Urinary Incontinence

One of the little discussed complications of diabetes is urinary incontinence. Some people wake multiple times during the night to use the bathroom, disrupting their sleep; still others stop doing things they love like travel, or exercise because of fear of losing bladder control.

Though incontinence isn’t life threatening like many diabetes complications, it can easily affect a person’s quality of life through emotional stress, embarrassment, social isolation and even depression. As one sufferer put it, “Incontinence doesn’t kill you; it just takes your life away.”

As many as 13 million Americans experience the involuntary loss of urine. Women with diabetes have up to a 70% greater risk of developing urinary incontinence. Diabetes is also associated with an earlier onset and increased severity of incontinence. It’s believed that incontinence is actually more prevalent than complications commonly associated with diabetes, such as retinopathy and neuropathy though studies as yet don’t bear that out.

Urinary incontinence with diabetes is a progressive condition, encompassing a variety of symptoms including: urgency (or a strong pressure to urinate), frequent daytime and nighttime urination, and involuntary loss of urine.

Doctors are still trying to figure out the reasons for the level of incontinence for people with diabetes. But neuropathy is certainly responsible for incontinence in some individuals. Neuropathy can damage the nerves to the bladder resulting in an inability for an individual to recognize when their bladder is full or to successfully control their bladder.

High blood sugar levels can also increase in the amount of urine produced in an attempt to flush out excess sugar, resulting in urgency, frequent urination, and possibly incontinence. So, as with most diabetic complications, good glucose control helps to avoid problems.

Finally, people who are overweight may also suffer from incontinence due to increased pressure on the bladder which can create a feeling of urgency; but extra weight may also obstruct urine flow and keep individuals from fully emptying their bladder.

The best defense is a good offense. The best way to treat diabetes related incontinence is to treat your diabetes. Ask your doctor what you can do to control your blood sugar levels.

Of course, diabetes is not the only cause of urinary incontinence. Some commonly used substances and drugs such as alcohol, diuretics, caffeine and some antidepressants can also trigger incontinence or exacerbate existing symptoms.

Types of Urinary Incontinence

Urge Incontinence. This is the sudden loss of large amounts of urine after a strong, unexpected urge. It can occur anytime of the day or night, including during sleep. Often, urge incontinence can be set off by everyday events such as drinking water, hearing water run, or even stress. Diabetic nerve damage can give the patient almost no warning that they need to urinate.

Overactive Bladder. Overactive Bladder causes frequent, urgent urination and can be the result of damaged nerves in the bladder. The damaged nerves will send out the wrong signals, resulting in the bladder muscles squeezing too often and sometimes without warning. Those who suffer from an overactive bladder don’t necessarily experience leakage, like those with urge incontinence, but this is not uncommon.

Functional Incontinence. Functional Incontinence is the inability to make it to the restroom in time due to physical disability such as peripheral arterial disease, diabetic neuropathy or amputation—all of which severely limit mobility.

Overflow Incontinence. Overflow incontinence occurs when the bladder doesn’t empty fully during urination, causing the excess urine to leak. Overflow incontinence is more common in men than women. Long term diabetics or people with Multiple Sclerosis often have weakened bladder muscles, resulting in the inability to fully empty their bladder. Some diabetes medications such as Calcium Channel Blockers are also known to weaken the bladder.

Stress Incontinence. Stress incontinence is the loss of small amounts of urine when laughing, coughing or sneezing which put stress on the bladder. Stress incontinence often occurs in women after childbirth. Diabetes treatments such as ACE inhibitors are known to cause coughing, which may increase the frequency of stress incontinence.

Mixed incontinence. It is possible to have a combination of urge and stress incontinence symptoms. This condition is called mixed incontinence. Often one or another of the types will predominate.

Dealing with Incontinence on a Daily Basis

An estimated $25 to $36 billion is spent every year on medical and personal care costs associated with incontinence, from doctor evaluations and treatments to extra loads of laundry.

You can begin dealing with the issue by using absorbent underwear, pads, shields and/or protective bed pads to absorb the urine. One of the problems with pads, shields and disposable incontinence products are that they add to our landfill problem.

DDF has evaluated the Wearever line of re-usable incontinence underwear and they look and feel like traditional underwear, but offer absorbent protection that works as well as or better than the alternative, adult diapers. The line’s innovative Unique-dri™ sewn-in pad features a three-layer design: the top layer lets liquid in; the middle layer moves liquid out to the edges of the fabric, wicking it away so it doesn’t pool and helping to resist bacteria growth and odor; and the urethane bottom layer prevents leak through so that the moisture is contained within. Wearever makes these products with absorbency levels to suit users’ needs, including light, moderate and heavy absorbency. Wearever

Change soiled underwear, pads and linens immediately to prevent skin injuries, preserve dignity and avoid odor.

Make sure you wash with soap and water and dry completely after each incontinent episode. Barrier cream may also be used on the skin to form a protective coating and prevent further skin irritation.

Keeping Incontinence under Control

Don’t ignore the problem! 80% of people who seek treatment make major improvements. But, less than 50% of incontinence sufferers seek any sort of professional medical help. It’s a good idea to consult your doctor to find the best incontinence control strategy for you.

When you notice your incontinence problem, begin keeping a diary that includes: how often you urinate, the times and circumstances when you had leakage, and what you drink during the day. This information can be helpful as a management tool for you and your health-care provider.

Next, discuss your incontinence with your primary physician or health-care provider. Ask about the treatments they can offer for incontinence, and ask whether you should see a specialist.

The initial evaluation may be as simple as answering some questions about incontinence (that diary will be helpful here) and having a urine test to check for a bladder infection. For women, doctors may perform a pelvic exam to check for pelvic muscle strength and signs of the pelvic organs being out of place, which can cause stress incontinence.

Some of the options for treating incontinence include behavioral treatments, drug therapy, devices, and, as a last resort, surgery. Losing excess weight can also help restore continence, although other methods are often prescribed simultaneously since a weight-loss program can take some time to show results.

Behavioral treatments

Behavioral treatments are effective for most types of incontinence, and have no harmful side effects. These can include pelvic muscle exercises, urge suppression techniques, and/or bladder retraining.

Urge suppression is a technique for managing sudden urgency and regaining control when the need to urinate is mounting. It involves remaining still, tightening and relaxing the pelvic floor muscles rapidly several times, breathing deeply, and using a distraction such as making lists or humming a song until the urge to urinate wanes.

Bladder retraining uses timed visits to the toilet to relearn normal bladder function. For example, a person might visit the bathroom every hour and a half and ignore (or suppress) the urge to urinate or any leakage which may occur in that time frame. As the individual gets used to waiting, they increase the bathroom intervals by half-hour blocks until they can urinate at a comfortable interval. As the time between trips to the bathroom is increased, bladder capacity improves and leaking accidents are reduced.

It’s okay to try some of these techniques on your own and you may get additional information on these techniques here. If things don’t improve be sure to talk with your doctor about other treatments.

Drug therapy

There are several different drugs approved for the treatment of overactive bladder, which block the chemicals that act on bladder nerves and decrease bladder contractions. These drugs which can provide relief have side effects that include dry mouth and constipation. It’s also often necessary to go through a process of trial and error to find the drug and dose that works best.

Other treatments

There are other treatments available, including injections, devices that can be inserted into women’s pelvic regions and surgery for stress incontinence, but they should only be considered once simpler treatments have failed.

Urinary incontinence more common than you think; chronic, and costly. A wide variety of treatment and coping options are available that can help improve quality of life. Diabetes is bad enough; don’t let urinary incontinence keep you from the activities you enjoy.

Sources

Ashmi M. Doshi, Stephen K. Van Den Eeden, Michelle Y. Morrill, Michael Schembri, David H. Thom, and Jeanette S. Brown, Women with Diabetes: Understanding Urinary Incontinence and Help Seeking Behavior for the Reproductive Risks for Incontinence Study at Kaiser (RRISK) Research Group

Brown, MD, Jeanette S. and and Janis Luft, NP, MSN Urinary Incontinence Diabetes Self-Management 2006

Yerkes, BSN, MPH Adeline M. Urinary Incontinence in Individuals With Diabetes Mellitus, Diabetes Spectrum Volume 11 Number 4, 1998, Pages 241-247

Health Central

National Institute of Health

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)

Simon Foundation for Continence