Diabetes is a condition that is on the rise. It is estimated that there are around 2.9 million sufferers in the UK.
Diabetes is commonly thought of as a condition that heightens the risk of heart disease and kidney disease. However, it might come as a surprise to many that individuals with Diabetes have up to a 70% greater risk of developing urinary incontinence.
Recent research reveals urinary incontinence in people with Diabetes to be a progressive condition, causing problems including frequent daytime and night-time voiding and incontinence. A study in 2005 set out to evaluate the association between type 2 Diabetes and the development of urinary incontinence in women. Researchers performed a cross-sectional analysis of 1, 017 postmenopausal women, 218 whom were diabetic. The women were asked to record their incontinence episodes over the next 2 months. Women with diabetes reported disproportionately more severe incontinence, difficulty controlling urination, inability to completely empty the bladder and being unaware of leakage and discomfort with urination. Notably, a history of urinary tract infection and measures of general health were associated with this outcome. The study concluded that Diabetes independently increases the risk of urinary incontinence.
Why does Diabetes often cause Incontinence?
The following reasons are considered to be the main factors for this common combination:
The Risk of a High Body Mass Index
It is now thought that incontinence in individuals with Diabetes is a progressive condition. One of the main reasons for these conditions being linked is due to the high risk of Diabetic individuals having a high body mass index. Type 2 Diabetes, which accounts for up to 90% of all Diabetes cases, is strongly linked to weight gain. Research suggests obese people are up to 80 times more likely to develop type 2 Diabetes than those with a BMI of less than 22. Having a high body mass index is one of the most common causes of incontinence. It is estimated that each 5-unit increase in body mass index is associated with an incontinence prevalence risk of up to 50%. This is partially due to increased weight causing additional stress to be placed on a person’s pelvic floor muscles. Researcher Noblett et al found strong correlations between BMI and intra-abdominal pressure and intravesical pressure, suggesting obesity can cause extreme additional pressure. Excessive weight can ultimately lead to chronic strain, stretching and weakening of the nerves and muscles of the pelvic area. This causes them to become weakened more quickly than in a person with a lower BMI.
High Body Sugar Levels
Another prominent factor that increases the prevalence of incontinence and Diabetes is the risk of having high blood sugar levels. High blood sugar levels affect people with both type 1 and type 2 Diabetes. In individuals with Diabetes, cells struggle to get enough energy to function properly, causing blood sugar to rise. Having high blood sugar levels can cause an increase in the amount of urine produced, often resulting in lack of bladder control. High blood sugar levels can also often cause nerve damage. The Simon Foundation for Continence explains that your body has a network of autonomic nerves that go from the spinal cord to your lungs, heart, stomach, intestines, bladder and sex organs. When nerves in the bladder and the bowel are damaged, this can lead to incontinence. A common reason for becoming incontinent is due to decreased bladder sensation, resulting in having no warning before feeling the urge to urinate. In many people with severe or longstanding Diabetes, the bladder muscle becomes so weak that you cannot empty the bladder fully each time you urinate.
A Weaker Immune System
A less well-known fact about Diabetes is that the condition ultimately interferes with the immune system, putting you at greater risk of infections. In Diabetes type 1, the body’s immune system reacts against its cells and begins to kill them. An infection often experienced by people with Diabetes is a urinary tract infection. Common symptoms of this condition are a pain in the lower abdomen and urine that is cloudy. A urinary tract infection can also cause a feeling that you need to pass urine more often and more urgently, causing embarrassing accidents.
Additional reasons as to why Diabetes increases the risk of developing incontinence range from problems with childbirth to mobility issues. Diabetic women often give birth to largely sized babies. They can, therefore, suffer injuries to the perineum and bladder during giving birth. The sphincter controlling the mouth of the bladder can often be severely damaged. This can manifest as retention of urine in the bladder or incontinence. In addition to this, constipation, which affects nearly 60% of people with Diabetes, can make it difficult for individuals to empty their bladder. Congestive heart failure from Diabetes-related coronary artery disease can cause your legs and feet to retain water, causing your body to create too much urine at night. This can lead to getting up many times a night to urinate and may lead to experiencing incontinence at night. Mobility challenges due to diabetic neuropathy and amputation can prevent you from reaching a toilet on time. Finally, it has been proven that some medications used to control Diabetes can cause urine leaks and loose bowel actions. These medicines include Metformin, Acarbose and Gliclazide.
Preventing and Treating Incontinence
Keeping your Diabetes well-controlled is the best way to prevent nerve damage or further damage from happening. Healthcare experts recommend weight loss to prevent incontinence in Diabetic individuals. A new study has suggested that overweight women with Diabetes may be able to cut their risk of urine leakage in half if they work to shed some pounds. Studies analysing the benefits of weight loss have found that when overweight women drop even a modest amount of weight, they can curb their risk of incontinence. Researcher Suzanne Phelan asserts “overweight and obese women with type 2 Diabetes should consider weight loss as an effective way to reduce their risk of developing urinary incontinence”.
In addition to exercising, it is important that you eat a healthy, balanced diet with a suitable amount of fibre. It is recommended that you avoid caffeine, fizzy drinks and alcohol as these are known to both irritate the bladder and increase blood sugar levels. There are various medications that are used to treat the frequency and urgency of incontinence caused by Diabetes. Betmiga, for example, is an oral medication that can act a muscle relaxant. There are also several medications available to help prevent spasms of the bladder muscle. These belong to a group of medicines known as antimuscarinic or anticholinergic drugs. You can talk to your GP and your Doctor about which medication is the most suitable for you.
Constipation caused by Diabetes can often be solved through staying hydrated. Consuming 1.5-2 litres of fluid each day can prevent you from suffering from constipation. When exercising or sitting in hot weather, you should drink extra fluids to ensure you stay hydrated. If your medication for Diabetes is causing loose bowels as a side effect, soluble fibre can help firm up the diarrhoea and slow down the bowel motions. Try and consume at least 30gm of fibre each day. Eat at least 2-3 serves of fruit, 5 serves of vegetables and 5 serves of cereals and bread. It is important to increase your fluid consumption as you add more fibre to your diet to avoid causing constipation.
If your incontinence is severe and you are suffering from autonomic neuropathy, several medicine treatments may help people with autonomic neuropathy. Research suggests that Alpha-Lipoic Acid may be helpful in slowing down or reversing neuropathy that’s causing blood pressure or heart rate problems. Alternatively, acupuncture, which uses numerous needles placed at specific points in the body, may help treat slow stomach emptying. Additional studies have found electrical nerve stimulation to be helpful in easing pain associated with Diabetic Neuropathy. Oral estrogen and vaginal estrogen have also been proven to be useful in reducing the frequency of incontinence episodes in Diabetic individuals.
If a urinary tract infection is the cause of incontinence, your GP will be able to prescribe an antibiotic treatment to clear the infection. In many cases, this can help alleviate any incontinence issues once the infection is resolved. Treatment includes antibiotics and strategies to promote bladder emptying. Personal hygiene is also important, and you should avoid transferring bowel bacteria to the vagina.
Remember that incontinence caused by Diabetes is not an uncommon problem. By talking to your GP and maintaining a healthy lifestyle, your symptoms will rapidly reduce.