Autonomic neuropathy

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Symptoms

By Mayo Clinic staff

Signs and symptoms of autonomic neuropathy vary, depending on which parts of your autonomic nervous system are affected. They may include:

  • Dizziness and fainting upon standing caused by a drop in blood pressure.
  • Urinary problems, including difficulty starting urination, urinary incontinence and an inability to completely empty your bladder, which can lead to urinary tract infections.
  • Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men, and vaginal dryness and difficulties with arousal and orgasm in women.
  • Difficulty digesting food, due to abnormal digestive function and slow emptying of the stomach (gastroparesis). This can cause a feeling of fullness after eating little, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn.
  • Sweating abnormalities, such as excessive or decreased sweating, which affects the ability to regulate body temperature.
  • Sluggish pupil reaction, making it difficult to adjust from light to dark and causing problems with driving at night.
  • Exercise intolerance, which may occur if your heart rate remains unchanged instead of appropriately increasing and decreasing in response to your activity level.

When to see a doctor
Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy. If you have diabetes, a compromised immune system or another chronic medical condition, see your doctor regularly to be checked for nerve damage.

The American Diabetes Association (ADA) recommends that people with type 2 diabetes be screened every year for autonomic neuropathy starting as soon as they receive their diabetes diagnosis. For people with type 1 diabetes, the ADA advises annual screening beginning five years after being diagnosed with diabetes.

Causes Definition
References
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  2. Freeman R. Autonomic peripheral neuropathy. The Lancet. 2005;365:1259.
  3. Stevens MJ. Diabetic autonomic neuropathy. http://www.uptodate.com/index. Accessed May 25, 2012.
  4. Boulton AJM, et al. Diabetic neuropathies: A statement from the American Diabetes Association. Diabetes Care. 2005;28:956.
  5. Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=9146961. Accessed May 25, 2012.
  6. Diabetic neuropathies: The nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/. Accessed May 21, 2012.
  7. Overview of the autonomic nervous system. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/neurologic_disorders/autonomic_nervous_system/overview_of_the_autonomic_nervous_system.html. Accessed May 25, 2012.
  8. Philips JC, et al. Squatting, a posture test for studying cardiovascular autonomic neuropathy in diabetes. Diabetes & Metabolism. 2011;37:489.
  9. Bethanechol (prescribing information). Pomona, N.Y.: Barr Laboratories, Inc.; 2007. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=80ee6156-18b8-45aa-9402-b40647173da8. Accessed May 25, 2012.
  10. Detrol (prescribing information). New York, N.Y.: Pharmacia and Upjohn; 2012. http://labeling.pfizer.com/ShowLabeling.aspx?id=719. Accessed May 25, 2012.
  11. Ditropan (prescribing information). Raritan, N.J.: Ortho McNeil Pharmaceuticals; 2011. http://www.janssenpharmaceuticalsinc.com/assets/ditropanxl.pdf. Accessed May 25, 2012.
  12. Vinik AI, et al. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387.
  13. Robinul and Robinul Forte (prescribing information). Atlanta, Ga.: Shionogi Pharma, Inc.; 2010. http://www.robinul.com/Robinul%20PI.pdf. Accessed May 25, 2012.
  14. Shakher J, et al. Update on the management of diabetic polyneuropathies. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2011;4:289.
  15. Wang CP, et al. A single-blinded, randomized pilot study evaluating effects of electroacupuncture in diabetic patients with symptoms suggestive of gastroparesis. The Journal of Alternative and Complementary Medicine. 2008;7:833.
  16. Sandroni P (expert opinion). Mayo Clinic, Rochester, Minn. May 29, 2012.
DS00544 July 12, 2012

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