How is autonomic dysfunction treated?

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.