Autonomic neuropathy

Diagnosis

The necessary diagnostic tests for a patient suspected of having autonomic neuropathy will be determined based on their symptoms and risk factors for autonomic neuropathy.

• Having risk factors: The patient’s healthcare provider will conduct a physical examination and inquire about their symptoms if they have diabetes or another illness that raises their risk of autonomic neuropathy. Their healthcare provider will look for signs of neuropathy if they are receiving cancer therapy that includes a medication that is known to cause nerve damage.
• Having no risk factors: When a patient has autonomic neuropathy symptoms but no associated risk factors, the diagnosis can be more complicated. Most likely, their healthcare provider will go over their medical history, talk with them about their symptoms, and perform a physical examination. A healthcare provider might suggest the following tests to assess autonomic functions:
  • Tilt-table test: This examination keeps track of how blood pressure and heart rate change in response to posture and position. It mimics what happens when standing up from lying down. The patient must lie flat on a table that is then inclined to elevate the upper portion of their body. In order to make up for the decline in blood pressure, blood arteries often close and heart rate rises. If you suffer from autonomic neuropathy, this reaction may take longer.

A simpler test for assessing autonomic neuropathy response involves checking blood pressure in three different positions: lying down, sitting down, and standing up after three minutes. Another test involves the subject standing for a minute, squatting for a minute, and then standing again while monitoring their blood pressure and heart rate.

• • Autonomic function tests: These tests track how the heart rate and blood pressure change in response to breathing activities like the Valsalva maneuver and deep breathing.
  • Gastrointestinal tests: The most frequent tests to look for digestive problems, such as sluggish digestion and delayed stomach emptying (gastroparesis), are gastric-emptying tests.
  • Urinalysis and bladder function tests: A set of urine and bladder tests can assess bladder function in patients who exhibit bladder or urinary signs and symptoms.
  • Ultrasound: Healthcare provider may advise an ultrasound of the patient’s urinary tract if they exhibit bladder signs and symptoms. High-frequency sound waves are used in this examination to provide a picture of the bladder and other urinary tract organs.
  • Quantitative sudomotor axon reflex test: The nerves that control the sweat glands are tested to see how they react to stimulation. On the forearm, upper and lower leg, and foot, capsules are positioned, and they each get a modest electrical current. The response of the nerves and sweat glands is analyzed by a computer. During the test, they can experience warmth or a tingling feeling.
  • Thermoregulatory sweat test: Patients have a powder coating that changes color while they sweat. Digital pictures are taken when they begin sweating as they are lying in a room that gradually heats up. Their sweat pattern may point to further causes of decreased or excessive sweating or support the diagnosis of autonomic neuropathy.

Treatment

While there is no cure for autonomic neuropathy, the symptoms of the condition can be managed. Healthcare providers may offer a variety of treatments to address specific conditions associated with autonomic neuropathy. Some common treatments for autonomic neuropathy include:

• Underlying disease treatment: In order to address the disorder that is causing the nerve damage, autonomic neuropathy must first be treated. They will need to closely regulate blood sugar if diabetes is the root of the nerve damage in order to stop further harm.
• Managing specific symptoms: The signs and symptoms of autonomic neuropathy can be treated. The area of the body where nerve damage is most severe will determine the course of treatment.
• Gastrointestinal symptoms
  • Dietary changes: The patient may require additional water and dietary fiber. Supplements containing fiber, such Metamucil or Citrucel, may also be beneficial. Increase their fiber intake gradually to prevent gas and bloating.
  • Medication for stomach empty: Metoclopramide, a prescription medication, helps patients have their stomachs empty more quickly by causing the digestive tract to contract more. Use of this medication shouldn’t go beyond 12 weeks because it could cause drowsiness.
  • Medications for constipation: Constipation can be relieved by over-the-counter laxatives. How frequently the patient should use a laxative should be discussed with the healthcare provider.
  • Medications for diarrhea: By limiting the growth of bacteria in the intestines, antibiotics can alleviate diarrhea. It might be beneficial to take over-the-counter anti-diarrheal medication.
• Urinary symptoms
  • Bladder retraining: The capacity of the bladder can be increased, and the bladder can be retrained to empty entirely at the right times, by adhering to a schedule of when to consume fluids and when to urinate.
  • Medication for bladder symptoms. A medicine to reduce an overactive bladder may be prescribed by the healthcare provider. Other drugs could aid in bladder emptying.
  • Urinary catheter: To empty the bladder, a tube called a urinary catheter is placed into the urethra.
• Sexual dysfunction:

The following treatment options could be suggested to men with erectile dysfunction:

• Medications for erections. Patient can obtain and sustain an erection with the use of medications like sildenafil, vardenafil, tadalafil, and avanafil. Low blood pressure, a light headache, flushing, an upset stomach, and alterations in color vision are all potential adverse effects which should be observed.

Use these medications with caution if someone have a history of heart disease, an arrhythmia, a stroke, or high blood pressure. If they are using any kind of organic nitrate, they should also refrain from taking these medications. If they experience an erection that lasts longer than four hours, they need to seek medical attention immediately.

• External vacuum pump: Using a hand pump, this device assists in drawing blood into the penis. For up to 30 minutes, an erection can be sustained with the help of a tension ring.

Healthcare providers may advise the following for women exhibiting sexual symptoms:

• Lubricants: To reduce dryness and improve the comfort and pleasure of sexual contact, use vaginal lubricants.
• Medication: Flibanserin, is one of a selected few drugs authorized for use in premenopausal women who lack sex desire.
• Heart rhythm and blood pressure symptoms: Problems with blood pressure and heart rate might result from autonomic neuropathy. The healthcare provider might suggest:
  • High-salt and high-fluid diet: A diet rich in salt and fluids can benefit a patient whose blood pressure lowers when they stand up by keeping their blood pressure stable. High blood pressure or edema in the feet, ankles, or legs may result from this medication. Therefore, it is typically only advised for extremely serious blood pressure issues. Additionally, this treatment is not recommended for patients with heart failure.
  • Compression garments:  Improving blood flow can be aided by wearing a waist binder or thigh-high compression stockings.
  • Medications to increase blood pressure:  If you experience faintness or dizziness upon standing, your healthcare provider may recommend medications to address the issue. Fludrocortisone aids in salt retention, thereby regulating blood pressure. Midodrine and droxidopa can elevate blood pressure, but may cause hypertension while lying down. Octreotide can increase blood pressure in individuals with diabetes who experience low blood pressure after meals, though it may have side effects. Pyridostigmine may assist in maintaining stable blood pressure when standing.
  • Medication to regulate heart rate: If the heart rate increases too much when exercising, a family of drugs known as beta blockers can help control it.
• Sweating: A medicine that lessens perspiration may be prescribed by the patient’s healthcare provider if they sweat excessively. Sweating can be lessened by the drug glycopyrrolate. Diarrhea, dry mouth, urine retention, impaired vision, changes in heart rate, headache, loss of taste, and tiredness are just a few of the possible side effects. Because glycopyrrolate inhibits sweating, it also raises the risk of heat-related illnesses including heatstroke.