Diabetes

autonomic nerves

Over time, diabetes will damage nerves.

Type 2 diabetes is a chronic condition where your body resists the effects of insulin (or does not produce enough insulin) to maintain a normal glucose level in your body.  Type 2 is the most common form of diabetes, with about 95% of all people with diabetes in the USA having this form.  Type 2 diabetes increases your risk and severity for both urinary and fecal incontinence. One of the main reasons for this is that an unhealthy weight, often associated with Type 2 diabetes, can cause incontinence from the increased weight placed on the pelvic floor muscles. Recent studies have shown that a healthy weight loss done under the guidance of a healthcare professional may reduce incontinence.

Who Has Type 2 Diabetes

Type 2 diabetes is more common in adults, but we are now seeing children, teenagers, and young adults being diagnosed with Type 2 diabetes. Diabetes occurs when you have too much glucose (also called blood sugar) in your blood. Too much glucose will damage your body over time. When left untreated, Type 2 diabetes can be life threatening.  There is no cure for diabetes, but Type 2 can be managed with the help of your healthcare professional through diet, exercise and maintaining a healthy weight. If diet and exercise do not bring your blood sugar into a healthy range, your healthcare professional will discuss the need for medications or insulin therapy with you.

Symptoms of Diabetes

One of the common symptoms of diabetes (there are many others), is frequent urination. This is because excess glucose that is building up in your blood stream causes fluid to be pulled from your tissues, leaving you thirsty. As a result, you drink more and more fluids in an attempt to quench your thirst, making you urinate more than normal. In addition, your body is also trying to get rid of the extra glucose by excreting it out of your body in your urine. This process causes a large increase in the amount of urine produced.

Complications

Diabetes can lead to nerve damage, which includes the nerves in the bladder and bowel. The nervous system has four main parts – cranial, central, peripheral, and autonomic. Diabetes can damage the peripheral, autonomic, and cranial nerves. Autonomic nerves go from your spinal cord to your lungs, heart, stomach, intestines, bladder, and sex organs.

Nerve damage may lead to several changes in bladder function:

  • An over active bladder (OAB), which can lead to urgency and urge urinary incontinence (UUI)
  • Decreased bladder sensation, which can lead to little to no warning before feeling the urge to urinate, which can lead to episodes of incontinence
  • Weak bladder muscles.  In persons with severe and/or longstanding diabetes, the bladder muscle may become so weak that you do not completely empty the bladder each time you urinate. Residual (or leftover) urine in the bladder may lead to a urinary tract infection (UTI). In severe cases, the bladder does not contract, causing “overflow incontinence.” A UTI will also lead to increased frequency and urgency of urination. Persistent and repeated UTIs can lead to chronic infection of the kidneys.

Diabetic women, or women who develop gestational diabetes, may give birth to large sized babies. During delivery, they can suffer injuries to the perineum and bladder, particularly the sphincter controlling the mouth of the bladder. This can manifest as retention of urine in the bladder or incontinence.

Constipation, which affects nearly 60% of persons with diabetes, can make it difficult to empty your bladder.

Congestive heart failure (CHF) from diabetes-related coronary artery disease can cause your legs and feet to retain water, and can cause your body to create too much urine at night. This can lead to getting up many times at night to urinate (nocturia), and may lead to experiencing incontinence at night.

Stroke from diabetes can affect bladder sensation and your ability to hold back from urinating. Additionally, mental impairment can make it difficult for an individual to toilet himself or herself (and when severely advanced, even toileting with assistance becomes difficult).

Diabetes may cause frequent urination

Diabetes may cause more frequent and urgent  trips to the  bathroom.

Mobility challenges due to diabetic neuropathy, peripheral vascular disease, and amputation can prevent you from reaching a toilet, removing clothing, etc. “in time”, leading to episodes of leakage. This is called “functional incontinence.”

Some medications for the treatment of diabetes, or for the treatment of the complications of diabetes, can impair continence or complicate its treatment:

  • Some medications may cause fluid retention in the legs and feet and congestive heart failure (CHF), thereby leading to an increased production of urine at night, and nighttime urinary incontinence.
  • Some individuals may experience a cough from ACE inhibitors, which are frequently used to treat high blood pressure in persons with diabetes. Such coughing can trigger stress urinary incontinence, or make it worse.
  • Calcium channel blockers (CCBs) used for hypertension can make it difficult for the bladder to contract and empty completely, potentially leading to overflow incontinence. Some CCBs can cause swelling in the feet and constipation, also worsening incontinence.

Prevention

The best way to prevent incontinence associated with diabetes is to:

  • Prevent Type 2 diabetes (maintain a healthy weight, eat a healthy diet that reduces blood sugar, exercise regularly, and use medication if prescribed)
  • Work closely with your healthcare professional to control blood sugar and treat any associated hypertension, high cholesterol, and obesity
  • Avoid alcohol and smoking
  • Drink plenty of water each day
  • Practice good perineal hygiene to help prevent infection

For those diagnosed with prediabetes, Diabetes Prevention Programs focusing on diet and exercise can significantly reduce the occurrences of urinary incontinence. Several studies have found that overweight women (at risk for diabetes) who lower their weight , lower their risk of incontinence.

Treatment and Management

The most important thing that persons with diabetes or prediabetes can do is tell your health care provider if you experience frequent or urgent urination, having to get up to urinate more than once a night, or if you have any incontinence episodes. People experiencing incontinence often do not tell their healthcare professional. In most cases, incontinence can be treated or managed comfortably. Everyone’s body is different, so everyone responds to treatment and management techniques differently. You are encouraged to discuss the many available options today with your healthcare professional.

Note: Incontinence in persons with diabetes is not always related to the diabetes. Incontinence could be caused by completely separate factors. This is why all changes in your toileting habits should be reported to your healthcare professional.

Shanna Atnip, MSN, WHNP-BCMedical Reviewer: Shanna Atnip, MSN, WHNP-BC

Ms. Atnip is a Women’s Health Nurse Practitioner in the Urogynecology Division at Parkland Hospital in Dallas, Texas. At Parkland, the Urogynecology Division handles the full gamut of pelvic floor issues. Ms. Atnip has been a part of this department for sixteen years. She is a member of the Society of Urologic Nurses and Associates (SUNA) and the American Urogynecologic Society (AUGS). She has been the Southeast Regional Director of SUNA since 2011 and has served in many leadership roles within SUNA. She has also been a local and national speaker for SUNA conferences and symposia.

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