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Diabetes

People with diabetes commonly experience problems with controlling their bladder and bowel. This can involve accidental leakage, incomplete emptying, passing urine frequently (frequency) or feeling the need to rush to the toilet (urgency).

Common causes of incontinence

There are four main ways that diabetes may cause problems with bladder and bowel control:

Obesity: This is a key factor in people developing Type 2 (non-insulin dependant) diabetes and  it is also a major risk factor for developing incontinence.  The pelvic floor muscles support most of your body weight.  Any excess weight further strains these muscles, weakening them.  Weak pelvic floor muscles do not support the bladder and bowel as it should.  If this happens you may notice leakage when coughing and sneezing (also known as stress incontinence) or the need to frequently or urgently visit the toilet.
 
Nerve damage: Poorly controlled or 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 loss of sensation so there may be little warning of needing to go to the toilet or lack of awareness of the bladder filling.  The bladder and bowel may 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 (UTI).  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.  In addition personal hygiene is particularly important and all women should wipe from front to back to avoid transferring bowel bacteria to the vagina.  Cranberry juice (drink or capsules) may help prevent urinary tract infections
 
Medication - the medications used to control Type 2diabetes may cause loose bowel actions (diarrhoea).  The combination of weak pelvic floor muscles and loose bowel actions may cause bowel incontinence. If these problems are experienced talk to the doctor or diabetes nurse or dietician.  Soluble fibre can help firm up the diarrhoea and slow down the bowel motions.  Sources of soluble fibre are oats, barley, rye, peeled fruit and vegetables.

Prevention

Keeping your diabetes well-controlled is the best way to prevent nerve damage or further damage happening.

There are five things you can do to 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 often have constipation, see your doctor.
  • Drink well: 1.5 – 2 litres of fluid each day to prevent bladder irritation and constipation, unless otherwise advised by your doctor. Drinking extra fluids is recommended in hot weather or when exercising. Spread your drinks evenly throughout the day. Water is best. Limit caffeine, alcohol and fizzy drink as they may cause bladder irritation. Always have an extra drink of water following these drinks.  
  • Exercise regularly: Keep moving. Aim to exercise for 30 minutes most days. Remember that walking is great exercise. Keep your pelvic floor muscles strong with a pelvic floor exercise program.    These are muscles that gives 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 or open you bowels, 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.
  • Practice good toilet habits: 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.

For more information, download the Diabetes and bladder and bowel control fact sheet.

Phone National Continence Helpline 1800 33 00 66 – continence nurse advisors provide information about bowel and bladder function, products and local continence clinics.

Visit Diabetes Australia website or phone the Diabetes Infoline on 1300 136 588