Peripheral neuropathy - Symptoms 

Symptoms of peripheral neuropathy often develop first in the extremities of the body, such as the hands, feet, legs and arms.

However, symptoms of peripheral neuropathy vary depending on the type of neuropathy.

Most cases affect the sensory and motor nerves. This type of neuropathy is called generalised sensorimotor polyneuropathy. 

Sensorimotor polyneuropathy

Symptoms of generalised sensorimotor polyneuropathy can include:

• prickling and tingling sensation in the affected body part (pins and needles)
• numbness and a reduced ability to feel pain or changes in temperature, particularly in your feet
• a burning pain, usually in the feet and legs, followed by the hands and arms as the neuropathy progresses
• sharp stabbing pain, which is often worse at night (the feet and legs are often affected first, followed by the hands and arms)
• muscle weakness
• loss of co-ordination
• muscle paralysis
• increased risk of developing foot problems, such as skin infections and ulcers

Some people with peripheral neuropathy also develop dysesthesia. Dysesthesia is where you experience problems with your sense of touch, which can cause the following symptoms:

• a burning or tingling sensation in your skin
• abnormally sensitive skin that often causes severe pain when you come into contact with objects such as bedding or towels

Automatic neuropathy

Damage to the automatic nerves (automatic neuropathy) can result in a wide range of symptoms depending on where in the body the damage occurs.

Symptoms of automatic neuropathy include:

• loss of co-ordination
• loss of balance
• problems swallowing (dysphagia)
• nausea
• vomiting
• bowel incontinence
• diarrhoea 
• constipation 
• excessive sweating 
• erectile dysfunction (impotence)
• rapid heartbeat (tachycardia)
• difficulty fully emptying your bladder of urine
• low blood pressure (hypotension), which can make you feel very dizzy when standing up from a sitting or lying position

Mononeuropathy

In some cases, the damage that is caused by peripheral neuropathy is limited to a single nerve or group of nerves. This is known as mononeuropathy.

Symptoms of mononeuropathy include:

• double vision or other problems with focusing your eyes
• eye pain
• weakness or paralysis in one side of your face (Bell’s palsy)
• foot or shin pain
• chest pain

Another type of mononeuropathy is known as carpal tunnel syndrome (CTS). The carpal tunnel is a small tunnel that runs from the bottom of your wrist to your lower palm. Running through the carpal tunnel is a nerve known as the median nerve. In cases of CTS, the space inside the tunnel shrinks, placing pressure on the median nerve. Compression of the nerve results in symptoms of pain and numbness.

It is estimated that almost 5% of women and 3% of men have carpal tunnel syndrome. The condition is more common in people with diabetes. It is estimated that up to 8% of people with type 2 diabetes and 85% of people with type 1 diabetes will develop carpal tunnel syndrome at some point in their life. 

When to seek medical advice

Generally, the sooner peripheral neuropathy is diagnosed, the lower the chance of serious complications. Therefore, it is important to remain alert for the early signs and symptoms of peripheral neuropathy, such as:

• a cut, graze or ulcer on your foot that does not appear to be getting better
• feelings of numbness, weakness, tingling or pain in your hands and feet
• dizziness when standing up, which could be the result of low blood pressure (hypotension)
• changes in your normal bowel and bladder functions, such as persistent diarrhoea or constipation, or a sudden episode of bowel incontinence

See your GP if you experience the above signs and symptoms.

It is also recommended that people with pre-existing risk factors for peripheral neuropathy have regular check-ups, so that their nerve function can be assessed. Read about the causes of peripheral neuropathy for more information.