Editing Autonomic neuropathy

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'''Autonomic neuropathy''' ('''AN''' or '''AAN''') is a form of [[polyneuropathy]] that affects the non-voluntary, non-sensory [[nervous system]] (i.e., the [[autonomic nervous system]]), affecting mostly the internal organs such as the [[urinary bladder|bladder]] muscles, the [[cardiovascular system]], the [[digestive tract]], and the [[genital]] organs. These nerves are not under a person's conscious control and function automatically. Autonomic nerve fibers form large collections in the thorax, abdomen, and pelvis outside the [[spinal cord]]. They have connections with the spinal cord and ultimately the brain, however. Most commonly autonomic neuropathy is seen in persons with long-standing [[diabetes mellitus]] type 1 and 2. In most—but not all—cases, autonomic neuropathy occurs alongside other forms of neuropathy, such as sensory neuropathy.

Autonomic neuropathy is one cause of malfunction of the autonomic nervous system (referred to as [[dysautonomia]]), but not the only one; some conditions affecting the brain or spinal cord also may cause [[autonomic dysfunction]], such as [[multiple system atrophy]], and therefore, may cause similar symptoms to autonomic neuropathy.

== Signs and symptoms ==
The signs and symptoms of autonomic neuropathy include the following:{{citation needed|date=September 2016}}
* [[Urinary bladder]] conditions: [[bladder incontinence|urinary incontinence]] or [[urinary retention]] which happens due to the uncoordinated contraction of the bladder. [[Neurogenic bladder dysfunction|Neurogenic bladder]] is a broad term describing this dysfunction.<ref>{{Cite web|date=2019-12-05|title=Neurogenic Bladder: Overview, Neuroanatomy, Physiology and Pathophysiology|url=https://emedicine.medscape.com/article/453539-overview}}</ref>
* [[Gastrointestinal tract]]: [[dysphagia]], [[abdominal pain]], [[nausea]], [[vomiting]], [[malabsorption]], [[fecal incontinence]], [[gastroparesis]], [[diarrhea]], [[constipation]]
* [[Cardiovascular system]]:  disturbances of heart rate ([[tachycardia]], [[bradycardia]]), [[orthostatic hypotension]], inadequate increase of heart rate on exertion
* [[Respiratory system]]: impairments in the signals associated with regulation of breathing and [[gas exchange]] ([[central sleep apnea]], [[hypopnea]], [[bradypnea]]).<ref>{{cite journal|last=Vinik|first=AI|author2=Erbas, T|title=Diabetic autonomic neuropathy.|journal=Handbook of Clinical Neurology|year=2013|volume=117|pages=279–94|pmid=24095132|doi=10.1016/b978-0-444-53491-0.00022-5|isbn=9780444534910}}</ref>
* [[Nervous system]]: [[pupillary defect]], exaggerated [[hippus]], [[dizziness]] or lightheadedness.
* Other areas: [[hypoglycemia]] unawareness, genital [[impotence]], sweat disturbances, [[Sjögren syndrome|sicca (dryness)]].
* Absence of signs of cerebellar dysfunction, cognitive decline, or parkinsonian symptoms, as the presence of these would indicate the more serious diseases [[multiple system atrophy]] or [[lewy body dementia]].

== Causes ==
Many health conditions can cause autonomic neuropathy. Some common causes of autonomic neuropathy include:
* [[Diabetes]], which is the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.
* [[Vitamin B12 deficiency|Vitamin B<sub>12</sub> deficiency]] ([[pernicious anemia]])
* 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 ([[amyloidosis]]), which affects the organs and the nervous system.
*  An abnormal attack by the immune system ([[autoimmune autonomic ganglionopathy]]), 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 disorder]]s can cause autonomic neuropathy.
* [[Autoimmune disease]]s, 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 ==

{{Empty section|date=February 2017}}

== Treatment ==

=== Neurogenic bladder ===
Depending on the symptoms and severity of the [[neurogenic bladder dysfunction]], the doctor might suggest one of the following treatments<ref>{{Cite web|url=https://my.clevelandclinic.org/health/diseases/15133-neurogenic-bladder/management-and-treatment|title=Neurogenic Bladder Management and Treatment|website=Cleveland Clinic|access-date=2020-03-08}}</ref><ref>{{Cite web|url=https://urology.weillcornell.org/clinical-conditions/neurogenic-bladder/neurogenic-bladder-treatment-options|title=Neurogenic Bladder - Treatment Options|date=2017-11-16|publisher=Weill Cornell Medicine: Department of Urology - New York|language=en|access-date=2020-03-08}}</ref>

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

== References ==
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| MedlinePlus     = 000776
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| eMedicineTopic  = 1173756
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[[Category:Peripheral nervous system disorders]]


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