Diabetes mellitus more commonly referred to as diabetes is a metabolic disease characterized by high blood sugar levels in the body. It’s a well-known fact that diabetes can lead to severe health complications, especially if blood sugar levels are left uncontrolled. But a significant, yet lesser-known truth is that it can contribute to urological problems, such as incontinence—the loss of bladder control—a reality for approximately 40% of women with diabetes. However, research suggests that 50% of severe incontinence could be avoided by preventing type 2 diabetes, specifically. Therefore, knowing more about diabetes can help women manage the condition and prevent major complications like urinary incontinence.
THERE ARE FOUR BASIC WAYS THAT DIABETES CONTRIBUTES TO INCONTINENCE, ESPECIALLY IN WOMEN:
EXCESS WEIGHT & OBESITY
Type 2 diabetes accounts for roughly 90% percent of all diagnosed cases of diabetes, and around 90% of individuals with type 2 diabetes are considered overweight or obese. Being overweight and obese can contribute to weaker bladder control because it puts pressure on your bladder and your pelvic floor. This makes it more difficult for these muscles to support your bladder and your urethra, leading to involuntary leaks, which can result in urinary frequency or urge incontinence. The easiest method to gauge obesity is to calculate one’s body mass index (BMI). This is an important factor for diabetes and incontinence as the risk of urinary incontinence in diabetic women increases with a greater BMI. Specifically, women with a BMI greater than 30 kg/m2 were 1.5 times more likely to develop urinary incontinence. Knowing your BMI can help manage your diabetes as well as avoid incontinence.
It is known that poorly managed or long term diabetes may cause damage to nerves, mostly expressed as peripheral neuropathy. In fact, about 60% of people with diabetes have some form of nerve damage. Unfortunately, nerve damage can lead to a neurogenic bladder if blood sugar levels are not brought under control, as nerve damage affects the nerves that help to control the bowel and the bladder. Symptoms of a neurogenic bladder include:
- Overflow incontinence
- Inability to fully empty bladder
- Overactive bladder
- Urge incontinence
People with diabetes suffering from neurogenic bladder may also experience nocturia. This is the need to urinate more than once during the night, which can be a sign of uncontrolled blood sugar levels. Generally, to help manage the effects of bladder irregularities, it is recommended that people pay close attention to what they consume and make necessary dietary changes. Cutting out things like artificial sweeteners, caffeine and carbonated beverages and replacing them with increased water intake and a vitamin rich diet is often the first step.Similarly, diabetes patients can delay or avoid neurogenic bladder and incontinence by referencing a diabetes diet plan to help control their blood sugar levels over the long-term. Diet management is nothing new for diabetics, diet planning often includes close attention to carbohydrate, protein, fat, and fluid intake. All of which will have a heightened awareness when diabetes is paired with the involuntary urination and incontinence.
COMPROMISED IMMUNE SYSTEM
Unfortunately, diabetes can also interfere with your immune system, putting you at a greater risk for urinary tract infections (UTIs) which can cause incontinence. In fact, a history of recurrent UTIs was found to be the main risk factor and predictor of urinary incontinence amongst diabetic women. This is likely due to the fact that high blood sugar levels can weaken the immune system as a hyperglycaemic environment can enhance the presence of certain microorganisms which may increase the risk of developing a UTI. Not to mention, some women have bladders that don’t empty all of the way because of diabetes, creating a perfect environment for bacteria to grow. Diabetic women also have a two to threefold higher prevalence of asymptomatic bacteriuria (ASB), a condition in which greater than normal numbers of bacteria are present in the urine but symptoms do not result. Patients with both type 2 diabetes and ASB have an increased risk for developing a symptomatic UTI. UTIs can cause pain and an intense, sudden need to urinate. Although women with diabetes tend to have an increased likelihood of repeated infection, UTIs are treatable.
Constipation (having fewer than three regular bowel movements each week) is a common issue that many diabetics face. It’s estimated that around 60 percent of people with long-standing diabetes deal with constipation. Damage to the nerves controlling the digestive tract can lead to constipation as well as some medications used to manage diabetes can slow gut mobility and cause constipation. Constipation can then lead to urinary incontinence. Think of it this way, if space in your abdomen is taken up by a bowel movement that just won’t move, it leaves less space for your bladder to fill with urine. Constipation is also a risk factor in pelvic floor weakness, a major cause of incontinence. Talk to your doctor if you’re experiencing constipation to help avoid urinary incontinence.
HOW TO TREAT DIABETES-RELATED INCONTINENCE
The treatment of urinary incontinence depends on the cause. If your medications are causing incontinence, your doctor may be able to recommend different treatment options. If you have a UTI, you may need antibiotics. Your doctor may even suggest incorporating more soluble fiber into your diet if you’re experiencing constipation to help regulate bowel movements. Keeping your blood sugar levels within the targets set by you and your doctor can also help as well-controlled blood glucose levels can reduce the risk of diabetes related complications such as nerve damage that can lead to incontinence.
If there’s no underlying cause, adopting certain lifestyle changes is an effective way to manage incontinence as well. These lifestyle changes include:
- Kegel exercises – These exercises can help keep your pelvic floor strong. Focus on the muscles you use to hold in urine. Squeeze them for 10 seconds before relaxing. Try to aim to do about 5 sets of these exercises per day. (Note: Kegels are not for everyone. It’s important to consult your doctor or a pelvic health physical therapist prior to starting a new workout routine.)
- Use a bladder diary – Schedule bathroom breaks using a bladder diary. You can retrain your bladder to hold more urine by extending the time between trips a few minutes at a time.
- Eat more fiber – Eating high-fiber foods such as fruits, vegetables and bran can help avoid constipation.
- Maintain a healthy weight – If you are overweight, implement exercise and healthy food choices into your daily routine to reach a healthy weight. Maintaining a healthy weight helps to avoid extra pressure on your bladder and pelvic floor.
- Completely empty your bladder – After you urinate, wait a minute and try to go again. This can help completely empty your bladder and reduce your number of trips to the restroom.
- Try herbal remedies – Herbs can be used as remedies for maintaining a healthy bladder. Consider adding pumpkin seeds, capsaicin, and khoki tea to your diet. (Talk to your doctor first to make sure they don’t interfere with an medications you may be taking.)
- Drug therapy – Consult with your doctor about medications that can help you manage urinary incontinence.
- Insertion devices – These devices can help women avoid leakage and manage stress incontinence.