We reviewed the autonomic dysfunction in multiple system atrophy (MSA) with reference to the new MDS criteria. MSA is a major neurodegenerative disorder that presents with autonomic and motor dysfunctions (cerebellar ataxia and/or parkinsonism). Autonomic dysfunction in MSA affects urinary, cardiac, gastrointestinal, otorhinolaryngologic, and respiratory functions. Therefore, autonomic dysfunction in MSA should be recognized, collaborating with each faculty for the treatment and care of the patients. Moreover, it is highly recommended that neurologists request for an ultrasound measurement of the post-void residual urine volume. MSA has no cure; hence, active participation in the treatment and care of autonomic dysfunction in MSA patients is warranted.