Diabetes & Incontinence – Is There a Link?

In simple terms, diabetes is a chronic disease in which a person’s blood sugar is too high. There are different forms of diabetes, but Type 2 (diabetes mellitus or adult-onset diabetes) is most common in adults and is a fast-emerging problem in young adults and even children. People with Type 2 diabetes are not able to produce or use insulin effectively, and prolonged periods of excess blood sugar often lead to complications, including:

Heart disease
Nerve damage
Eye problems
Kidney failure
Reduced blood flow
Wound recovery problems
and other often debilitating illnesses.

According to the National Diabetes Statistics Report, about 38.4 million Americans are living with diabetes, which is roughly 11% of the population. The prevalence of diabetes increases with age: 4.8% among people ages 18-44, 18.9% among people 45-64, and 29.2% among people 65 and above. Roughly 15.4% of men and 14.1% of women have diabetes. Diabetes affects all racial and ethnic groups; 13.6% of non-Hispanic white people, 17.4% of non-Hispanic black people, 16.7% of non-Hispanic Asian people, and 15.5% of Hispanic people.

There Is Hope for Diabetes Management

Patients can prevent or slow the worsening of diabetic neuropathy by managing their blood sugar, cholesterol, and weight. GLP-1 medications and even bariatric surgery may both be indicated for poorly controlled diabetes. Ultimately, self-determination and empowerment to pursue lifestyle and behavioral changes are critical to reversing the effects of diabetes, despite it being a lifelong condition.

The Scourge of Diabetic Neuropathy

Diabetic neuropathy involves nerve damage to various organs and bodily structures, including the heart, bladder, eyes, sexual organs, and sweat glands. A person with diabetes may be further predisposed to diabetic neuropathy if they smoke, have high blood pressure, high cholesterol, binge drink alcohol, or have kidney disease. About 30 percent of people with diabetes have this form of neuropathy, but importantly, many people may not notice minor nerve damage that slowly worsens over time. This nerve damage may cause bladder control issues known as urinary incontinence.

Types of Urinary Incontinence

There are three types of urinary incontinence. Stress incontinence occurs due to force exerted, such as laughing, exercise, coughing, or sneezing. Urge incontinence is a sudden, strong desire to urinate, after which urine spontaneously flows out of the body. Overflow incontinence occurs if the bladder does not empty properly, reaching maximum capacity, and leading to inadvertent urinary flow. It is common for patients to have both stress and urge incontinence.

Urinary incontinence may be mild, whereby a person leaks urine now and then, or severe, where the person is not able to hold urine at all.

Patients do not often discuss UI during office visits due to stigma and embarrassment, instead managing the effects with decidedly negative lifestyle changes to cope, avoiding enjoyable activities and/or frequently wearing pads to go out and about, for example.

The Link Between Diabetes and Urinary Incontinence

Diabetes is one of many causes of urinary incontinence. High blood sugar levels lead to osmotic diuresis, which leads to frequent urination. Nerve damage in the pelvic (detrusor) muscles may also lead to an inability to control bladder function. People with diabetes also have lower immune responses and are more susceptible to urinary tract infections. Notably, untreated urinary tract infections may lead to dangerous kidney infections.

Treatment for Diabetes-Related Incontinence

There are varied treatments for UI, and your Georgia Urology provider can help you understand your options, which include:

Trying to quit smoking.
Minimizing alcohol, coffee, or other caffeinated drink consumption, which stimulates the bladder.
Managing your weight to reduce abdominal fat.
Reducing blood sugar and aiming for hemoglobin A1C levels of less than 7%.
Going to the bathroom every 2 to 3 hours.
Being mindful of your water intake. Drink when thirsty, but do not drink water more than necessary.
Performing Kegel exercises and bladder training to strengthen the pelvic floor muscles.
Discussing medications that may reduce bladder spasms or treat the risk factors of urinary tract infections.
Considering BOTOX injections to relax the bladder muscle.
Learning more about neuromodulation, which uses electrical pulses to control bladder function (Axonics, Interstim, and PTNS)
Learning more about female slings, male urinary slings, or artificial urinary sphincters

Start the Conversation With Your Healthcare Provider

If you are experiencing urine leakage with or without diabetes, talk with your urologist. There is nothing to be shy or ashamed of. Urinary incontinence, even due to diabetes, can be managed effectively with a multidisciplinary approach to blood sugar reduction and continence restoration.