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The Connection Between Diabetes and Incontinence 

Many of us have heard of the common complications associated with diabetes: heart disease eye problems, kidney disease and amputations, but did you know that diabetes can also lead to urinary incontinence?

Diabetes is the fastest growing chronic disease in Australia. Today alone, 280 Australians will develop diabetes - that’s one person every five minutes and in more than 1.7 million, women and children in total living with diabetes.

There is a known connection between diabetes and incontinence. In fact, studies have found that women with diabetes have up to a 70% greater risk of developing urinary incontinence than women without diabetes. Why is this and what can you do about it? 

Nerve Damage and Neurogenic Bladder

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.

The Risk of a High Body Mass Index

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 Weaker Immune System

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.

Other Risk Factors

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.

Prevention

Ultimately, managing your blood sugar levels and keeping diabetes well controlled is the greatest prevention of risk factors associated with incontinence. For those looking to regain control of their bladder or bowel additional lifestyle factors can help:

  1. Eat Well – to prevent constipation ensure you consume at least 30gm of fibre each day. This can be achieved through a well-balanced diet including 2-3 serves of fruit, 5 serves of vegetables and 5 serves of cereals or grains. Addition of a fibre supplement made from psyllium can also greatly benefit those struggling to get enough fibre into their daily diet. It’s important to note that with increased fibre you should also increase your water consumption, as too little water with a high fibre diet can actually make constipation worse. If you continue to experience regular constipation, see your doctor or healthcare practitioner for more advice.
  2. Drink Plenty – Contrary to what you might believe, drinking plenty of fluid each day can actually reduce your risk of incontinence. Aim for at least 1.5-2 litres of water spread throughout the day to prevent bladder irritation, infections and constipation (unless otherwise advised by our doctor). Make sure to limit caffeine, alcohol, sugary or fizzy drinks as these can irritate the bladder.
  3. Get Moving – Regular exercise not only helps with keeping your BMI under control but can assist with constipation. Walking is a great option and you should aim for at least 30 minutes of activity most days.
  4. Exercise Your Pelvic Floor – Diabetes can result in a weakened pelvic floor, daily exercises take just a few minutes and can assist in regaining strength. Speak to your doctor or visit the Continence Foundation to learn how to do these correctly.
  5. Practice Good Toilet Habits – Avoid the habit of going to the toilet ‘just in case’. Instead go when your bladder feels full or you have the urge to open your bowels and take the time to empty them completely. A great tip for this is to ensure you are in the correct sitting position - sit on the toilet leaning forward with your elbows on knees and your feet on a footstool to elevate your knees above your hip height.

As with all medical conditions, it is important to talk to your doctor or healthcare practitioner so they can correctly assess your risk factors and give you relevant medical advice.

 

References:

1) https://www.diabetesaustralia.com.au/diabetes-in-australia

2)  https://www.diabetesselfmanagement.com/managing-diabetes/.../urinary-incontinence/

3) http://simonfoundation.org/diabetes/

4) https://www.nafc.org/bhealth-blog/the-link-between-diabetes-and-neurogenic-bladder

5) https://www.incontinence.co.uk/diabetes-and-incontinence

6) https://www.news-medical.net/health/Obesity-and-Urinary-Incontinence.aspx

7) https://www.continence.org.au/news.php/454/diabetes-awareness

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