Neuropathy is one of the most common complications of diabetes, caused by high blood sugar levels. According to the Simon Foundation, diabetes leads to damage of the autonomic nerves that run from the spinal cord to the bladder amongst other organs. This can increase the risk of developing a neurogenic bladder resulting in changes to bladder function that prevent it from emptying properly.

Neurogenic Bladder Symptoms can include:

• An overactive bladder (OAB), resulting in urgency and urge urinary incontinence (UUI)
• Decreased bladder sensation causing episodes of incontinence due to reduced awareness of bladder fullness leading to little of no warning before feeling the urge to urinate
• Reduced ability to fully empty the bladder because of weakened bladder muscles for those with severe and/or longstanding diabetes
• Increased risk of UTIs due to residual (or leftover) urine in the bladder. In severe cases, this may lead to “overflow incontinence” due to the bladders inability to contract. It may also lead to increased frequency and urgency of urination.

The same neuropathy that can lead to a neurogenic bladder can affect mobility and dexterity, indirectly leading to functional incontinence as decreased mobility and /or pain with movement creates difficulty in getting to the bathroom quickly enough.

Several studies have shown that a high body mass index (BMI) and obesity are strong risk factors for stress and mixed incontinence. It is estimated for every 5-unit increase in BMI there is an associated increased risk of up to 50% in incontinence prevalence. At the same time, Type 2 diabetes, which accounts for up to 90% of all diabetes cases, is strongly linked to weight gain and a higher body mass index creating a strong correlation between the two conditions.

Increases in weight cause additional stress to be placed on the pelvic floor muscles and higher intra-abdominal pressure leading to chronic strain, stretching and weakening of the nerves and muscles of the pelvic region. These weakened muscles and nerves are directly related to changes in bladder function and an increased likelihood of stress incontinence which is the leaking of small amounts of urine during activities such as coughing, sneezing and exercise.

A less well-known fact about diabetes, particular type 1, is that the condition interferes with the immune system, putting individuals at a greater risk of infection. The combination of declining immunity and poor bladder emptying (due to nerve damage) puts people at a greater risk of urinary tract infections (UTIs). A common sign of a UTI, is urinary incontinence along with the frequent urge to urinate among other symptoms.

Additional factors that increase the risk of individuals living with diabetes developing incontinence range from medication to childbirth. It has been proven that some medications used to control diabetes can cause urinary leaks and loose bowel actions, while constipation which affects nearly 60% of those living with diabetes can reduce the ability to fully empty the bladder. In addition, diabetic women have an increased likelihood of giving birth to larger babies often leading to injuries to their perineum and bladder during childbirth.