DIABETES AND INCONTINENCE
There are four main ways that diabetes can cause problems with a person's bladder and bowel control:
Weight
This is a key factor in people developing Type 2 (non-insulin dependent) diabetes and is also a major risk factor for developing incontinence. The pelvic floor muscles support most of your body weight and any excess weight puts further strain these muscles, weakening them. Weak pelvic floor muscles do not support the bladder and bowel as they should. If this happens you may notice leakage when coughing and sneezing (known as stress incontinence) or the need to frequently or urgently visit the toilet (known as urge incontinence).
Nerve damage
Long-term diabetes may cause damage to the nerves (neuropathy) and commonly occurs in the feet. Similarly, it may affect the bladder and bowel. Nerve damage to the bladder and bowel causes a loss of sensation so there may be lack of awareness of the bladder filling. The bladder and bowel may also not empty well, increasing the risk of developing urinary tract infections, kidney damage, or constipation.
Reduced immunity
Diabetes interferes with the immune system increasing the risk to infections. A common infection experienced by people with diabetes is urinary tract infection. It is the combination of the immune system changes and the poor bladder emptying that causes these infections and often they keep reoccurring. Treatment includes antibiotics and strategies to promote bladder emptying.
Medication
The medications used to control Type 2 diabetes may cause loose bowel actions (diarrhoea). The combination of weak pelvic floor muscles and loose bowel actions may cause faecal incontinence. If these problems are experienced, talk to your family doctor, diabetes nurse or dietitian. Soluble fibre (oats, barley, rye, peeled fruit and vegetables) can help firm up the diarrhoea and slow down the bowel motions.
MANAGEMENT
Keeping your diabetes under control can help incontinence symptoms. There are a number of lifestyle changes that can help you regain control of your bladder or bowel:
Eat well
A healthy diet rich in dietary fibre to avoid constipation. We need at least 30gm of fibre each day. Eat at least 2‐3 serves of fruit, 5 serves of vegetables and 5 serves of cereals and breads. It is important to get the balance right as just adding fibre to your diet without increasing your fluids can cause or make constipation worse. If you continue to have constipation, see your doctor.
Drink well
Drink adequate fluids to quench your thirst. Speak to your doctor about how much fluid intake is right for you. Water is the best fluid as this can help stop bladder irritation and improve bowel function (which can affect bladder control). Be aware that recommended fluid intake varies with hotter weather, more exercise and other health conditions.
Get moving
Aim to exercise for 30 minutes most days. Remember that walking is great exercise.
Keep your pelvic floor muscles strong
Your pelvic floor muscles give you control over your bladder and bowel. Squeeze and draw up your pelvic floor muscles to control the urgency to go to the toilet. When you feel the urge to pass urine (wee) or open your bowels (poo), stop, stand still or sit down on a firm seat. Squeeze and draw up your pelvic floor muscles. Think about something else rather than the urge. The urge should diminish or go away at this point so you can get to the toilet without rushing.
Go to the toilet when your bladder feels full or when you get the urge to open your bowels. Do not get into the habit of going ‘just in case’. Take time to completely empty your bladder and bowel. To get into the correct sitting position on the toilet: sit on the toilet, elbows on knees, lean forward and support your feet on a footstool. To avoid kidney damage, if you think your bladder is not emptying completely talk to your doctor or diabetes nurse.
SEEK HELP
In many cases incontinence can be prevented, better managed and even cured. Talk to your doctor or contact the National Continence Helpline on 1800 33 00 66.
The National Continence Helpline is staffed by Nurse Continence Specialists who offer free and confidential information, advice and support. They also provide a wide range of continence-related resources and referrals to local services.