Autonomic dysfunction, Autonomic neuropathy, Dysautonomia
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Autonomic dysfunction, also known as autonomic neuropathy or dysautonomia, happens when the nerves that regulate automatic bodily functions are damaged. The condition could range from mild to severe. The signals that travel from the brain to different organs and autonomic nervous system regions are affected by the injury to the nerves. Blood pressure, digestion, controlling body temperature, bladder function, and even sexual function can all be affected.
Autonomic dysfunction comes in two primary types:
- Primary autonomic dysfunction: This type occurs on its own, without known cause. Compared to secondary autonomic dysfunction, which is caused by something else, they are less common.
- Secondary autonomic dysfunction: Secondary autonomic dysfunction can be brought on by or caused by a number of disorders.
Autonomic dysfunction is most commonly caused by diabetes. Infections with bacteria or viruses, specific medications, and other medical disorders might potentially be the cause. Treatment and symptoms differ according on the injured nerve.
Symptoms
Autonomic dysfunction signs and symptoms may affect several body systems and may differ in look based on the specific nerves affected. These could consist of:
- A sudden drop in blood pressure that results in dizziness and fainting when standing up.
- Issues related to sexual activity, such as ejaculation or erectile dysfunction, which are difficulty getting or maintaining an erection. Vaginal dryness, decreased libido, and trouble achieving an orgasm are among the issues women face.
- Not being able to identify hypoglycemia, or low blood sugar, because there are no warning signs, such shaking.
- Problems with food digestion, including feeling full after only a few bites, appetite loss, diarrhea, constipation, bloating in the abdomen, nausea, vomiting, dysphagia, and heartburn. All of these issues are brought on by modifications in digestive function.
- Problems with perspiration, such as excessive or insufficient sweating. The body’s capacity to regulate temperature is impacted by these issues.
- Problems with the urinary system, including loss bladder control, difficulties detecting fullness, difficulty starting urination, and difficulty emptying the bladder entirely. Urinary tract infections can occur as a result of incomplete bladder emptying.
- Slow pupil responsiveness, which impairs nighttime driving vision and makes it difficult to transition from light to dark.
- The inability to adapt your heart rate to your activity level, which can lead to exercise intolerance.
If you have any of the signs and symptoms of autonomic neuropathy, especially if you have poorly controlled diabetes, seek immediate medical attention.
It is recommended to have yearly autonomic neuropathy test for those with type 2 diabetes, starting as soon as you are diagnosed. The recommends yearly screening for individuals with type 1 diabetes starting five years following diagnosis.
Causes
Autonomic dysfunction is a result of numerous medical disorders. It may also develop as a side effect from other medical conditions, like cancer. Among the most common causes of autonomic dysfunction are:
- The most frequent cause of autonomic dysfunction is diabetes, particularly when it is poorly managed. Diabetes has the potential to progressively harm all of the body’s nerves.
- Amyloidosis, an irregular protein accumulation in the organs that affects the neurological system and organs.
- Autoimmune conditions, in which your body’s defenses, particularly your nerves, are attacked and damaged by your immune system. Sjogren syndrome, systemic lupus erythematosus, rheumatoid arthritis, and celiac disease are a few examples. An autoimmune condition that strikes quickly and can damage autonomic nerves is called Guillain-Barre syndrome.
- An immune system attack brought on by certain cancers can also result in autonomic dysfunction (paraneoplastic syndrome). Specific medications, such as those used in chemotherapy for the treatment of cancer.
- Certain bacteria and viruses, including those that cause botulism and Lyme disease, as well as the human immunodeficiency virus (HIV).
- Autonomic dysfunction can also be caused by some hereditary conditions.
Risk factors
There are some factors that could increase your susceptible to autonomic dysfunction:
- Diabetes: Autonomic dysfunction and other nerve damage are more likely to occur in people with diabetes, especially if it is not properly managed. The biggest risk is if you have trouble keeping your blood sugar under control.
- Other diseases: The number of medical conditions such as hypothyroidism, porphyria, and amyloidosis, may increase the risk of autonomic neuropathy. Cancer can also occur, typically as a result of therapy side effects.
Diagnosis
Diagnosing autonomic dysfunction involves a comprehensive approach that integrates multiple methods and tests. Healthcare providers rely on a process of elimination to identify potential causes. They examine patterns in symptoms, their timing, and occurrence to establish connections. For individuals with risk factors like diabetes or those undergoing nerve-damaging cancer therapies, physical examinations and symptom inquiries are crucial steps in the diagnostic process. Even in the absence of typical risk factors, healthcare providers may pursue a thorough assessment involving detailed symptom discussions, medical history reviews, and comprehensive physical exams to reach an accurate diagnosis.
Your healthcare provider may suggest the following tests to assess autonomic functions:
- Autonomic function tests: These tests monitor your blood pressure and heart rate in response to exercises like the Valsalva maneuver, which involves deep breathing and forceful exhalation.
- Tilt-table test: With this test, blood pressure and heart rate are tracked in relation to changes in position and posture. It replicates the feeling of standing from a lying position. You are flat on a table that has been slanted to elevate your upper body. In order to make up for the decline in blood pressure, blood vessels usually narrow and heart rate rises. If you have autonomic dysfunction, this reaction can be slower.
Checking your blood pressure while reclining, sitting, and standing after three minutes is a simpler way to assess this response. Another test involves monitoring heart rate and blood pressure as the subject stands for one minute, squats for another, and then stands again.
- Gastrointestinal tests: The most popular test for digestive problems, such as delayed stomach emptying and slow digesting, is the gastric-emptying test (gastroparesis). A gastroenterologist, a healthcare provider who specializes in digestive issues, typically performs these tests.
- Quantitative sudomotor axon reflex test: This test measures the response to stimulation of the nerves that control your sweat glands. An electrical current of a tiny magnitude flows through capsules positioned on your foot, upper and lower leg, and forearm. Your sweat glands and nerve responses are evaluated by a computer. During the test, you may experience warmth or tingling.
- Thermoregulatory sweat test: A powder that turns color when you sweat is applied on you. You start to perspire while lying in a room that is gradually getting hotter, and digital pictures capture the outcome. A diagnosis of autonomic dysfunction may be supported by your sweat pattern, which may also point to alternative reasons for decreased or increased sweating.
- Urodynamic tests: Urine and bladder tests can be used to assess bladder function if you have symptoms related to your bladder or urine.
- Ultrasound: Your healthcare provider may suggest an ultrasound of your urinary system if you have symptoms and indications related to your bladder. High-frequency sound waves are used in this examination to provide a picture of the bladder and other urinary tract organs.
Treatment
While there is no known cure for autonomic dysfunction, many of its symptoms can be effectively managed. Treatment approaches for autonomic dysfunction are highly variable and depend significantly on the underlying cause.
Autonomic dysfunction treatment includes:
- Treatment for underlying disease: Managing the disease or condition that is harming your nerves is the primary objective of treating autonomic dysfunction. You will need to closely monitor your blood sugar if diabetes is the cause of your nerve damage in order to stop the damage from getting worse. The underlying cause of autonomic dysfunction is not identified in around half of cases.
- Treatment of specific symptoms: The autonomic dysfunction symptoms may be relieved by some treatments. The area of your body where nerve damage is most noticeable will determine how you are treated.
- Treatment for digestive symptoms:
- Diet changes: You may require extra fluid and dietary fiber. Supplements containing fiber, like Citrucel or Metamucil, may also be beneficial. To prevent bloating and gas, gradually increase your intake of fiber.
- Medication for stomach empty: Metoclopramide (Reglan), a prescription medication, increases the contractions of the digestive tract to assist your stomach empty more quickly. It is not recommended to use this medication for more than 12 weeks because it can make you drowsy.
- Medications for constipation: Over-the-counter laxatives can be used to relieve constipation. Find out from your healthcare provider how frequently you should take a laxative.
- Medications for diarrhea: By preventing excessive bacterial growth in the intestines, antibiotics may help in the treatment of diarrhea. Over-the-counter anti-diarrheal medications may be beneficial.
- Treatment for urinary symptoms:
- Retraining your bladder: Your bladder’s capacity can be increased and it can be trained to empty entirely at the appropriate times by following to a timetable for when to drink fluids and when to urinate.
- Medication for bladder symptoms: Medicines that reduce an overactive bladder may be prescribed by your healthcare provider. Other medications could help with bladder emptying.
- Urinary catheterization: Your bladder is emptied by passing a tube or catheter through your urethra.
- Treatment for sexual dysfunction (men): In treating men with erectile dysfunction, healthcare providers may recommend:
- Medications for erections: You can obtain and sustain an erection with the use of medications like vardenafil, tadalafil (Cialis), avanafil (Stendra), and sildenafil (Viagra).
When using these medications, use caution if you have a history of high blood pressure, heart disease, arrhythmia, or stroke. Additionally, do not take these medications if you are taking any kind of organic nitrate. If your erection persists for more than four hours, seek medical attention immediately.
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- External vacuum pump: With the use of a hand pump, this device facilitates blood flow to the penis. An erection can last for up to thirty minutes with the use of a tension ring to assist hold the blood in place.
- Treatment for sexual dysfunction (Women): Healthcare providers may advise the following for women experiencing sexual symptoms:
- Vaginal lubricants are used to reduce dryness and enhance the ease and pleasure of sexual activity. One of the few medications that has been authorized for premenopausal women who have little desire for sex.
- Treatment for heart rhythm and blood pressure: Problems with blood pressure and heart rate might result from autonomic dysfunction. Your healthcare provider may recommend the following:
- A high-salt and high-fluid diet: A high salt and hydrated diet can help keep your blood pressure stable if it decreases when you stand up. Hypertension or edema of the legs, ankles, or feet may result from this medication. Therefore, healthcare providers typically only advise it in cases of severe blood pressure issues. Moreover, patients with heart failure shouldn’t receive this kind of treatment.
- Compression garments: Thigh-high compression stockings or a binder wrapped around the waist could help in enhancing blood flow.
- Medications for blood pressure: Your healthcare provider may recommend medication if standing up causes you to feel lightheaded or faint. By assisting your body in retaining salt, fludrocortisone lowers blood pressure.
- Droxidopa (Northera) and midodrine (Orvaten) can help elevate blood pressure. But when you’re lying down, these medications may increase your blood pressure. When used in conjunction with food, octreotide (sandostatin) can help elevate blood pressure in diabetics with hypotension; nevertheless, there may be side effects. When standing, pyridostigmine (Mestinon) may assist maintain stable blood pressure.
- Medication for regulating your heart rate: When you engage in physical activity, a class of medication known as beta blockers can help control your heart rate if it becomes too high.
- Treatment for sweating:
- Your healthcare provider may recommend a medicine that reduces sweating if you perspire excessively. Sweating can be reduced by glycopyrrolate (Cuvposa, Robinul, and other brands).
- Due to its decreased sweating capacity, glycopyrrolate can further raise the risk of heat-related illnesses including heatstroke.
