Some diabetes complications are more dangerous, but few are more annoying than diabetic bladder. You can’t pee when you want to, or you go when you don’t want to, or both. What causes diabetes bladder symptoms, and what can we do to prevent and manage them?
Bladder problems are among the most common and least talked about diabetes symptoms. Maybe they’re embarrassing to talk about, but they can make you miserable and cause worse problems, such as kidney infections.
A study by Saeid Golbidi and Ismail Laher of the University of British Columbia found that 55% of people with diabetes have hyperactive “detrusor” muscles, the muscles that push urine out, while 23% have underactive detrusors that won’t empty the bladder completely. Either way, you are set up for incontinence and for urinary tract infection.
Many of these problems come from nerve damage. You need a lot of healthy nerves for normal bladder function. Nerves to sense fullness, nerves to tell muscles to start pushing, nerves to close sphincters and to open sphincters. All these nerves need to be working and working together. This is difficult, which is one of the reasons toilet training is such a big project for kids.
Writing in Diabetes Self-Management, urologist Bradley W. Anderson, MD, said, “Common [symptoms of diabetic bladder] include frequent urination, incontinence, difficulty starting a urinary stream, urinary tract infections, and sensations of needing to urinate urgently. The underlying problem is that neuropathy (nerve damage) causes the bladder to lose the ability to sense when it is full, just as neuropathy in the feet can interfere with a person’s ability to sense pressure or pain.”
At first, that feels good. You don’t have to go to the bathroom as much. A healthy bladder usually signals “full” with about 300 cubic centimeters (cc), or roughly 10 ounces, of urine. Diabetic nerve damage may let bladders swell to 600 cc or more without feeling full.
So there’s a honeymoon effect with that, but the bladder stretching weakens the detrusor muscles. Over time, it becomes harder to urinate at all. People with diabetic (or “neurogenic,” meaning caused by nerve damage) bladder often end up spending hours a day trying to urinate.
According to Dr. Anderson, because the bladder doesn’t empty well, it fills up again quickly, causing frequent urination. “If a bladder is not emptying regularly, it can become so full that it overcomes the sphincter muscle and just ‘overflows,’ resulting in incontinence.” This is called “overflow incontinence.” Incontinence caused by an overactive bladder is called “urge incontinence.”
I have had both kinds. I’ve been living with a neurogenic bladder for 30 years because of multiple sclerosis (MS). On a good day, I might urinate every hour in the day and every three hours at night.
What can you do?
There are ways to prevent diabetic bladder and to manage it, often the same ways. Here are some:
• Urinate regularly, whether you feel a need or not. Every two hours is often suggested. According to an article on our site, this helps keep the bladder from stretching too far. “Sometimes it is helpful to push against the bladder to determine whether it is full as well as to start the flow of urine.”
• Drink a proper amount of fluids. Six to eight glasses of water a day are often suggested. According to Medscape, “Trying to prevent incontinence by restricting fluids excessively may lead to bladder irritation and actually worsen urge incontinence.”
• Avoid constipation. The rectum and the bladder are right next to each other. Having hard stool in the rectum can press on the bladder, making it hard to hold urine and hard to push it out. Eat more fiber, do more walking, and take a laxative if necessary.
• Watch for infection. Diabetic bladders can easily be infected, because urine sits there stagnant instead of flowing through. Watch for cloudy or bloody urine, increased burning, and fever. If you get any of those symptoms, call your doctor. Taking cranberry capsules every day can reduce the risk of infection.
• If you have an overactive bladder, stay away from spicy foods; orange, grapefruit, and other citrus fruits; and caffeine.
• Other ways to push urine out: Cross one foot over the other knee to squeeze the bladder. Dip your hand in water or run water to relax the sphincter muscles.
• Some drugs may help. Bethanechol strengthens detrusor muscles. Terazosin (Hytrin) and doxazosin (Cardura) can relax the urinary sphincter to allow it to open.
• Maintain good glucose control. Since all these problems come from sugar damage to nerves, the better your glucose control, the fewer problems you are likely to have.
• Self-catheterizing. If you can’t urinate adequately, sometimes it’s worth inserting a catheter when your bladder needs to be emptied, and removing it afterward. “This may seem intimidating,” says Dr. Anderson, “but it is usually easier than feared… People new to self-catheterization may also worry about contracting an infection, but there is less risk of infection with self-catheterization than there is with a full-time Foley catheter.”
Dr. Anderson says to catheterize every 3–4 hours during the day to train the bladder. Then you may be able to cut back. “As your bladder recovers,” he says, “you may be able to self-catheterize less frequently…you may be able to get down to a single catheterization at bedtime, then perhaps every other day, then once a week. In most people, the bladder eventually recovers, and catheterization can be eliminated entirely.”
You don’t need sterile technique, just clean technique. If you can’t do it yourself, you may have a family member or caregiver who can help you. Catheters can be reused, but that slightly increases the risk of infection. Insurance will usually pay for catheters if a doctor orders them and documents their necessity.
Please let us know what you do to maintain and improve your bladder function. People might benefit from knowing.