Treatment

Treatment of autonomic neuropathy includes:

• Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you'll need to tightly control blood sugar to prevent autonomic neuropathy from progressing. About half of the time, no underlying cause for autonomic neuropathy is found.
• Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.

Digestive (gastrointestinal) symptoms

Your doctor may recommend:

• Diet changes. You might need to increase dietary fiber and fluids. Fiber supplements, such as Metamucil or Citrucel, also might help. Slowly increase fiber to avoid gas and bloating.
• Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication can cause drowsiness and isn't advised for long-term use.
• Medications to ease constipation. Over-the-counter laxatives can help ease constipation. Ask your doctor how often you should use a laxative.
• Medications to ease diarrhea. Antibiotics can help treat diarrhea by preventing excess bacterial growth in the intestines, and over-the-counter antidiarrheal medication might be helpful.

Urinary symptoms

Your doctor may suggest:

• Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder's capacity and retrain your bladder to empty completely at the appropriate times.
• Medication to manage bladder symptoms. Your doctor may prescribe medications that decrease an overactive bladder. Other medications may help empty your bladder.
• Urinary assistance (catheterization). A tube is guided through your urethra to empty your bladder.

Sexual dysfunction

For men with erectile dysfunction, your doctor might recommend:

• Medications that enable erections. Drugs such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) can help you achieve and maintain an erection. Possible side effects include low blood pressure, mild headache, flushing, upset stomach and changes in color vision.

  If you have a history of heart disease, arrhythmia, stroke or high blood pressure, use these medications with caution. Also avoid taking these medications if you are taking any type of organic nitrates. Seek immediate medical assistance if you have an erection that lasts longer than four hours.

• External vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.

For women with sexual symptoms, your doctor might recommend:

• Vaginal lubricants to decrease dryness and make sexual intercourse more comfortable and enjoyable.
• Flibanserin (Addyi) for premenopausal women with low sexual desire.

Heart rhythm and blood pressure symptoms

Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor might prescribe:

• A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high-fluid diet can help maintain your blood pressure. This is generally only recommended for severe cases of blood pressure problems, as this treatment may cause blood pressure that is too high or swelling of the feet, ankles or legs. This treatment shouldn't be used in patients with heart failure.
• Compression garments. A binder worn around the waist or thigh-high compression stockings may help improve blood flow.

• Medications to raise your blood pressure. If you feel faint or dizzy when you stand up, your doctor might suggest medications. Fludrocortisone helps your body retain salt, which helps regulate your blood pressure.

  Midodrine (Orvaten) and droxidopa (Northera) can help raise blood pressure. But these drugs can cause high blood pressure when you're lying down. Pyridostigmine (Mestinon) may help keep blood pressure stable when standing.

• Medication to regulate your heart rate. A class of medications called beta blockers helps regulate your heart rate if it goes too high during physical activity.

Sweating

If you sweat too much, your doctor might prescribe a medication that decreases sweating. Glycopyrrolate can decrease sweating. Side effects can include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headache, loss of taste and drowsiness. Glycopyrrolate can also increase the risk of heat-related illness, such as heatstroke, from a reduced ability to sweat.