What happens if the autonomic nervous system is damaged

Autonomic neuropathies are disorders affecting the peripheral nerves that automatically (without conscious effort) regulate body processes (autonomic nerves).

Table of Contents Show

Management and Treatment
How is autonomic dysfunction treated?
Specific symptom management
Lifestyle changes to improve vascular tone:
Medications to improve vascular tone:
Lifestyle changes to improve blood pressure:
Lifestyle changes to improve blood volume:
What happens when the autonomic nervous system fails?
What causes the autonomic nervous system to fail?
What are symptoms of autonomic failure?
What effects does the autonomic nervous system control?

Causes include diabetes, amyloidosis, autoimmune disorders, cancer, excessive alcohol consumption, and certain drugs.
People may feel light-headed when they stand and have urination problems, constipation, and vomiting, and men may have erectile dysfunction.
Doctors do a physical examination and various tests to check for autonomic malfunction and possible causes.
The cause is corrected or treated if possible.

Somatic nerves, which connect with muscles under voluntary (conscious) control or with sensory receptors in the skin.

Common causes of autonomic neuropathies include

Some of the antibodies produced by the immune system attack the surface of a nerve fiber or the tissues that wrap around the fiber and enable it to conduct impulses quickly and accurately. (These tissues are called the myelin sheath Nerves .)

Sometimes antibodies produced by the immune system attack acetylcholine receptors (the part of nerve cells that enables them to respond to acetylcholine). Acetylcholine is one of the chemical messengers (neurotransmitters) used to communicate within the autonomic nervous system.

Other causes of autonomic neuropathies include cancer, drugs, excessive alcohol consumption, and toxins.

A common symptom of autonomic neuropathies is

As a result, the person feels light-headed or as if about to faint.

When somatic nerves are also damaged, people may lose sensation or feel a tingling (pins-and-needles) sensation in the hands and feet, or muscles may become weak.

A doctor's evaluation
Sometimes blood tests

Blood tests are sometimes done to check for antibodies to acetylcholine receptors, which indicate an autoimmune reaction. About half of people with an autonomic neuropathy due to an autoimmune reaction have these antibodies.

Treatment of the cause if identified
Sometimes immunosuppressants
For severe symptoms, sometimes immune globulin or plasma exchange

The cause of the autonomic disorder, if identified, is treated. Neuropathies due to an autoimmune reaction are sometimes treated with drugs that suppress the immune system (immunosuppressants) and lessen the reaction. These drugs include azathioprine, cyclophosphamide, and prednisone.

Generic Name	Select Brand Names
immune globulin	Gammagard S/D
azathioprine	IMURAN
cyclophosphamide	No US brand name
prednisone	RAYOS

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Management and Treatment

How is autonomic dysfunction treated?

Treating or managing any underlying cause is key. For example, if the underlying cause is diabetes, then controlling blood sugars will be the main treatment. In some cases, treatment of the underlying disease may allow damaged nerves to repair and regenerate. Other treatments are aimed at improving daily quality of life and managing specific symptoms through medications and lifestyle modifications. A combination of approaches is likely to result in the best symptom management.

Specific symptom management

GI symptoms: Certain medications may be prescribed to help empty stomach more rapidly (i.e., Reglan®) or ease constipation (i.e., laxatives). Modify diet by increasing fiber intake.

Urinary symptoms: Retrain the bladder by following a schedule, and/or take medications to help with complete bladder emptying and decrease overactive bladder symptoms (i.e., bethanechol and Ditropan®).

Exercise intolerance: Join a rehabilitation program to ease into a custom exercise routine or begin physical activity at home at a slow rate.

Sexual dysfunction: For men, certain medications may be recommended for erectile dysfunction (i.e. Viagra®, Cialis®). For women, vaginal lubricants may be recommended.

Stress and anxiety: Stress-relieving activities and techniques (i.e. yoga, visualization, massage therapy), as well as certain medications may be recommended (i.e., Celexa®, Effexor®). Numbness and tingling: Certain medications may be recommended to help decrease associated pain (i.e. Neurontin®, Cymbalta®).

Lifestyle changes to improve vascular tone:

Use physical counter-maneuvers such as leg crossing, leg raising, toe crunching, and lower extremity muscle contracting to increase blood pressure and help pump venous blood back to heart.
Perform lower extremity exercises daily to improve the strength of the leg muscles. This will help prevent blood from pooling in the legs when standing and walking. Preferred exercises include walking, jogging, swimming, and/or using a stationary bike.

Medications to improve vascular tone:

Fludrocortisone: improves blood vessel response and causes fluid retention
Midodrine: produces increase in vascular tone and elevation of blood pressure; has no effect on heart rate
Beta-blockers: prevent veins from opening excessively and help lower heart rate
Pyridostigmine: causes blood vessels to constrict which causes slight increase in blood pressure; has no effect on heart rate

Lifestyle changes to improve blood pressure:

Drink 500ml (16 oz.) of water quickly and all at once, first thing in the morning (before getting out of bed) and when bad symptoms occur. This will result in an increased blood pressure within 5 minutes. The effects should last up to 1 hour and may improve orthostatic intolerance (OI). This condition involves symptoms associated with standing upright and improved by lying down.
Avoid large meals that can cause low blood pressure during digestion. It is better to eat smaller, more frequent meals throughout the day than to eat three large meals.
Avoid excessive caffeine intake, as it may increase urine production and reduce blood volume.

Lifestyle changes to improve blood volume:

Raise the head of your bed by 6-10 inches. The entire bed must be at an angle. Raising only the head portion of the bed at waist level or using pillows will not be effective. Raising the head of the bed will cut urine formation overnight, allowing for more volume in the circulation in the morning. You may use cinder blocks or bed raising kits.
Drink 2-2.5 liters (about 8.5 to 11 cups) of fluids/day.
Use custom-fitted elastic support stockings. These will reduce a tendency for blood to pool in legs when you are standing and may improve OI. An abdominal binder or Spanx® may also be useful. Thigh-high stockings are best with some abdominal compression, with pressure of at least 20-30 mmHg (30-40 mmHg pressure is ideal). Put them on first thing in the morning and remove before going to bed.
Increase the sodium intake in your diet to 3-5 grams/day. If no improvement is noticed and blood pressure remains stable, you may increase sodium intake to 5-7 grams/day. This will help the body retain fluid in the blood vessels to compensate for low blood pressure or excessive pooling of blood in veins. Please note that 1 teaspoon of salt equals 5g and 1/2 teaspoon of salt equals 3g.

Salty Food Ideas (1000 mg = 1 g)
Item	Amount	Mg of salt
Green olives	10 medium	529 mg
Pretzels	1 cup/15 twists	543 mg to 1,715 mg
Beef jerky	1 large piece	443 mg
Pumpkin seeds (packaged)	1/4 cup	950 mg
Kale chips (packaged) 1 cup	1 cup	431 mg
Artichoke hearts	1/2 cup	388 mg
Whole dill pickle	1 large pickle	420 mg
Broth	1 bouillon cube	1,200 mg
Soy sauce	1 teaspoon	335 mg
Salami	1 slice	226 mg
Sun-dried tomatoes	1 cup	1,047 mg
Salt-water crab	1 leg	1,436 mg
Cottage cheese (small curd)	1 cup	911 mg
V8® drink	12 ounces	690 mg
Tomato sauce (canned)	1 cup	1,284 mg
Canned green beans	1/2 cup	390 mg
Chicken noodle soup	1 cup	720 mg
Gatorade® sports drink	8 ounces	110 mg
Salt tablet 1 tab 1 g	1 tablet	1 g

Exercises

Exercises for autonomic neuropathy to increase blood volume and physical function may be done at home, at the gym, with a physical therapist, or through a local cardiac rehabilitation program, depending on your comfort level and beginning condition. It is best to begin with exercises that do not cause orthostatic stress such as reclined exercises which may include stretches, yoga poses (in seated or lying position), recumbent bicycle, rowing or swimming. Most individuals will begin at level 2, but before beginning any routine it is important to understand your own comfort level as well as determining a starting point with your health care provider.

Reclined gentle movements (level 1)

Leg pillow squeeze: While lying in bed, place pillow between legs and squeeze, hold for 10 sec, rest and repeat.

Arm pillow squeeze: Place pillow folded pillow between palms and squeeze together (like in a praying position), hold for 10 sec, rest and repeat.

Side leg lifts: While lying on your side, lift leg up sideways and then bring leg back down without touching the opposite leg and repeat.

Front leg lifts: While lying on your back, lift leg up, point toes towards ceiling, and repeat.

Gentle stretches

Recumbent cardio exercises (level 2)

Rowing: Use rowing machine 2-5 minutes per day and increase on weekly basis. Try to reach 45 minutes per day on five days a week.

Swimming: Always swim with a partner or where someone can see you just in case symptoms occur.

Weight training (specifically leg and core muscle training): Begin with light weights and use in reclined or seated position. Try to avoid lifting above head or in any standing position.

Normal exercises (level 3)

Eventually you may get to the point where you are ready to participate in normal upright cardiovascular activities, such as walking, jogging, bicycling and running. Once you get to a good and safe point, you can begin these types of exercises and eventually increase your time to 45 minutes per day three times per week.

What happens when the autonomic nervous system fails?

Pure autonomic failure is a rare degenerative disorder that causes orthostatic hypotension, sexual dysfunction, a decreased ability to sweat, elevated blood pressure when lying down, and changes in gastrointestinal and urinary habits.

What causes the autonomic nervous system to fail?

Pure autonomic failure is caused by abnormal accumulation of synuclein (a protein in the brain that helps nerve cells communicate, but whose function is not yet fully understood). Synuclein also accumulates in people who have Parkinson disease.

What are symptoms of autonomic failure?

Disease at a Glance The main symptom of PAF is orthostatic hypotension, a sudden drop in blood pressure upon standing. This can cause dizziness, lightheadedness, blurry vision, and weakness. Other symptoms can include fatigue, bladder problems, constipation, abnormal sweating, and sleep disorders.

What effects does the autonomic nervous system control?

The autonomic nervous system is a component of the peripheral nervous system that regulates involuntary physiologic processes including heart rate, blood pressure, respiration, digestion, and sexual arousal.