Symptoms:

Symptoms vary depending on the nerve(s) affected. They usually develop gradually over years.

Symptoms may include:

Digestive tract

• Constipation
• Diarrhea
• Feeling full after only a few bites (early satiety)
• Nausea after eating
• Swollen abdomen
• Unintentional loss of more than 5% of body weight
• Vomiting of undigested food

Heart

• Blood pressure changes with position
• Dizziness that occurs when standing up

Urinary tract

• Difficulty beginning to urinate
• Feeling of incomplete bladder emptying
• Urinary incontinence (overflow incontinence)

Other symptoms

• Abnormal sweating
• Fainting
• Heat intolerance, induced by exercise
• Male impotence

Signs and tests:

A medical history and general physical exam are critical. A brain and nervous system (neurological) examination may show evidence of injury to other nerves. However, it is very difficult to directly test for autonomic nerve damage.

Signs of autonomic neuropathy include:

• Abnormal sounds in the abdomen, indicating decreased gastric movement (motility)
• Decrease of blood pressure upon standing up (postural hypotension)
• Sluggish pupil reaction in the eye
• Swollen (distended) abdomen
• Swollen (distended) bladder

Occasionally, other symptoms may indicate a problem in the function of the autonomic nervous system, including:

• Difficulty swallowing
• Excessive sweating
• Irregular heart rhythms
• High blood pressure
• Rapid or slow heart rate

Special measurements of sweating and heart rate are called "autonomic testing" and can assist in diagnosis and treatment.

Other tests include:

• Measurement of blood pressure lying down, sitting, and standing
• Measurement of changes in heart rate
• Upper GI
• Esophagogastroduodenoscopy (EGD)
• Isotope study
• Voiding cystourethrogram (VCUG) or other tests of bladder function

Other tests for autonomic neuropathy are based on the suspected cause of the disorder, as suggested by the history, symptoms, and the way symptoms developed.