Urinary Problem of Women with Diabetes

Dr. Tony Bazi
Associate Professor of Obstetrics and Gynecology at AUB
Certified, American Board of Obstetrics and Gynecology
Certified subspecialty Female Pelvic Medicine and Reconstructive Surgery

A common and true belief is that diabetics produce more urine than non-diabetics, and consequently have to make more trips to the toilet. While this is true, especially with poor diabetes control, producing a lot of urine (polyuria) constitutes only one of many aspects of urinary problems in diabetics.

The bladder is a “reservoir” that stores urine produced by the kidneys, and expels the urine when appropriate, i.e. when ordered by the brain. The filtration of urine by the kidneys may be affected after longstanding diabetes, but this by itself is not related to the bladder problems as discussed below.

The function of the bladder itself may be affected in the following ways:

-          Frequency: going too often to the toilet, even when passing small amounts.

-          Urgency: sudden desire to pass urine that cannot be postponed.

-          Incontinence: involuntary loss of urine before reaching the toilet.

-          Nocturia: waking up at night because of the need to go to the toilet.

These symptoms (frequency, urgency, incontinence, nocturia) are collectively known as “overactive bladder”. Why does this happen? The affection of nerves that supply the bladder in both the sensation and the function may cause a hyper excitatory state so your bladder feels it is full. In addition, there could be delayed sensation so you may have a short warning time before you actually lose the urine.

What can be done? First, do not be tempted to avoid drinking water, you always need it. Second, go to the toilet regularly (for example every two hours during the daytime) before the full sensation; remember, the warning time is short. This by itself may improve your condition tremendously. Third, exercise your pelvic floor muscles by contracting them regularly.  Your doctor or physiotherapist should teach you how to do these (kegel exercises). A word of caution: do not perform these exercises during urination. To decrease the impact of nocturia, avoid eating late and minimize fluids before bedtime. This would prevent overfilling of the bladder when you are asleep. If you have varicose veins, stockings in the evening would help reduce the amount of urine manufactured after you lie down. Finally, there are some safe medications that can be taken either continuously or when needed (for example before going on trips or to long social events). Incidentally, make sure you do your “bathroom mapping”,as in you first locate the toilet in any public place you go to.

In addition to overactive balder, susceptibility to frequent bladder infections (cystitis) is common in diabetic patients. This is mostly due to decreased immunity. Symptoms of infections include pain during urination, intermittency and smelly urine. Antibiotics should be taken in these situations. When the symptoms go away, it is not necessary to repeat the urine test to demonstrate that the infection is gone.

It is important to note that one cannot attribute all bladder symptoms to diabetes. A woman may have stress incontinence (losing urine during cough or activity), uterine prolapse or bladder descent due to other factors, the most common of which is childbearing.

In conclusion, while there are many bladder problems peculiar to diabetics that can be efficiently identified and treated, the presence of diabetes should not pose an obstacle to treating other common bladder problems.

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