Autonomic neuropathy

Signs and symptoms

• Urinary bladder conditions: urinary incontinence or urinary retention which happens due to the uncoordinated contraction of the bladder. Neurogenic bladder is a broad term used to describe this dysfunction.
• Gastrointestinal tract: dysphagia, abdominal pain, nausea, vomiting, malabsorption, fecal incontinence, gastroparesis, diarrhea, constipation
• Cardiovascular system: disturbances of heart rate, orthostatic hypotension, inadequate increase of heart rate on exertion
• Respiratory system: impairments in the signals associated with regulation of breathing and gas exchange.
• Nervous system: pupillary defect, exaggerated hippus, dizziness or lightheadedness.
• Other areas: hypoglycemia unawareness, genital impotence, sweat disturbances, sicca.
• Absence of signs of cerebellar dysfunction or parkinsonian symptoms as the presence of either would indicate the more serious disease of multiple system atrophy.

  Causes

• Diabetes, which is the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.
• Injury to nerves caused by surgery or radiation to the neck.
• Treatment with certain medications, including some drugs used in cancer chemotherapy.
• Abnormal protein buildup in organs, which affects the organs and the nervous system.
• Neurodegenerative diseases including Parkinson's disease and “Parkinson’s Plus diseases” including multiple system atrophy and Lewy body dementia, and multiple sclerosis
• Autonomic neuropathy may also be caused by an abnormal attack by the immune system, sometimes as part of a paraneoplastic syndrome which can occur even when cancer has not yet been diagnosed.
• Certain infectious diseases. Some viruses and bacteria, such as botulism, Lyme disease and HIV, can cause autonomic neuropathy.
• Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy.
• Autoimmune diseases, in which the immune system attacks and damages parts of the body, including the nerves. Examples include Sjögren syndrome, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. Guillain–Barré syndrome is an autoimmune disease that happens rapidly and can affect autonomic nerves.

  Diagnosis

Treatment

Neurogenic Bladder

• Behavioral changes: such as reducing water intake, kegel exercises, biofeedback training
• Clean intermittent catheterization: insertion of a foley catheter to remove the urine every few hours and prevent retention, done in a sterile manner.
• Pharmacological therapy, which includes anticholenergic drugs which reduce the contraction of the bladder
• Botox injections into the bladder
• Surgical treatment: Urinary diversion, Artificial Urinary Sphincter, Urethral sling, or insertion of electrical devices adjacent to the bladder to stimulate its contraction.