperature control6. Patients may experience night sweats, excessive sweating, or reduced sweating, which can affect their ability to maintain a stable body temperature6.

Exercise Intolerance

Autonomic neuropathy can also lead to exercise intolerance, resulting in shortness of breath and difficulties managing physical activities5. This issue is particularly concerning for individuals with diabetes, as hypoglycemia unawareness may occur, wherein patients are unable to recognize the symptoms of low blood sugar during exercise, potentially leading to dangerous situations5.

Diagnosis and Tests

Diagnosing autonomic neuropathy involves a combination of methods, which are essential to determine the extent of nerve damage and identify the underlying condition causing it. The process typically consists of the following steps:

Medical History and Physical Examination

The first step in diagnosing autonomic neuropathy is conducting a thorough review of the patient's medical history and discussing their symptoms. This provides the doctor with a better understanding of the patient's condition and helps identify any risk factors, such as diabetes, alcoholism, or chronic illnesses like HIV or Parkinson's disease 1.

During a physical examination, doctors check for signs of autonomic neuropathy such as numbness, tingling, or unusual changes in blood pressure. These observations are crucial to establish the need for further tests 3.

Blood Tests

Blood tests are used to assess blood glucose levels, which may indicate diabetes, one of the primary causes of autonomic neuropathy. Depending on the patient's symptoms, other tests may include checking for thyroid disorders and vitamin deficiencies, all of which can contribute to nerve damage 6.

Neurological Examinations

A variety of neurological examinations are used to evaluate the extent of nerve damage and assess autonomic functions, such as:

  • Autonomic function tests: These tests measure the body’s response to various activities, such as changes in blood pressure, heart rate, and sweat production 2.
  • Quantitative sensory testing: This involves using a device to measure the patient's ability to detect temperature and vibration changes on the skin, providing insight into the severity of neuropathy 5.
  • Nerve conduction studies: These tests measure the speed at which electrical signals travel through the nerves. Slower conduction rates may indicate autonomic neuropathy 4.

Validating a diagnosis of autonomic neuropathy requires careful consideration of the patient's symptoms, medical history, blood test results, and findings from neurological examinations. A comprehensive approach allows doctors to create targeted treatment plans to manage the condition and address its underlying causes.

Treatment and Management

Blood Sugar Control

The first step in treating autonomic neuropathy is to manage the underlying disease or condition causing nerve damage. For instance, if diabetes is causing nerve damage, it's crucial to maintain tight control of blood sugar levels to prevent further damage.


Depending on the cause and symptoms, your doctor may prescribe various medications to manage autonomic neuropathy. Some commonly prescribed medications include:

  • Beta-blockers to help regulate heart rate and blood pressure
  • Pyridostigmine to improve muscle strength and nerve function
  • Fludrocortisone for managing blood pressure and blood volume
  • Midodrine to improve orthostatic intolerance and increase blood pressure when standing

In some cases, over-the-counter pain relievers may be helpful. Consult your doctor before taking any medication.

Physical Therapy and Exercises

Physical therapy and exercises can help improve muscle strength and function. Consult with a physical therapist or healthcare provider to develop a personalized exercise plan that may include:

  • Stretching to improve flexibility and reduce muscle stiffness
  • Aerobic exercises such as walking, swimming, or riding a stationary bike to help improve cardiovascular health
  • Resistance exercises, like rowing, to help build muscle strength
  • Balance exercises to reduce the risk of falls and improve coordination

Remember always to consult your healthcare professional before starting any exercise or treatment program.

Additional Management Strategies

Based on the specific symptoms and complications of autonomic neuropathy, additional management methods may be recommended by your doctor, such as:

  • Dietary changes to help manage digestive issues or constipation
  • Vaginal lubricants and erectile dysfunction medications to improve sexual function
  • Intermittent catheterization for bladder control issues
  • Orthostatic training to increase standing tolerance and minimize dizziness
  • Laxatives to treat constipation due to slow gastrointestinal transit

The treatment and management strategies for autonomic neuropathy vary based on the underlying cause, symptoms, and individual needs. It's essential to work closely with your healthcare provider to develop the most suitable approach for you.

Prevention and Lifestyle Changes

Managing Medical Conditions

One of the key aspects of preventing autonomic neuropathy is to address any underlying medical conditions. For example, keeping your blood sugar stable if you have diabetes is crucial in preventing autonomic neuropathy complications 1. Similarly, taking steps to prevent or control high blood pressure, maintaining a healthy weight, and getting appropriate treatment for autoimmune diseases can help reduce the risk of developing autonomic neuropathy 3.

Exercise and Physical Activity

Regular exercise and physical activity play an important role in the prevention of autonomic neuropathy. A consistent exercise routine can help maintain healthy nerve function and blood circulation, which is essential for people with a higher risk of developing neuropathy 6. Some beneficial types of exercise include:

  • Aerobic exercises, such as walking, swimming, or cycling
  • Strength training exercises using resistance bands or weights
  • Balance and flexibility exercises, like yoga and tai chi

Always consult with your healthcare provider before starting a new exercise program, especially if you have any pre-existing health conditions.

Stress Reduction and Breathing Techniques

Stress can have a negative impact on the autonomic nervous system, potentially exacerbating symptoms of autonomic neuropathy or increasing the risk of developing the condition. Incorporating stress reduction techniques and practicing proper breathing habits can help improve the overall functioning of the autonomic nervous system 2. Some effective methods to reduce stress and promote relaxation include:

  • Meditation and mindfulness practices
  • Deep breathing exercises, such as diaphragmatic breathing, or "belly breathing"
  • Progressive muscle relaxation
  • Visualization or guided imagery exercises

In conclusion, managing medical conditions, maintaining regular exercise and physical activity, and implementing stress reduction techniques can significantly contribute toward preventing autonomic neuropathy or reducing the severity of the condition.

Living with Autonomic Neuropathy

Autonomic neuropathy can have a significant impact on daily life, as it affects various functions such as breathing, eyesight, body temperature, bladder control, and the digestive system. By implementing coping strategies, joining support groups, and addressing mental health, living with this condition can become more manageable.

Coping Strategies

  • Regulate body temperature: Since autonomic neuropathy may disrupt the body's ability to maintain a stable temperature, be mindful of your environment and dress accordingly. Wear layers to easily adjust to varying conditions.
  • Manage bladder function: To improve bladder control, schedule regular bathroom breaks and avoid bladder irritants like caffeine and alcohol. If necessary, discuss medication options with your healthcare provider.
  • Optimize the digestive system: Consume small, frequent meals, and include fiber in your diet to aid digestion. Elevating the head of your bed and avoiding lying down after meals can help alleviate reflux symptoms.
  • Tackle exercise intolerance: Engage in gentle, low-impact exercises, such as swimming or yoga, to help manage symptoms. Consult your healthcare provider for a personalized exercise plan.
  • Address sweating problems: Choose lightweight, moisture-wicking clothing to minimize sweating. Stay hydrated and avoid hot environments to prevent overheating.

Support Groups

Participating in support groups can provide emotional and informational assistance to individuals with autonomic neuropathy. Online forums or local groups can connect individuals who share experiences, coping tips, and resources. The Dysautonomia International community is one example of a support network for those living with dysautonomia, a common form of autonomic dysfunction.

Mental Health

It is essential to prioritize mental health when living with autonomic neuropathy. Addressing feelings of anxiety, depression, or stress can improve overall well-being. Consider seeking professional help from a therapist or counselor, practicing mindfulness techniques such as meditation, and cultivating a strong social support network.


  1. Mayo Clinic - Autonomic Neuropathy Symptoms and Causes 2 3 4

  2. NIDDK - Autonomic Neuropathy 2 3 4

  3. Cleveland Clinic - Autonomic Neuropathy & Dysautonomia 2 3

  4. NIDDK - Urinary Tract Infections 2

  5. Mayo Clinic - Autonomic Neuropathy Diagnosis and Treatment 2 3 4

  6. WebMD - Autonomic Neuropathy: Symptoms, Causes, Diagnosis, Treatment 2 3 4