Diabetes & Urologic Problems

Bladder dysfunction can have a profound effect on quality of life. Diabetes can damage the nerves that control bladder function. Men and women with diabetes commonly have bladder symptoms that may include a feeling of urinary urgency, frequency, getting up at night to urinate often, or leakage of urine (incontinence). These symptoms have been called overactive bladder. Less common but more severe bladder symptoms include difficulty urinating and complete failure to empty (retention). These symptoms are called a neurogenic bladder. Some evidence indicates that this problem occurs in both men and women with diabetes at earlier ages than in those without diabetes.

Neurogenic Bladder

In neurogenic bladder, damage to the nerves that go to your bladder can cause it to release urine when you do not intend to urinate, resulting in leakage. Or damage to nerves may prevent your bladder from releasing urine properly and it may be forced back into the kidneys, causing kidney damage or urinary tract infections.

Diabetes or other diseases, accidents that damage the nerves, or infections, can cause neurogenic bladder.

Symptoms of neurogenic bladder include

• urinary tract infections

• loss of the urge to urinate when the bladder is full

• leakage of urine

• inability to empty the bladder

Your doctor will check both your nervous system (your brain and the nerves of the bladder) and the bladder itself. Tests may include x rays and an evaluation of bladder function (urodynamics).

Treatment for neurogenic bladder depends on the specific problem and its cause. If the main problem is retention of urine in the bladder, treatment may involve medication to promote better bladder emptying and behavior changes to promote more efficient urination, called timed urination. Occasionally, people may need to periodically insert a thin tube called a catheter through the urethra into the bladder to drain the urine. Learning how to tell when the bladder is full and how to massage the lower abdomen to fully empty the bladder can help as well. If urinary leakage is the main problem, medications or surgery can help.

Urinary Tract Infections

Infections can occur in any part of the urinary tract. They are caused when bacteria, usually from the digestive system, reach the urinary tract. If bacteria are growing in the urethra, the infection is called urethritis. The bacteria may travel up the urinary tract and cause a bladder infection, called cystitis. An untreated infection may go farther into the body and cause pyelonephritis, a kidney infection. Some people have chronic or recurrent urinary tract infections.

Symptoms of urinary tract infections may include

• a frequent urge to urinate

• pain or burning in the bladder or urethra during urination

• cloudy or reddish urine

• fatigue or shakiness

• in women, pressure above the pubic bone

• in men, a feeling of fullness in the rectum

If the infection is in your kidneys, you may be nauseous, feel pain in your back or side, and have a fever. Since frequent urination can be a sign of high blood glucose, you and your doctor should also evaluate recent blood glucose monitoring results.

Your doctor will ask for a urine sample, which will be analyzed for bacteria and pus. If you have frequent urinary tract infections, your doctor may order further tests. An ultrasound exam provides images from the echo patterns of soundwaves bounced back from internal organs. An intravenous pyelogram (IVP) uses a special dye to enhance x-ray images of your urinary tract. Another test, called cystoscopy, allows the doctor to view the inside of the bladder.

Early diagnosis and treatment are important to prevent more serious infections. To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic based on the bacteria in your urine. Current recommendations are for a full 7-day course of antibiotic treatment in people with diabetes, instead of the shorter course used for other people. Kidney infections are more serious and may require several weeks of antibiotic treatment. Drinking plenty of fluids will help prevent another infection.

Will I Experience Sexual and Urologic Problems Sooner or Later?

Risk factors are conditions that increase your chances of getting a particular disease. The more risk factors you have, the greater your chances of developing that disease or condition. Diabetic neuropathy, including related sexual and urologic problems, appears to be more common in people who

• have poor blood glucose control

• have high levels of blood cholesterol

• have high blood pressure

• are overweight

• are over the age of 40

• smoke

What Can I do to Prevent Diabetes Related Sexual and Urologic Problems?

You can lower your risk of sexual and urologic problems by keeping your blood glucose, blood pressure, and cholesterol close to the target numbers your doctor recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. Smoking is a particular problem, and quitting will improve your health in many ways. For example, if you quit smoking, you can lower your risk not only for nerve damage but also for heart attack, stroke, and kidney disease.

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