Monday, November 9, 2009

Is Diabetes and Urinary Incontinence Related?

Diabetes Mellitus, the condition where the body is resistant to insulin, leading to elevated blood sugars, is a common condition that can lead to many detrimental health issues such as heart disease and stroke. Often, if diabetes is poorly controlled, patients will notice they have more urine, and urinate more frequently. The extra sugar in the blood spills into the urine through the kidneys and draws more water into the urine, increasing urinary volume.

This is a somewhat oversimplified look at diabetes, but diabetes can lead to muscle and nerve deterioration of the pelvic organs as well. This I will discuss further below.

Ask yourself, what can happen if you’re constantly making more urinate and have to void every hour? Well, drip, drip, gush sometimes. Controlling diabetes is one very simple and reversible way to treat urinary incontinence.

The number of people with diabetes is rising worldwide, which itself is contributed by increasing obesity rates and an aging population. As an aside, obesity and aging are themselves correlated to urinary incontinence rates as well. I posted a blog entry not too long ago, that weight reduction by 18 lbs showed a significant reduction in urinary incontinence. Aging, simply put, is unavoidable and many women will experience urinary incontinence, whether stress related (exercise-induced) or urge related (overactive bladder), and often times both together.
Women with urinary incontinence are known to experience social or sexual isolation, whether from friends, lovers, or even self-imposed. This adds to psychosocial stress and diminished quality of life. It is important when evaluating diabetes to include all co-morbid conditions that can be associated with it, when eye, kidney, heart or bladder related.

It is believed that the same damage that diabetes causes to small blood vessels and nerves that leads to poor circulation and numbness, also occurs with the bladder and urethral sphincter. I’m sure most of us have a relative with diabetes with “bad feet”. They can’t feel their toes, or they have bad circulation with foot, pain, or non-healing ulcers. Similarly, poor blood flow and nerve injury can lead to incontinence. Bladder muscle injury and bladder nerve injury can lead to overactive bladder. A “numb” bladder may not sense it’s full till it’s “too late”, leading to urge incontinence. Bladder muscle can lose its elasticity and not fill all the way, leading to frequent urges. Poor muscle function may lead to incomplete bladder emptying (that is not perceived due to nerve injury), leading to the constant sense of urge. Incomplete bladder emptying and bad sugar control are ripe conditions for recurrent urinary tract infections.

Poor muscle function or nerve injury of the urethral sphincter can lead to stress incontinence, but diabetes can lead to obesity which itself is a risk for stress incontinence anyway.
A recent large study from Turkey compared groups of women with and without diabetes and found a 2.5 fold increased risk of urinary incontinence with diabetes. Age and BMI were also weakly related to incontinence as well. Among diabetics, 41% had urinary incontinence, while only 22% of non-diabetics had urinary incontinence. This is an astounding set of figures. Other researchers suggest that nearly 50% of severe incontinence could be avoided by preventing diabetes. Where does this lead us? Lifestyle changes, diet regimen and exercise are all important interventions. Since diabetes is an independent risk factor for urinary incontinence, all diabetics should be questioned about it for overall health promotion.

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