Choose the description that sounds most like what you’re experiencing:

👣 My feet or toes are numb → What Causes Numbness in My Toes?

🔥 My feet burn → Why Do My Feet Burn at Night?

⚖️ I’m losing my balance → Can Peripheral Neuropathy Affect My Balance?

💪 My legs or feet feel weak → Can Peripheral Neuropathy Cause Muscle Weakness?

🧬 I have an autoimmune disease → Can Autoimmune Disease Cause Peripheral Neuropathy?

🩺 I have diabetes and neuropathy → Can Diabetes Cause Peripheral Neuropathy Even When My Blood Sugar Is “Under Control”?

💫 I get dizzy when I stand, have unusual sweating, digestive problems, or bladder changes → You’re in the right place. Keep reading.

What You’ll Learn

In this chapter you’ll discover:

• What autonomic neuropathy is
• How autonomic nerves differ from sensory and motor nerves
• Which body functions the autonomic nervous system helps regulate
• Why autonomic neuropathy can affect blood pressure
• How it can affect digestion
• How bladder function may be affected
• Why sweating may change
• How sexual function may be affected
• Why diabetes is an important cause
• What other conditions can affect autonomic nerves
• How autonomic neuropathy is evaluated
• Which symptoms deserve urgent medical attention

Quick Answer

Autonomic neuropathy is damage or dysfunction involving the nerves that help regulate automatic body functions.

These nerves are part of the:

Autonomic nervous system

They help regulate functions you normally don’t have to think about, including:

• Blood pressure
• Heart rate
• Digestion
• Sweating
• Body-temperature regulation
• Bladder function
• Sexual function
• Certain aspects of pupil function

When these nerves aren’t working properly, symptoms can appear in several different parts of the body.

That is one reason autonomic neuropathy can be difficult to recognize.

Peripheral Neuropathy Is More Than Numb Feet

When most people hear:

“Peripheral neuropathy,”

they think of:

• Numb toes
• Burning feet
• Tingling
• Pins and needles

Those symptoms usually involve sensory nerves.

But peripheral nerves do much more than carry sensation.

Broadly speaking, peripheral nerves include:

Sensory nerves

They tell your brain what you feel.

Motor nerves

They help control muscles.

Autonomic nerves

They help regulate automatic body functions.

Neuropathy may affect one or several of these systems.

What Does “Autonomic” Mean?

Think about what your body does without asking permission.

You stand up.

Your cardiovascular system adjusts so blood continues reaching your brain.

You eat.

Your digestive system moves food through your stomach and intestines.

You walk outside on a hot day.

You sweat.

Your bladder fills.

Your body signals when it is time to empty it.

Most of this happens automatically.

You don’t consciously tell your body:

“Increase my heart rate slightly.”

“Adjust my blood vessels.”

“Move this meal through my stomach.”

Your autonomic nervous system helps handle these functions behind the scenes.

What Happens When Autonomic Nerves Are Damaged?

The answer depends on which nerves are affected.

Autonomic neuropathy may cause problems involving:

• Cardiovascular regulation
• Digestion
• Bladder control
• Sweating
• Temperature regulation
• Sexual function
• Other automatic functions

One patient may mainly have blood-pressure symptoms.

Another may have digestive problems.

Another may experience several systems at once.

Can Autonomic Neuropathy Cause Dizziness When Standing?

Yes.

One important symptom is:

Orthostatic hypotension

This refers to a significant drop in blood pressure when moving into an upright position.

A person may experience:

• Lightheadedness
• Dizziness
• Blurred or dimmed vision
• Weakness
• Feeling faint
• Fainting

Normally, when you stand, your nervous system helps adjust your heart and blood vessels to maintain blood flow to the brain.

If autonomic regulation is impaired, that adjustment may not work normally.

But Not Every Dizzy Spell Is Autonomic Neuropathy

This distinction is extremely important.

Dizziness when standing may also result from:

• Dehydration
• Blood-pressure medications
• Other medications
• Anemia
• Heart problems
• Blood loss
• Illness
• Fluid imbalance
• Other medical conditions

So if someone says:

“I get dizzy when I stand,”

we should not automatically diagnose autonomic neuropathy.

We should ask why.

Why Does Orthostatic Hypotension Matter?

Because it can increase the risk of:

• Fainting
• Falls
• Injuries

Imagine someone who already has:

• Numb feet
• Poor balance
• Muscle weakness

and then becomes lightheaded every time they stand.

Those problems can compound one another.

This is why neuropathy care sometimes has to extend beyond the feet.

Can Autonomic Neuropathy Affect the Heart?

Autonomic nerves help regulate heart rate and cardiovascular responses.

When those nerves are affected, some patients may develop abnormal heart-rate responses to:

• Exercise
• Standing
• Physical stress

In diabetes, cardiovascular autonomic neuropathy is an important recognized complication.

Because heart-related symptoms can have many serious causes, symptoms such as chest pain, unexplained shortness of breath, fainting, or significant palpitations should not simply be blamed on neuropathy.

They deserve appropriate medical evaluation.

Can Autonomic Neuropathy Affect Digestion?

Yes.

Autonomic nerves help regulate movement through the gastrointestinal tract.

Neuropathy affecting these nerves may contribute to symptoms such as:

• Feeling full unusually quickly
• Nausea
• Bloating
• Vomiting
• Constipation
• Diarrhea
• Alternating constipation and diarrhea

But gastrointestinal symptoms have many possible causes.

The presence of diabetes or neuropathy doesn’t mean every stomach problem is neurological.

What Is Gastroparesis?

Gastroparesis means the stomach empties more slowly than expected without a mechanical blockage explaining the delay.

Diabetes is one possible cause.

Symptoms may include:

• Early fullness
• Nausea
• Vomiting
• Bloating
• Upper abdominal discomfort
• Difficulty managing blood glucose

Autonomic nerve dysfunction may contribute to diabetic gastroparesis.

Proper evaluation is important because many other conditions can produce similar symptoms.

Why Can Gastroparesis Complicate Diabetes?

Normally, food moves from the stomach into the intestine in a reasonably predictable pattern.

If stomach emptying becomes unpredictable, nutrient absorption—and therefore blood-glucose changes—may also become less predictable.

That can make diabetes management more complicated.

This illustrates an important point:

Neuropathy can sometimes affect much more than sensation.

Can Autonomic Neuropathy Affect the Bowels?

Yes.

Depending on which autonomic pathways are affected, patients may experience:

• Constipation
• Diarrhea
• Changes in bowel patterns

However, bowel symptoms are extremely common and may be caused by:

• Diet
• Medications
• Gastrointestinal disease
• Infection
• Irritable bowel syndrome
• Other conditions

A neurological cause should be considered within the larger clinical picture.

Can Autonomic Neuropathy Affect the Bladder?

Yes.

Autonomic nerves help coordinate bladder filling and emptying.

Nerve dysfunction may contribute to problems such as:

• Difficulty sensing a full bladder
• Difficulty emptying completely
• Urinary retention
• Urinary leakage
• Changes in urinary frequency

Incomplete bladder emptying may increase the risk of urinary complications in some patients.

But bladder changes can have many other causes.

These may include:

• Prostate enlargement
• Urinary infection
• Pelvic-floor problems
• Medications
• Urological disease
• Spinal or neurological disorders

Don’t assume.

Evaluate.

Can Autonomic Neuropathy Affect Sweating?

Yes.

Sweat glands are regulated through autonomic nerve pathways.

Neuropathy may result in:

• Reduced sweating
• Excessive sweating
• Abnormal patterns of sweating

Some areas may sweat less while other areas sweat more.

Reduced sweating may also interfere with the body’s ability to regulate temperature appropriately.

Why Skin and Foot Care Still Matter

If someone has:

• Reduced sensation
• Reduced sweating
• Dry skin

the feet may become more vulnerable to:

• Cracking
• Skin breakdown
• Unnoticed injury

That is another reason patients with neuropathy should inspect their feet regularly.

Neuropathy can affect both what you feel and how the skin environment is maintained.

Can Autonomic Neuropathy Affect Sexual Function?

Yes.

Autonomic nerves are involved in normal sexual function.

Autonomic neuropathy may contribute to problems such as:

In men:

• Erectile dysfunction
• Ejaculatory problems

In women:

• Reduced lubrication
• Changes in sexual response

But sexual dysfunction can have many other causes, including:

• Vascular disease
• Hormonal changes
• Medications
• Psychological factors
• Relationship factors
• Other medical conditions

The symptom deserves respectful evaluation rather than assumptions.

Can Autonomic Neuropathy Affect the Eyes?

Autonomic nerves help regulate aspects of pupil function.

Some autonomic disorders may affect how pupils respond to changes in light.

This is usually not the first symptom people associate with neuropathy, but it demonstrates how widely the autonomic nervous system reaches throughout the body.

What Causes Autonomic Neuropathy?

Several conditions may affect autonomic nerves.

One of the best-known causes is:

Diabetes

But other possibilities include:

• Autoimmune or inflammatory disorders
• Certain neurodegenerative disorders
• Amyloidosis
• Certain infections
• Some medications or treatments
• Hereditary neuropathies
• Other systemic illnesses

Sometimes the cause remains unclear.

Diabetes and Autonomic Neuropathy

Diabetes can damage several types of peripheral nerves.

That includes:

• Sensory nerves
• Motor nerves
• Autonomic nerves

A person with diabetic neuropathy may therefore have more than burning or numb feet.

Depending on the nerves involved, symptoms may affect:

• Blood pressure
• Heart-rate regulation
• Digestion
• Bladder function
• Sexual function
• Sweating

Good diabetes management remains important even after neuropathy has developed.

Does Having Diabetic Neuropathy Mean I’ll Develop Autonomic Neuropathy?

No.

Not everyone with diabetic peripheral neuropathy develops clinically significant autonomic neuropathy.

Risk varies.

The presence of sensory neuropathy does not automatically mean every other peripheral nerve system will become affected.

What About Autoimmune Disease?

As we discussed in our article on autoimmune neuropathy, immune-mediated disorders can sometimes affect autonomic nerve fibers.

Some patients may experience combinations of:

• Sensory symptoms
• Pain
• Blood-pressure changes
• Abnormal sweating
• Digestive symptoms

When the pattern is unusual, additional neurological evaluation may be appropriate.

What Is Amyloidosis?

Amyloidosis refers to a group of disorders in which abnormal proteins called amyloid accumulate in tissues.

Certain forms of amyloidosis can affect peripheral and autonomic nerves.

Possible symptoms may include:

• Sensory neuropathy
• Weakness
• Orthostatic hypotension
• Gastrointestinal problems
• Autonomic dysfunction

Amyloidosis is much less common than diabetes, but it can be important in selected patients with the right clinical pattern.

Can Autonomic Neuropathy Affect Blood Sugar Awareness?

In some people with longstanding diabetes, autonomic dysfunction can interfere with warning symptoms normally associated with low blood glucose.

This can contribute to reduced awareness of hypoglycemia.

That can be dangerous.

People with diabetes who experience episodes of low blood sugar without their usual warning symptoms should discuss this with their diabetes-care team.

How Is Autonomic Neuropathy Diagnosed?

There is no single test that evaluates every autonomic function.

Evaluation begins with:

• Medical history
• Symptoms
• Medication review
• Physical examination
• Blood-pressure and heart-rate assessment

Depending on the symptoms, additional testing may evaluate:

• Blood-pressure response to standing
• Heart-rate responses
• Sweating
• Gastrointestinal function
• Bladder function
• Other autonomic pathways

Testing should be directed toward the patient’s symptoms.

Why Measuring Blood Pressure Lying and Standing Can Matter

If a patient reports dizziness when standing, clinicians may compare blood pressure and heart rate in different positions.

For example:

• Lying down
• Sitting
• Standing

This can provide useful information about how the cardiovascular system responds to posture.

But an abnormal result still needs interpretation.

Autonomic neuropathy is only one possible explanation.

What About Autonomic Testing?

Specialized centers may perform tests designed to evaluate different components of autonomic function.

Depending on the situation, these may include assessments of:

• Heart-rate variability
• Blood-pressure responses
• Sweat function
• Other autonomic reflexes

Not every patient with neuropathy needs extensive autonomic testing.

Testing should answer a clinical question.

Could Medications Be Causing My Symptoms?

Absolutely.

This is one reason medication review is so important.

Some medications can contribute to:

• Low blood pressure
• Dizziness
• Constipation
• Urinary problems
• Sexual dysfunction
• Abnormal sweating

A patient may have peripheral neuropathy and medication side effects at the same time.

Never stop an important medication on your own.

Instead, ask:

Could this medication be contributing to what I’m experiencing?

When Are Autonomic Symptoms an Emergency?

Some symptoms require prompt or emergency evaluation rather than assuming they are from neuropathy.

Seek urgent medical attention for symptoms such as:

• Fainting with injury or repeated unexplained fainting
• Chest pain
• Significant difficulty breathing
• Severe or persistent vomiting with dehydration
• Vomiting blood
• Black or bloody stools
• New inability to urinate
• Severe abdominal pain
• Sudden neurological changes
• Signs of stroke

And if symptoms are severe, rapidly worsening, or accompanied by major weakness, seek appropriate urgent evaluation.

How We Evaluate Possible Autonomic Neuropathy at Advanced Integrated Medical

When a patient with neuropathy reports symptoms beyond the hands and feet, I want to know:

• Do you become dizzy when standing?
• Have you fainted?
• Does your heart race unexpectedly?
• Has your sweating changed?
• Do you become full unusually quickly?
• Do you have unexplained nausea?
• Have your bowel habits changed?
• Are you having bladder problems?
• Has sexual function changed?
• Do you have diabetes?
• Do you have an autoimmune disease?
• What medications are you taking?
• When did these symptoms begin?
• Did they all begin together?

The goal is not to label every symptom as autonomic neuropathy.

The goal is to recognize when the pattern deserves additional evaluation.

Treatment Depends on the Cause

There is no single treatment for autonomic neuropathy.

Treatment depends on:

• The underlying cause
• Which autonomic functions are affected
• Severity
• Other medical conditions
• Medications

Management may involve:

• Improving control of the underlying disease
• Medication adjustments
• Blood-pressure management
• Dietary changes
• Gastrointestinal treatment
• Bladder management
• Treatment of sexual dysfunction
• Hydration strategies when medically appropriate
• Compression garments in selected patients
• Specialist referral

The treatment for dizziness is not necessarily the treatment for gastroparesis.

The treatment must match the problem.

Be Careful With “Drink More Water and Eat More Salt”

People with orthostatic symptoms sometimes hear advice to increase fluid and sodium intake.

That may help selected patients.

But it is not appropriate for everyone.

Patients with:

• Kidney disease
• Heart failure
• High blood pressure
• Certain other medical conditions

may need fluid or sodium restrictions.

This is a perfect example of why one-size-fits-all advice can be dangerous.

The right recommendation depends on the patient.

How Autonomic Symptoms Can Affect Quality of Life

Autonomic symptoms may be invisible to everyone else.

But they can dramatically affect daily life.

A patient may be afraid to:

• Stand quickly
• Eat a normal meal
• Travel
• Exercise
• Leave home without knowing where the restroom is
• Discuss sexual problems
• Attend social activities

These symptoms deserve to be taken seriously.

They are not “just inconvenient.”

About Dr. Dee

Dr. D. Scott (“Dee”) Stevens has spent nearly four decades helping patients with peripheral neuropathy, chronic pain, musculoskeletal disorders, sports injuries, and regenerative medicine.

Throughout his career, he has cared for patients from all walks of life—including professional, collegiate, and Olympic athletes, professional football players, Major League Baseball players, professional boxers, and MMA fighters.

One thing I’ve learned is that patients don’t always realize which symptoms belong in the same conversation.

They may tell me about their numb feet.

Then ten minutes later say:

“By the way, I get dizzy every time I stand.”

Or:

“My stomach hasn’t been working right.”

Or:

“I’ve been having bladder problems.”

Sometimes those symptoms are unrelated.

Sometimes they are important pieces of the same neurological puzzle.

Dr. Dee’s Clinical Pearl

When a patient has peripheral neuropathy, I don’t want to ask only:

“What do your feet feel like?”

I also want to know:

“What else has changed?”

Blood pressure.

Digestion.

Sweating.

Bladder function.

Sexual function.

Sometimes the clue to understanding neuropathy isn’t located in the feet at all.

Dr. Dee’s Office Conversation

Patient: “Doctor, my feet are numb, but I also get dizzy every time I stand up. That’s probably unrelated, isn’t it?”

Dr. Dee: “Maybe. But let’s not assume.”

Patient: “Dizziness can come from neuropathy?”

Dr. Dee: “Certain autonomic nerves help regulate blood pressure when you stand. If those nerves aren’t functioning properly, dizziness can occur. But medications, dehydration, heart problems, anemia, and other conditions can cause it too.”

Patient: “So how do we know?”

Dr. Dee: “We start by asking the right questions and measuring what your body is doing.”

Facing One of the Biggest Fears

“Does This Mean My Neuropathy Is Spreading Through My Whole Body?”

Not necessarily.

Having one autonomic symptom does not mean neuropathy is taking over every nerve in your body.

Remember:

• Dizziness has many causes.
• Constipation has many causes.
• Bladder problems have many causes.
• Sexual dysfunction has many causes.
• Sweating changes have many causes.

The purpose of learning about autonomic neuropathy isn’t to make you worry about every symptom.

It is to help you recognize when seemingly unrelated symptoms may deserve a closer look.

Patient Success Principle #27

Tell Your Healthcare Provider About the Symptoms You Think Are Unrelated

Patients naturally organize symptoms into categories.

“That’s my stomach.”

“That’s my bladder.”

“That’s my blood pressure.”

“That’s my neuropathy.”

But the body doesn’t always separate things that neatly.

When your healthcare professional asks what has changed, mention the whole picture.

The symptom you almost forgot to mention may be the clue that connects everything else.

Ask Dr. Dee

“Doctor, I have neuropathy and sometimes get dizzy when I stand. Does that mean I have autonomic neuropathy?”

No.

It means autonomic dysfunction is one possibility worth considering.

But we also need to consider:

• Medications
• Dehydration
• Anemia
• Heart problems
• Blood-pressure disorders
• Other medical conditions

One symptom rarely makes the diagnosis by itself.

Lesson I’ve Learned in Nearly 40 Years

Listen for the “By the Way” Symptoms

Some of the most useful information I’ve received from patients begins with:

“By the way, Doctor…”

“By the way, I almost fell twice last week.”

“By the way, my foot has started slapping.”

“By the way, I get dizzy when I stand.”

“By the way, my hands have started going numb too.”

Those comments can change the entire direction of an evaluation.

After nearly four decades, I’ve learned:

Never ignore the “by the way.”

The Hope Principle

Autonomic neuropathy can sound frightening because it involves functions we normally don’t think about.

But understanding the problem gives us somewhere to begin.

Maybe the dizziness is medication-related.

Maybe the diabetes needs better management.

Maybe the gastrointestinal symptoms have another explanation.

Maybe autonomic nerves truly are involved.

Whatever the answer, understanding the pattern is better than living with unexplained symptoms and assuming nothing can be done.

Hope doesn’t mean every damaged autonomic nerve will completely recover.

Hope means discovering what is happening, identifying what can be treated, and protecting the function you still have.

“I believe the best healthcare decisions are made when patients understand their condition. My job isn’t simply to treat symptoms—it’s to help you understand why they’re happening and what your options are.”

— Dr. D. Scott (“Dee”) Stevens

Frequently Asked Questions

What is autonomic neuropathy?

Autonomic neuropathy is damage or dysfunction involving peripheral nerves that regulate automatic body functions such as blood pressure, digestion, sweating, bladder function, and sexual function.

Can diabetes cause autonomic neuropathy?

Yes. Diabetes is one of the best-recognized causes of autonomic neuropathy.

Can autonomic neuropathy cause dizziness?

Yes. Autonomic dysfunction can contribute to orthostatic hypotension, which may cause dizziness or faintness when standing.

Can autonomic neuropathy affect digestion?

Yes. Autonomic nerve dysfunction can affect movement through the gastrointestinal tract and may contribute to problems such as gastroparesis, constipation, or diarrhea.

Can neuropathy affect the bladder?

Yes. Autonomic nerve dysfunction can interfere with normal bladder sensation and emptying.

Can autonomic neuropathy affect sweating?

Yes. It may cause reduced, excessive, or abnormally distributed sweating.

Can neuropathy cause erectile dysfunction?

Autonomic neuropathy can contribute to erectile dysfunction, although vascular disease, medications, hormonal factors, and other conditions can also cause it.

Can autonomic neuropathy affect women sexually?

Yes. Autonomic nerve dysfunction may contribute to reduced lubrication or changes in sexual response, although many other factors can also contribute.

Does dizziness when standing prove I have autonomic neuropathy?

No. Dehydration, medications, anemia, heart conditions, and other problems may cause similar symptoms.

Can autonomic neuropathy be treated?

Management depends on the underlying cause and which autonomic functions are affected. Some symptoms can be treated or managed even when the underlying nerve injury cannot be completely reversed.

Key Takeaways

• Peripheral neuropathy can affect more than sensory nerves.
• Autonomic nerves regulate many automatic body functions.
• Autonomic neuropathy may affect blood pressure, heart-rate responses, digestion, sweating, bladder function, and sexual function.
• Diabetes is an important cause.
• Autoimmune and other systemic diseases may also affect autonomic nerves.
• Orthostatic hypotension can increase fall risk.
• Gastroparesis may occur when stomach emptying is impaired.
• Many autonomic symptoms have non-neurological causes.
• Medication review is extremely important.
• Treatment depends on the cause and the body system involved.
• Severe or rapidly changing symptoms may require urgent evaluation.
• Tell your healthcare provider about symptoms even when you think they are unrelated.

Why Patients Choose Advanced Integrated Medical

At Advanced Integrated Medical, we believe neuropathy evaluation should look beyond the feet.

We may ask:

What do your feet feel like?

But also:

Do you get dizzy when you stand?

Has your balance changed?

Has your digestion changed?

Has your sweating changed?

Are you having bladder problems?

Has sexual function changed?

What medications are you taking?

Do you have diabetes or an autoimmune condition?

Sometimes those questions uncover unrelated problems.

Sometimes they uncover a pattern.

Either way, they help us understand the patient more completely.

Continue Exploring the Learning Center

You may also want to read:

• What Is Small Fiber Neuropathy?
• Can Autoimmune Disease Cause Peripheral Neuropathy?
• Can Diabetes Cause Peripheral Neuropathy Even When My Blood Sugar Is “Under Control”?
• Can Kidney Disease Cause Peripheral Neuropathy?
• Can Medications Cause Peripheral Neuropathy?
• Can Peripheral Neuropathy Affect My Balance?
• Can Peripheral Neuropathy Cause Falls?
• Why Is My Peripheral Neuropathy Worse at Night?
• What Tests Are Used to Diagnose Peripheral Neuropathy?
• I’ve Been Diagnosed With Peripheral Neuropathy—What Should I Do Next?

Medical Disclaimer

This article is intended for educational purposes only and is not a substitute for individualized medical diagnosis or treatment.

Dizziness, fainting, digestive problems, bladder symptoms, abnormal sweating, sexual dysfunction, and heart-rate changes have many possible causes and should not automatically be attributed to autonomic neuropathy.

Seek prompt or emergency medical care for chest pain, significant difficulty breathing, repeated or unexplained fainting, severe dehydration, vomiting blood, black or bloody stools, new inability to urinate, severe abdominal pain, rapidly progressive weakness, or sudden neurological symptoms such as facial drooping, speech difficulty, confusion, or one-sided weakness.

Do not change prescription medications, fluid intake, sodium intake, or other medical treatment based solely on information in this article. This is particularly important for people with kidney disease, heart disease, or blood-pressure disorders.

Ready to Learn More?

If you have neuropathy and symptoms that seem unrelated, don’t automatically dismiss them.

Ask:

Do I become dizzy when I stand?

Has my digestion changed?

Has my sweating changed?

Has bladder function changed?

Has sexual function changed?

Could medications be contributing?

Could diabetes or another condition be affecting my autonomic nerves?

And most importantly:

“What else has changed?”

At Advanced Integrated Medical, we believe listening to the entire story matters.

Because sometimes the symptom that seems least connected is the one that helps connect the dots.