Bladder problems caused by diabetic autonomic neuropathy (nerve disease). The bladder stores urine produced by the kidneys. Ordinarily, once urine is collected in the bladder, the pressure on the inner wall of the bladder signals the urge to urinate. Urine flows out of the bladder through a narrow channel called the urethra, and this flow is controlled by a ring of muscles known as the urinary sphincter.
Various nerves are responsible for signaling the brain that we need to urinate, signaling the bladder to contract to force the urine out and controlling the tone of the urinary sphincter to allow us to urinate — and then stop urinating when we’re done. Diabetic autonomic neuropathy can damage any of these nerves, causing individuals to urinate less often, have difficulty completely emptying the bladder, have a weak stream of urine, have difficulty starting to urinate or have dripping afterward. In some cases, diabetic bladder can lead to urinary tract infections (UTIs).
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One complication of a diabetic bladder is infection of the bladder or urinary tract. Having urine in the bladder for a long time allows bacteria to gain a foothold in the urethra and possibly move into the bladder itself, especially if there is glucose in the urine. From there, the bacteria can also infect the rest of the urinary tract, including the kidneys. The symptoms of a bladder or UTI include frequent urination of only small amounts of urine, pain or burning when urinating, being unable to urinate despite feeling the urge, and cloudy or discolored urine. If you have signs of a UTI, call your health-care provider. Usually, antibiotics can clear up the problem.
People with diabetic bladder should drink plenty of fluids and go to the bathroom every two hours, whether they feel the need to go or not. Sometimes it is helpful to push against the bladder to determine whether it is full as well as to start the flow of urine.
Some drugs may help. Bethanechol increases the tone of the muscle that contracts to begin bladder emptying. Terazosin and doxazosin can relax the urinary sphincter to allow it to open and let urine pass through.
In some cases, people with tight urinary sphincters can be taught to catheterize themselves when they need to urinate. If all else fails, bladder neck surgery can be used to open up the inner urinary sphincter.
Want to learn more about UTIs and other bladder issues? Read “Resolving Diabetes-Related Bladder Problems,” “What You Need to Know About UTIs,” and “What Is Your Urine Trying to Tell You?”
A contributing editor at Diabetes Self-Management, Dinsmoor is an award-winning medical journalist who has written hundreds of articles on health and medicine, including dozens related to diabetes.
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