Urological problems usually affect men and women in old age, appear earlier with diabetes. These include urinary bladder problems and urinary tract infections (UTI). While the former is equally present in both sexes, UTI is more prevalent in women.
Bladder problems: Diabetes is amongst the leading causes of damage to nerves controlling the bladder function. Another associated cause is infections. Studies revealed that more than 50 per cent of men and women with diabetes have bladder dysfunctions. Bladder dysfunction can deeply impact a person’s confidence and the quality of life.
The physiology of urination: Our two kidneys excrete water and waste products from blood in the form of urine. The urinary bladder is the receptacle of urine and receives the same from the kidneys through two ureters, one from each kidney. The capacity of an adult urinary bladder is about 600 – 700 ml. The bladder wall is made up of muscles, called Detrusor, which can stretch to accommodate urine and can contract during voiding. The outlet pipe, called the urethra, has sphincters or muscles that keep the outlet closed until voiding is attempted. The urethral sphincters are under volitional control. When sufficient urine is collected in the bladder, the desire to urinate occurs and if situation permits, signal from the brain goes to the sphincters to relax. The detrusor muscles are supplied by involuntary nerves that give signal for contraction and voiding takes place. It is highly integrated action of the brain, voluntary [somatic] nerves and involuntary [autonomic] nerves.
Overactive bladder: Because of the damage to the nerves in diabetes, bladder receives signals at wrong and unwarranted times, causing the bladder muscles to squeeze.
- Sudden, strong need or urgency to urinate.
- Increased frequency of urination up to eight or more times a day or three or more times at night.
- Urinary incontinence, in which there is an involuntary leakage of urine following a sudden, strong urge to urinate. The same may happen due to the insufficient control of sphincter muscles of the bladder.
However, if the nerves to the sphincter muscles are damaged as in the case of diabetes, the sphincter muscles become loose and cause leakage, as it happens in an infant.
Urine retention: On the other hand, nerve damage may also prevent the sphincter muscles or bladder muscles from getting the message for urinating. In such a case, the bladder is not emptied completely and there can be a back flow or back build-up of urine and the same can damage kidneys.
Urinary tract infections: Urinary tract infections may occur due to a host of other reasons in addition to the aforementioned, including from bacteria reaching urinary tract. It is important to treat a UTI without delay since left untreated it may reach kidneys causing pyelonephritis, an infection of the kidneys.
At times the UTIs become chronic and recurring. The infection can get localized in urethra or bladder (cystitis) before traveling up the kidneys.
- Burning sensation while passing urine.
- Increased urge to urinate and frequent urination.
- While women experience heaviness or pressure on the top of the pubic bone, men experience the same in the rectum.
- Pain in the loins or side and fever in case of kidney infection.
- Diagnosis of UTI is usually made from the presence of bacteria and pus cells in the urine routine sample and subsequent culture. An ultrasound, intravenous pyelogram and cystoscopy may be necessary in many cases.
How to prevent diabetic neuropathy and the associated sexual and urological problems related to diabetes
- Efficient blood glucose control
- Personal hygiene
- Shed those extra kilos and avoid being overweight
- Quit smoking
- Exercise regularly & avoiding sedentary lifestyles
- Manage diabetes through diet control as advised by the dietician and your diabetologist
Patients with the above symptoms need certain investigations to find the cause of bladder dysfunction. These include urine examination for any infection, Ultrasonography of kidneys and urinary bladder and Urodynamic Study. Urinary tract infections are treated with antibiotic treatment specific to the kind of bacteria in the urine after the urine culture. UTIs which reach kidneys require long-term antibiotic courses for treatment. Keep yourself well hydrated.
Problem of urine retention due to damage to bladder nerves is treated with medication for improving bladder emptying. Your doctor will advise you on ‘timed voiding’ wherein you are encouraged to urinate after regular intervals to increase proper urination and to treat urinary urgency as well. At times, catheter is inserted into the bladder through the urethra to flush out the urine. Similarly, in case of loose sphincter muscles resulting in urinary leakage, medications or Kegel exercises can strengthen the muscles. At times, the problem has to be rectified by surgery.
For any support required, visit our nearest Apollo Hospital today for proper diagnosis.