About Incontinence - Contributing Factors - Diabetes
Medical Reviewer: Catherine DuBeau, M.D.
Type 2 diabetes can increase the risk and severity of both urinary and fecal incontinence.
Why?
There are several factors that link diabetes and incontinence:
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Diabetes is often related to obesity, and obesity can cause incontinence due to the increased weight placed on the muscles of the pelvic floor. Studies have shown that weight loss may reduce incontinence.
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Diabetes can affect nerve function, which can also affect the nerves in the bladder and bowel. Nerve damage may lead to several changes in bladder function:
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The most common occurrence is “bladder overactivity,” which can lead to urgency and urge incontinence.
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Decreased bladder sensation, leading to little to no warning before feeling the urge to urinate, which can lead to episodes of incontinence.
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In persons with severe and/or longstanding diabetes, the bladder muscle may become weak so that you don't completely empty the bladder with each urination. Residual (or leftover) urine in the bladder may lead to urinary tract infection. In severe cases, the bladder does not contract, causing "overflow incontinence.”
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When diabetes is not well controlled and blood sugars run very high, your body tries to get rid of the extra glucose by excreting it in the urine. This causes a large increase in the amount of urine produced.
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Constipation, which affects nearly 60% of persons with diabetes, can make it difficult to empty your bladder.
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Congestive heart failure (CHF) from diabetes-related coronary artery disease can cause your legs and feet to retain water, and can cause your body to create too much urine at night. This can lead to getting up many times at night to urinate, and can also lead to experiencing incontinence at night.
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Stroke from diabetes can affect bladder sensation and your ability to hold back from urinating. Additionally, mental impairment can make it difficult for the individual to toilet themselves (and when severely advanced, even toileting with assistance becomes difficult).
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Mobility challenges due to diabetic neuropathy, peripheral vascular disease, and amputation can prevent you from reaching a toilet, removing clothing, etc. “in time”, leading to episodes of leakage. This is called "functional incontinence."
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Some medications for the treatment of diabetes, or for the treatment of the complications of diabetes, can impair continence or complicate its treatment:
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Some medications may cause fluid retention in the legs and feet and congestive heart failure (CHF), thereby leading to an increased production of urine at night, and nighttime urinary incontinence.
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Some individuals may experience a cough from ACE inhibitors, which are frequently used in to treat high blood pressure in persons with diabetes. Such coughing can trigger stress urinary incontinence, or make it worse.
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Calcium channel blockers (CCBs) used for hypertension can make it difficult for the bladder to contract and empty completely, potentially leading to overflow incontinence. Some CCBs can cause swelling in the feet and constipation, also worsening incontinence (see above).
Prevention
The best way to prevent incontinence associated with diabetes is to: 1) prevent diabetes, and 2) work closely with your doctor to control blood sugar and treat any associated hypertension, high cholesterol, and obesity. For those diagnosed with prediabetes, Diabetes Prevention Programs focusing on diet and exercise can significantly reduce the occurrences of urinary incontinence. Studies find that overweight women who lower their risk of diabetes also lower their risk of incontinence.
Treatment and Management
The most important thing that persons with diabetes or prediabetes can do is tell your health care provider if you experience frequent or urgent urination, over-urinating at night, or incontinence. Studies show that people experiencing incontinence often don’t tell their doctor. In most cases, incontinence can be treated or at least managed comfortably. Everyone's body is different, so everyone responds to treatment and management techniques differently. You may want to discuss with your doctor trying some of the available options.
Important Note
Incontinence in persons with diabetes is not always related to the diabetes. The incontinence could be caused by completely separate factors.
Dr. Catherine E. DuBeau is an Associate Professor of Medicine in the Section of Geriatrics at the University of Chicago . She has been actively engaged in teaching, management, and research regarding urinary incontinence in older persons for nearly 15 years. Her research focuses on quality of life impact and patient-centered outcomes. She has published numerous articles and book chapters on urinary incontinence and benign prostate disease in such publications as the Journal of the American Geriatrics Society, Journal of Urology, American Geriatric Society (AGS) Geriatric Review Syllabus, Cassell et al's Geriatric Medicine, Oxford Textbook of Geriatric Medicine, the on-line textbook UpToDate, and Chapple et al’s upcoming Multidisciplinary Management of Female Pelvic Floor Dysfunction. She was a member of the Urinary Incontinence Technical Subgroup of the National Committee for Quality Assurance that developed the Health Plan Employer Data and Information Set (HEDIS) regarding urinary incontinence, and chaired the Evaluation Committee for developing the National Association for Continence (NAFC) Blueprint for Continence Care in Assisted Living. Dr. DuBeau most recently co-chaired the Frail Elderly Committee for the 2004 3rd International Consultation on Incontinence. She is a member of the Editorial Board of the Journal of the American Geriatrics Society, and in 2004 was awarded the AGS/NAFC Continence Care Champion Award. She is a dedicated teacher and lectures nationally and internationally on incontinence.
Page last modified 29 May 2011