- Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves
- Some tumors, which can press on nerves and cause direct or remote damage (paraneoplastic syndrome)
- Multiple system atrophy, a degenerative disorder that destroys the nervous system
- Surgical or traumatic injury to nerves, injury can be from a car accident.
- Other chronic illnesses such as Parkinson's disease and HIV/AIDS
- Celiac disease more info
Treatment for autonomic neuropathy depends on the underlying cause and the particular signs and symptoms you're experiencing. For example, if the underlying cause is diabetes or an autoimmune disease, treatment will focus on modulating your immune system and decreasing inflammation. By using IVIg both autonomic and diabetic neuropathy can be treated universally, I have seen completely disabled people become fully mobile . You will first need to fix your vitamin or nutrition deficiency.
The goal of treatment is to manage the underlying condition, repair nerve damage, if possible, and provide symptom relief.
The type of medication your doctor may prescribe depends on your symptoms.
- Gastrointestinal symptoms. Your doctor may prescribe metoclopramide (Reglan, Metoclopramide HCL), which helps your stomach empty more rapidly by increasing the contractions of the stomach and intestines. Possible side effects include diarrhea when taken in high doses, drowsiness and restlessness. Other medications include fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) to relieve constipation and tricyclic antidepressants such as imipramine (Tofranil) and amitriptyline for diarrhea and abdominal pain. Possible side effects of tricyclic antidepressants include orthostatic hypotension, drowsiness, urinary retention, constipation and dry mouth.
- Sexual dysfunction. Your doctor may prescribe sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) for erectile dysfunction. Possible side effects include flushing, indigestion and headache. Don't take these medications if you've had a heart attack, stroke or life-threatening heart rhythm in the previous six months.Treatmentsfor vaginal dryness include vaginal estrogen cream (Premarin, Estrace), which you insert into your vagina with an applicator two or three times a week, and vaginal estrogen rings (Estring), which releases estrogen for 90 days.
- Bladder problems. Bethanechol (Urecholine) helps cause urination and emptying of the bladder. Possible side effects include dizziness, lightheadedness or fainting. Your doctor may prescribe an antibiotic to clear up a urinary tract infection.
- Postural hypotension. If you get dizzy or feel faint from a drop in blood pressure when you get up, your doctor may prescribe medication, a high-salt diet or support stockings. He or she may prescribe fludrocortisone acetate (Florinef) to help your body retain salt or recommend a blood pressure regulator such as midodrine (ProAmatine). Possible side effects of midodrine include blurred vision, headache and pounding in the ears. Recently, pyridostigmine (Mestinon) has shown promising results for treating postural hypotension without causing high blood pressure while lying down (supine hypertension), a common problem with midodrine.
- Sweating. If autonomic neuropathy affects sweating, it usually causes a decrease. But if you experience excessive sweating, your doctor may prescribe a drug that inhibits sweating, such as belladonna alkaloids (scopolamine, glycopyrrolate) or botulinum toxin type A (Botox). Possible side effects of belladonna alkaloids include blurred vision, drowsiness, dizziness and dryness of the mouth, nose and throat. Botox, given by injection, can cause a skin rash or reaction at the injection site.
Therapies and procedures
If you have trouble emptying your bladder fully, your doctor may recommend intermittent urinary catheterization, a procedure in which a tube is threaded through your urethra to empty your bladder. Psychotherapy or counseling may be appropriate if you're depressed. Sex therapy or couples counseling might be helpful if you're experiencing relationship problems as a result of sexual dysfunction.
Taking good care of your health in general and managing any medical condition that puts you at risk of autonomic neuropathy is the best prevention. Unfortunately, however, there's no way to prevent degenerative diseases, such as multiple system atrophy, that increase the risk of developing autonomic neuropathy. Ways to help prevent autonomic neuropathy may include:
- Control your blood sugar if you have diabetes.
- Get help if you have a problem with alcohol.
- Get appropriate treatment if you have an autoimmune disease.
- Achieve and maintain a healthy weight.
- Exercise regularly.
If you have trouble digesting food and your symptoms are mild, your doctor might recommend eating small, frequent meals, avoiding fats and reducing intake of dietary fiber. For a drop in blood pressure when you stand up, wearing elastic stockings and sleeping with your head elevated may help.
Living with a chronic illness or disability presents daily challenges. Some of these suggestions may make it easier for you to cope:
- Set priorities. Decide which tasks you need to do on a given day, such as paying bills or shopping for groceries, and which can wait until another time. Stay active, but don't overdo.
- Seek and accept support. Having a support system and a positive attitude can help you cope with the challenges you face. Ask for or accept help when you need it. Don't shut yourself off from family and friends.
- Prepare for challenging situations. If something especially stressful is coming up in your life, such as a move or a new job, knowing what you have to do ahead of time can help you cope.
- Talk to a counselor or therapist. Depression and impotence are possible complications of autonomic neuropathy. If you experience either, you may find it helpful to talk to a counselor or therapist in addition to your primary care doctor. There are treatments that can help.
Screening and diagnosis: Small Fiber Neuropathy can be tested by a skin biopsy.