By Denise Elser, MD
Urinary Incontinence is a condition affecting many, however it is particularly problematic for people with diabetes. Over 50% of men and women with diabetes have bladder dysfunction1. Obesity is a risk factor for both incontinence and type 2 diabetes.
Glycosuria:
Those who do not maintain strict control of blood sugar levels will spill glucose into the urine, a condition known as glycosuria (gly-cos-uria). Glucose in the urine results in irritative symptoms, such as urgency, frequency and urgency incontinence. These symptoms mimic a urinary tract infection (UTI) or cystitis. Many take repeat courses of unnecessary antibiotics, but are plagued by persisting symptoms. Better glucose control results in lower bladder irritation.
UTI/ Chronic Bacteruria:
People with diabetes are more prone to UTIs. Some will develop chronic bacteruria, which is the presence of bacteria in the urine, but not necessarily an infection. Most bladder infections are caused by a type of bacteria known as E. Coli (Escherichia coli). An E. Coli bladder infection can cause both stress and urgency incontinence. Adults with E. Coli UTI have been found to have higher rates of both detrusor overactivity (DO) and stress urinary incontinence (SUI) during the infection. The inflammation caused by the bacteria is irritating to the bladder, leading to urgency, frequency, and uninhibited bladder contractions (DO). In addition, E.Coli bacteria releases a toxin that interacts with receptors in the urethra (bladder opening) causing the urethra to relax, in turn leading to SUI. A mild infection can be present for weeks if not months.
Neuropathy:
Diabetes can lead to impaired function of blood vessels and nerves. While it is common knowledge that vision and kidney function frequently becomes impaired in diabetics, the bladder may be one of the first organs adversely affected. Dysfunctional voiding can develop with inability to completely empty the bladder. A bladder that is always partially full of urine results in a lower functional bladder volume, there is less room in the bladder to hold more urine. Resulting symptoms are urgency, frequency and urgency incontinence. In addition, one of our defenses against UTI is to keep urine flowing. Urine that is stagnant in the bladder creates increased risk for UTI.
Nocturia (waking up at night to urinate):
Diabetics commonly have coexisting medical problems, particularly heart disease. Even mild heart or vascular (blood vessel) can lead to fluid retention during the day. As a person ages, but especially in diabetics, the kidneys function more efficiently when one is sleeping or in a supine (lying flat) position. Many older women with diabetes, make more than 2/3 of a days urine during the sleeping hours. This causes frequent waking up at night with an urgent need to urinate, and can cause bedwetting.
Resources:
1 Brown JS, Wessells H, Chancellor MB, Howards SS, Walter SE, Stapleton AE, Steers WD, Van Deen Eeden SK, McVary KT. Urologic complications of diabetes. Diabetes Care. 2005; 28(1)177-185.
About The Author:
Denise Elser, MD, is a physician at Illinois Urogyencology, LTD. Her special interests include evaluation and development of minimally invasive procedures for the treatment of urinary incontinence, prolapse and other gynecologic indications. She travels nationally to lecture and teach surgical anatomy and new procedures to gynecologic and urologic surgeons. Dr. Elser is the principal investigator in several ongoing research studies, including: evaluation of the use of pessaries in women with pelvic organ prolapse, radiofrequency urethral collagen remodeling (Renessa), the success of pelvic floor physical therapy in treatment women with bladder dysfunction, hysteroscopic tubal occlusion for permanent birth control (Essure) and the optimal treatment for stress incontinence at the time of prolapse surgery.
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