Is There A Surgery For Autonomic Neuropathy?

Autonomic neuropathy is a group of symptoms that occur when there is damage to your nerves. The nerves affected manage everyday bodily functions which include blood pressure, heart rate, sweating, bowel and bladder movements, body temperature, and digestion. Due to the damage done to the nerves, the signals from the brain to various organs are also interfered with thus leading to the symptoms associated with the condition. These symptoms will, however, vary depending on the nerves affected. They may include, and not limited to; constipation, diarrhea, feeling full fast, swollen abdomen, high blood pressure, abnormal heart rhythm, leaking urine, sweating too much as well as unexpected weight loss.^[1]

Is There A Surgery For Autonomic Neuropathy?

Patients with autonomic neuropathy need to consider surgery in some cases, for example, when a patient has a transthyretin defect. Transthyretin is a serum transport protein that is primarily synthesized in the liver. Therefore, patients can consider a liver transplant so as to prevent its production in the abnormal form and thus preventing its deposition. A liver transplant may also be necessary in cases where a patient has neuropathy-related hepatic disorders. Other surgical care considerations for patients with autonomic neuropathy include a renal transplant, where dialysis seems ineffective. This is viable for patients with uremic neuropathy with autonomic dysfunction.^[2] Some patients may experience a very rare trait of autonomic neuropathy, especially patients with diabetes referred to as gastroparesis. In such cases, surgical treatment – gastroenterostomy or gastrojejunostomy may – may be required so as to improve the condition.^[3]

Precautions During Surgery For Patients With Autonomic Neuropathy

One of the causes of autonomic neuropathy is surgery, considering that in the process, there may be damage to a nerve thus resulting in the condition. Therefore, to prevent any likelihood of nerve damage during surgery, autonomic function testing can be done prior to surgery. It will help with determining the severity and extent of the autonomic impairment, and thus the surgeon(s) is aware of any complications that may arise. They may include; loss of cardiovascular reflexes apnea due to upper airway obstruction or impaired central regulation of respiration, and orthostatic hypotension to name a few.^[4]

The Ideal Treatment Plan For Autonomic Neuropathy

In treating autonomic neuropathy, the aim is often to manage the underlying cause and additionally, help ease the symptoms. In cases where the underlying disease or risk factor is known, say diabetes, it is crucial that your blood sugar levels are keenly controlled to avoid worsening of autonomic neuropathy. If the underlying cause is not clear, then the doctor may do a number of tests including breathing tests, gastrointestinal tests, thermoregulatory sweat tests, and tests associated with your blood pressure and heart rate to determine the exact underlying cause. Once that has been discovered, the doctor will advise on a treatment plan that includes controlling the underlying cause as well as autonomic neuropathy symptoms.

Symptom-based treatments are defined based on the symptoms one is experiencing. For gastrointestinal symptoms, your doctor may advise on dietary changes, and medication to ease constipation or diarrhea, and help with bloating problems. Patients with urinary symptoms can be prescribed with medication that helps with emptying the bladder as well as those that decrease an overactive bladder. Otherwise, one may be put a catheter to help with urination. In cases of blood pressure and heart rhythm symptoms, one may be prescribed with medication to raise blood pressure and regulate your heartbeat. For patients with blood pressure problems, it can also help to include a high-salt, high-fluid diet. In patients with sweating symptoms, the doctor will prescribe medication that decreases perspiration, or else recommend surgery to either cut the nerves linked to sweat glands or remove the sweat glands where possible. Alternative treatments plans for individuals with autonomic neuropathy include acupuncture and electric nerve stimulation.^[5]

Conclusion

Patients with autonomic neuropathy may need surgery in extreme cases where symptom relief is required and other treatment plans don’t seem to work effectively. For those with diabetes, a liver transplant may be performed if they have a transthyretin defect or a hepatic disease related to autonomic neuropathy. Surgery to cut nerves associated with the sweat glands, or removing the sweat glands themselves may also be considered for patients with sweating symptoms.

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Is There A Surgery For Autonomic Neuropathy?