Diabetes, especially when poorly controlled, can lead to neuropathy, which refers to the general malfunctions or diseases of the nerve. Excess glucose can inflame nerves and other tissues, which can cause nerve dysfunction, leading to the sensations of burning, stinging, numbness, tingling, and pain (in severe cases). It is the neuropathy of the bladder, otherwise known as neurogenic bladder, that makes the bladder dysfunctions. When the cause of the neurogenic bladder is specifically diabetes, it can also be called diabetic bladder.
The diabetic bladder can lead to urinary retention, which means the bladder cannot void completely. Diabetes has damaged the bladder nerves’ ability to signal when the bladder is full. Once the diabetic bladder develops to an advanced stage, bladder fullness is not sensed until the bladder if overfilled to two or three times its normal size.
Paradoxically, excess glucose in the blood leads to excessive thirst and urination, which make people urinate more frequently because they drink more fluid. Once nerve damage sets in, the sensation to void is diminished, causing the bladder to overfill with urine. The overfilling stretches the muscle in the bladder, which can weaken it leading to decreased contractility. Because the bladder doesn’t have enough strength to expel all the urine out, some urine is retained in the bladder. Retained urine increases the risk of infections, which are more common in people with diabetes in the first place.
Diabetes can cause external urethral sphincter dysfunction. The external urethral sphincters is a muscle that surrounds the urethra, keeping it shut so urine doesn’t leak out. Usually, when someone urinates, the external sphincter muscle relaxes, and when the person is done, the muscle contracts. But when the sphincter muscle’s control is damaged by diabetes, it can either fail to relax, causing urinary retention or fail to contract, causing the involuntary leakage of urine. Diabetes can also impair the relaxation of the internal urethral sphincter (urethral smooth muscle), which also affects the flow of urine out.
The bladder can also become overactive: the damaged nerves can send wrong signals to the bladder, making it squeeze and expel fluids without warning.
If the involuntary leakage of urine has caused the sleeping issues, one may consider using an incontinence pad at night.
The most common urodynamic findings (findings from tests that evaluate bladder function) in diabetic patients show impaired bladder sensation, increased residual urine after voiding, and decreased detrusor(bladder muscle) contractility. Many of the symptoms of diabetic bladder are the same as symptoms caused by diseases that are not diabetes.
The bladder diary helps you and your doctor keep track of and evaluate the fluids you’ve ingested and your urination pattern. Your doctor may ask you to keep a bladder diary to start an initial investigation into your bladder condition. You may also be asked to measure and write down the amount of urine retained after the attempt to void. The retained urine is known as post-void residuals (PVR), and a normal level of PVR has not been established. A suggested normal range in older adults is between 50 mL and 150 mL. PVR measurements are taken with an ultrasound immediately after voiding, or by using a catheter to drain and measure residuals.
Schedule your voiding (urination) every few hours and stick to it. You may want to discuss the time gap and frequency with your doctor. Help yourself stick to the schedule by setting reminders on your phone. If you have an overactive bladder as a result of diabetes, your doctor may recommend bladder training, which is also about sticking to a voiding schedule even when you feel the urge to urinate.
To double void, void once and then repeat in 10-15 minutes. This practice is to help you drain your bladder completely.
To help yourself void completely, you can push your fist/palm into your bladder, which is located in your pelvis, above and behind your pubic bone. Massage and push the urine out with a pressure you feel comfortable with. Do not apply excessive force to the point of discomfort.
You can do pelvic floor exercises to help yourself control urine flow. Both men and women benefit from the same exercises. Perform pelvic floor exercises daily a couple of times each day with 10 repetitions.
If your bladder dysfunction is specifically caused by diabetes’ damage to your nerves, then controlling diabetes can have a modest effect on improving your condition. Follow your doctor’s instructions on how to best deal with diabetes. Often times, having a well-balanced diet and taking up regular exercise are key to managing diabetes.
If you suffer from urinary retention as a result of diabetes, your doctor may prescribe intermittent catheters to help you empty your bladder completely. Chronic and untreated urinary retention can lead to frequent UTIs and kidney damage. If you suspect you have urinary retention, talk to your doctor to get a formal diagnosis.
If you are a catheter-user and are concerned about the risk of infection, look for a catheter that is non-touch. Non-touch means you don’t have to touch the tube of the catheter during self-catheterization. Touching the tube can introduce germs on your hands onto the catheter, which is then inserted into the urinary tract, causing an infection.
Hopefully, the above tips can help you get a better handle on your diabetic bladder. Please note that this article does not substitute medical advice from a doctor. Always consult a medical professional on what’s right for you.
CompactCath produces catheters that are compact, mess-free, non-touch, and pre-lubricated. They are discreetly designed, convenient, and perfect for those who lead an active life.
CompactCath is pocket-sized and convenient to use. It’s made out of high-quality PVC plastic that will not kink when coiled. CompactCath is FDA cleared in 2014, holds 6 patents, and two design awards.
We produce catheters that are compact, mess-free, non-touch, and pre-lubricated. They are discreetly designed, convenient, and perfect for those who lead an active life.
CompactCath® is designed at Stanford d.school. It is FDA-cleared in 2014, holds six patents, covered by CNN Money, won two grants (BioDesign Spectrum grant, LPCH Pediatric Innovation grant) and two iF product design awards (2016, 2017).