Diabetic Neurogenic Bladder And Urinary Incontinence
photo credit: SCA Svenska Cellulosa Aktiebolaget
Urinary incontinence is a common condition that is characterized by the leakage of urine or loss of bladder control in both male and female patients. Urinary incontinence is although a common affliction but patients find it to be very embarrassing. Most patients will not even discuss this diabetic complication with their doctor and chalk it up to aging when, infact, it is not a normal part of aging.
Patients with diabetes are at a higher risk for developing incontinence of urine. Years of high blood sugar levels causes neurological damage to the nerves that are responsible for sensing fullness in the bladder. The nerves that control bladder emptying are usually unaffected by diabetic neuropathy. Over time, abnormal glucose levels will continue to damage these nerves leading to leakage of urine, overactive bladder and sometimes an inability to completely empty the bladder. Although you may feel embarrassed and alone, this is not an uncommon problem among diabetic patients. It is estimated that approximately 6.5% of women with diabetes have some form of urinary incontinence.
Types of Urinary Incontinence
- Stress Urinary Incontinence: This type of urinary incontinence frequently affects women who have previously given birth. Stress urinary incontinence occurs because the urethral sphincter is unable to fully close when placed under stress by actions such as sneezing, coughing, lifting or laughing.
- Urge Urinary Incontinence: Urge urinary incontinence is often called overactive bladder because the muscle that controls bladder emptying will spasm causing sudden, intense urges to use the bathroom and leakage of urine.
- Overflow Urinary Incontinence: This type of urinary incontinence occurs when the nerves of the bladder cannot sense that it is full. This leads to overfilling of the bladder and constant leakage of urine. Overflow incontinence is often seen in patients with diabetes.
What Is Neurogenic Bladder?
Overflow urinary incontinence is associated with a condition called neurogenic bladder, which is a well-known complication of diabetes mellitus. Neurogenic bladder refers to the progressive loss of sensation and control of the bladder. This occurs when high blood glucose levels cause damage to the nerves that supply these areas of the bladder. Neurogenic bladder is one type of autonomic diabetic neuropathy but it affects less than 1% of patients with diabetic neuropathy.
Neurogenic Bladder Symptoms
The symptoms of neurogenic bladder include:
- Urine Leakage
- Incomplete Bladder Emptying
- Weak Urine Stream
- Less Frequent Urination
It is very important that all patients with diabetes report any symptoms of urinary incontinence to their doctor. It is possible to treat this condition and through improved sugar control, as reflected in the a1c blood test, patients may be able to slow the progression of neuropathies.
Treatment of Urinary Incontinence and Neurogenic Bladder
Lifestyle Modification
- Set a Schedule: It is best to try to manage overactive bladder with natural remedies that are as simple as setting a toileting schedule. Most people urinate 6-8 times per day. Patients with urinary incontinence should talk to their doctor about setting a schedule to help improve their quality of life.
- Drink Fluids: Patients with urinary incontinence will often avoid drinking to limit bathroom trips and accidents. This is not healthy of patients with diabetes because it places extra stress on the kidneys, which are already stressed by high blood sugar and are at risk for diabetic nephropathy. In addition, less fluid intake can actually irritate the bladder and cause muscle spasm and urine leakage.
- Avoid Triggers: Certain foods and substances can irritate the bladder. Avoid artificial sweeteners, caffeine and alcohol. Spicy foods and acidic foods can also worsen your symptoms.
- Bladder Retraining for Urinary Urge Incontinence: Bladder retraining is another overactive bladder natural rememdy that reduces dribbling of urine using routine, scheduled urination. The goal of this therapy is to retrain the bladder muscles to prevent urine leakage and muscle spasms. Typically, scheduled bathroom breaks are frequent and then gradually the duration between trips is extended as the bladder is retrained.
- Pelvic Floor (Kegel) Exercises for Urinary Stress Incontinence: Pelvic floor exercises are inexpensive, easy and can be done throughout the day. These exercises a natural way to combat overactive bladder, neurogenic bladder and to help prevent urinary stress incontinence in women.
- Catherization: For patients with neurogenic bladder that results in urinary retention (inability to completely empty the bladder) occasional catherization may be necessary to fully remove urine from the bladder and to prevent urinary tract infections. Although this is invasive, this neurogenic bladder treatment is necessary to limit the risk of recurrent urinary tract infections. Urinary tract infections can be very serious in patients with diabetes because high sugars can weaken the immune system and delay healing.
Medications
Patients with urge urinary incontinence may find relief with medications that reduce the “over activity” of the bladder. These types of medications include:
- Ditropan (oxybutynin)
- Detrol (tolterodine)
- Enablex (darifenacin)
- Toviaz (festerodine)
- Vesicare (solifenacin)
Women with stress incontinence may find relief from their symptoms with medications that contain pseudoephedrine or estrogen replacement therapy may be beneficial.
Surgery
Surgical procedures should be reserved for patients who fail all other methods of controlling urinary incontinence. There are several different procedures that differ depending on structural abnormalities, nerve damage and the patient’s symptoms.
If you suffer from an overactive bladder it is important to discuss your symptoms with your doctor. It is not necessary to live with these symptoms because, often, these problems are correctable. Patients with diabetes need to be vigilant with their diabetic diets, finger stick monitoring and daily medications to prevent diabetic complications, like neurogenic bladder, diabetic neuropathy and erectile dysfunction, due to high blood sugar levels.
