CIDPUSA.org Autoimmune diseases

Small Fiber neuropathy Part-1
by: Dr Imran Khan |JUNE 29, 2020

100 million people in the USA have neuropathy. Most have small nerve fiber type,  the symptoms consists of pain, burning, tingling, and numbness in a length-dependent or stocking-glove distribution. Autonomic neuropathy or small fiber neuropathy is caused by damage to the smallest nerves that supply sensory feelings, these help regulate your heart rate, blood pressure, sweat and digestion, among other functions. Neuropathy means damage to  nerves. Autonomic small fiber neuropathy is often due to  Celiac or diabetes, with other autoimmune diseases, infections or toxic conditions. The nerves transmit messages between the brain and organs. Damage to your autonomic nerves results in faulty communication with  brain and the affected parts of the body . The nerves are composed of many types of fibers and the thinnest fiber is affected by this neuropathy so it is called,

Small fiber neuropathy

 The condition is reversible if treated early. Signs and symptoms are variable on which nerves are affected but can range from dizziness to trouble with digestion, urination to sexual difficulties. Treatment involves addressing the underlying cause, if possible, and managing the signs and symptoms.


Signs and symptoms
Signs and symptoms of autonomic neuropathy depend on which function of  autonomic nervous system are affected. They symptoms may include:

A drop in blood pressure on standing (orthostatic hypotension), which can cause dizziness and fainting, brain fog.

Trouble with urination, including diminished sensation, overflow incontinence and inability to empty your bladder completely, which can lead to urinary tract infections.

Male impotence or weak erectile function.  Vaginal dryness and difficulties with arousal and orgasm in women.

Numbness in toes very common and may be the earliest and only symptom,feet or genitals, abdomen. Tendency to trip easily. Burning sensation on skin. Difficulty in judging accelerator position while driving. Trouble focusing eyes.

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Difficulty digesting food (gastroparesis),

Which can cause diarrhea, constipation, abdominal bloating, nausea, vomiting, heartburn, feeling full after eating little and loss of appetite.

Cardiovascular problems,

Heart rate abnormalities. Heat intolerance, especially during exercise, and usually decreased sweating or increase sweating. Exercise intolerance, which causes your heart rate to remain unchanged instead of increasing and decreasing in response to your activity level. Severe drop in blood pressure on standing: This is caused when the heart rate fails to accelerate on standing up.

 Sluggish pupil reaction to light and dark. 

Lack of the usual warning signs of low blood sugar (hypoglycemia), which include shakiness, sweating and palpitation .


One may not get all of these signs. Urinary incontinence, Urinary tract infection (UTI), Erectile dysfunction , Vaginal dryness , Diabetic gastroparesis.

Constipation Diarrhea, Cardiovascular disease ,  and Numbness feeling in toes, fingers or abdomen. with Burning  sensation and pain.

Please continue to next page of autonomic neuropathy

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