It is no secret that diabetes is on the rise in the United States. With 1.5 million new diagnoses each year, diabetes has a widespread effect on Americans. You may also know that individuals who have been diagnosed with one condition, such as diabetes, are often at a higher risk for developing other secondary conditions. Although often overlooked, diabetes is no exception, and the secondary condition can often be incontinence.
By its nature, diabetes causes increased glucose levels, decreased blood flow, and nerve issues. However, it can also affect sensory function and bladder sensation. Because of these factors, we often see links between diabetes and frequent urination, as well as diabetes and urinary tract infections (UTIs). A few ways that diabetes can lead to incontinence are:
Diabetes medication can often lead to urinary incontinence symptoms. The medication, in an attempt to regulate high blood sugar levels, forces glucose from the blood out into the urine. When this happens, the bladder can become irritated, leading to incontinence.
Increased glucose levels can also cause nerve damage (autonomic neuropathy) similar to peripheral neuropathy, which occurs in diabetics when they lose sensation in their legs and feet. This autonomic neuropathy can cause you to develop a neurogenic bladder, also resulting in urinary incontinence.
The excessive thirst caused by diabetes can be a contributor to incontinence issues, as well. Drinking excessive amounts of fluid at one time increases pressure on the bladder and leads to more frequent urination. It can also contribute to nocturia (waking up multiple times during the night to use the restroom) which disrupts sleep and irritates the bladder.
High blood sugar levels can contribute to frequent urinary tract infections (UTI) which can contribute to an overactive bladder and urinary frequency.
Other contributing risk factors that can lead to urinary incontinence are:
Enlarged prostate glands
Genitourinary syndrome due to menopause/hormonal changes
Previous urinary tract surgery
Types of Urinary Incontinence
There are several different types of incontinence that can develop from the symptoms of diabetes:
Urge Incontinence – Having a sudden, intense urge to urinate followed by an involuntary loss of urine. You may also need to urinate frequently, even during the night.
Stress Incontinence – Experiencing leakage when partaking in certain types of movement such as exercise, jumping, running, coughing, sneezing, laughing, etc.
Functional Incontinence – Feeling an intense urge to urinate but failing to make it to the restroom in time due to conditions such as dementia, arthritis, or diabetic neuropathy.
Overflow Incontinence – The frequent or constant dribbling of urine due to not being able to empty your bladder completely.
Mixed Incontinence – You may experience more than one of the above types of incontinence.
Types of Diabetes
Type 1 Diabetes – Also known as juvenile diabetes or insulin-dependent diabetes, Type 1 Diabetes occurs in both children and adults when the pancreas fails to produce enough insulin to break down glucose.
Type 2 Diabetes – Also known as adult-onset diabetes or non-insulin dependent diabetes, Type 2 Diabetes is the most commonly occurring type. It occurs when your body resists the effects of insulin or fails to produce enough to maintain normal glucose levels. Obesity and sedentary lifestyles are contributing factors.
Gestational Diabetes Mellitus – Can develop during pregnancy and affects how your body uses glucose. It can also increase your chances of developing Type 2 Diabetes after pregnancy.
Prediabetes – Occurs when your blood glucose levels are higher than normal but not high enough to be Type 2 Diabetes. It’s a warning sign that can often be reversed with diet and exercise.
Managing Your Incontinence
When trying to find relief from diabetic bladder symptoms, evaluation by a urologist is key. You want to be able to identify the type of urinary incontinence you have, so that your treatment can be specifically tailored to your needs. I recommend that anyone newly diagnosed with diabetes immediately seek a referral to a urologist. Remember, prevention is key!
Seeing a urologist immediately after a diabetes diagnosis can:
Help establish a baseline of bladder function and help rule out if there are any pre-existing factors that may have gone unnoticed (i.e. incontinence from pregnancy, recurrent urinary tract infections, menopause, etc).
Ensure that if the bladder starts to have complications from your diabetes, it can be caught early and treated accordingly.
Your doctor will want to run tests to find out what type of urinary incontinence you have. After the type is determined, you can proceed with treatment options that can help you manage your urinary incontinence more effectively.
Postvoid residuals: An ultrasound of your bladder is taken to see if there is any urine left behind after you empty your bladder. Between 60-100cc is a normal amount of urine to have in your bladder after voiding – but less is ideal.
Urinalysis: A test to check for the presence of glucose in the urine as well as bacteria, blood, and/or white blood cells that could indicate a potential urinary tract infection (UTI).
Urodynamics: A specialized test that assesses the bladder’s storage and release of urine function. This test is key to determining what type of urinary incontinence you may have.
In some cases, incontinence can only be managed. However, in other cases, it can be treated and will go away with time and dedicated treatment. Some treatment methods even overlap with diabetes management to manage both conditions at once. A few treatment options include:
Timed voiding or bladder retraining: Try to only allow yourself to urinate at certain time intervals and continue to prolong those intervals until they reach more “normal” levels (voiding every 2 hours is considered normal). This practice can help you regain bladder control over time.
Pelvic floor exercises: These are more than just Kegel exercises! Finding a pelvic floor physical therapist can help improve your bladder and bowel function, as well as help lessen diabetic bladder symptoms by strengthening your bladder muscles and pelvic floor muscles. Pelvic floor exercises can also improve sexual pleasure and help with pregnancy.
Medications: Certain medications, such as anticholinergics, can be used to protect your bladder from the nerves firing too much or decrease the urethra from moving as much, which can help prevent urge incontinence.
Intermittent self catheterization: If your diabetes is causing you to suffer from urinary retention, your doctor may suggest intermittent catheterization as a treatment option. Using a catheter can help you void your bladder, limiting the chance of overflow incontinence and damage to your bladder or kidneys.
Diet and lifestyle: A healthy diet and proper exercise play an important role in both managing blood sugar levels and reducing pressure on your bladder. For bladder and bowel health, eating a healthy, balanced diet with plenty of fiber and bladder happy foods is key. It is also important to drink 6-8 glasses of water each day to maintain proper hydration and reduce the diabetic symptom of excessive thirst. Lastly, moderate physical activity 3-5 times a week is a great way to combat the risk of incontinence and maintain a healthy lifestyle.
Limit certain foods and drinks: Refraining from eating spicy, acidic, or dairy-based foods could potentially help limit your incontinence symptoms. Avoiding alcohol, carbonated, or caffeine-filled drinks can also increase your chances of controlling an overactive bladder. Although limiting these foods and drinks won’t provide a perfect solution, it can still be beneficial in curbing the side effects of incontinence.
Keep a bladder diary: A bladder diary can help you and your doctor track and evaluate the amount of fluids you are taking in and compare this to how often you urinate. This is an easy, non-invasive test to determine the condition of your bladder and what type of urinary incontinence you may have.
Be prepared: This may be the most important treatment option. You may not always be able to control your bladder, but you can control your preparation for the surprises that often come with incontinence. Making sure you always have your incontinence supplies ready to use when you need them is a crucial step in managing urinary incontinence. Whether you need catheters to help fully empty your bladder or adult pull-ups to protect yourself from accidents, ensure that you have a plan (and supplies) to manage your symptoms.