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Diabetes and urologic problems
Urologic problems that affect men and women with diabetes include bladder problems and urinary tract infections.
Many events or conditions can damage nerves that control bladder function, including diabetes and other diseases, injuries, and infections. More than half of men and women with diabetes have bladder dysfunction because of damage to nerves that control bladder function. Bladder dysfunction can have a profound effect on a person's quality of life. Common bladder problems in men and women with diabetes include the following:
Overactive bladder. Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. The symptoms of overactive bladder include
- urinary frequency - urination eight or more times a day or two or more times a night
- urinary urgency - the sudden, strong need to urinate immediately
- urge incontinence - leakage of urine that follows a sudden, strong urge to urinate
Poor control of sphincter muscles. Sphincter muscles surround the urethra - the tube that carries urine from the bladder to the outside of the body - and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage or stay tight when a person is trying to release urine.
Urine retention. For some people, nerve damage keeps their bladder muscles from getting the message that it is time to urinate or makes the muscles too weak to completely empty the bladder. If the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. If urine remains in the body too long, an infection can develop in the kidneys or bladder. Urine retention may also lead to overflow incontinence - leakage of urine when the bladder is full and does not empty properly.
Diagnosis of bladder problems
Diagnosis of bladder problems may involve checking both bladder function and the appearance of the bladder's interior. Tests may include x rays, urodynamic testing to evaluate bladder function, and cystoscopy, a test that uses a device called a cystoscope to view the inside of the bladder.
Treatment of bladder problems
Treatment of bladder problems due to nerve damage depends on the specific problem. If the main problem is urine retention, treatment may involve medication to promote better bladder emptying and a practice called timed voiding - urinating on a schedule - to promote more efficient urination. Sometimes people need to periodically insert a thin tube called a catheter through the urethra into the bladder to drain the urine. Learning how to tell when the bladder is full and how to massage the lower abdomen to fully empty the bladder can help as well. If urinary leakage is the main problem, medications, strengthening muscles with Kegel exercises, or surgery can help. Treatment for the urinary urgency and frequency of overactive bladder may involve medications, timed voiding, Kegel exercises, and surgery in some cases.
Urinary Tract Infections
Infections can occur when bacteria, usually from the digestive system, reach the urinary tract. If bacteria are growing in the urethra, the infection is called urethritis. The bacteria may travel up the urinary tract and cause a bladder infection, called cystitis. An untreated infection may go farther into the body and cause pyelonephritis, a kidney infection. Some people have chronic or recurrent urinary tract infections. Symptoms of urinary tract infections can include
- a frequent urge to urinate
- pain or burning in the bladder or urethra during urination
- cloudy or reddish urine
- in women, pressure above the pubic bone
- in men, a feeling of fullness in the rectum
If the infection is in the kidneys, a person may have nausea, feel pain in the back or side, and have a fever. Frequent urination can be a sign of high blood glucose, so results from recent blood glucose monitoring should be evaluated.
The health care provider will ask for a urine sample, which will be analyzed for bacteria and pus. Additional tests may be done if the patient has frequent urinary tract infections. An ultrasound exam provides images from the echo patterns of sound waves bounced back from internal organs. An intravenous pyelogram uses a special dye to enhance x-ray images of the urinary tract. Cystoscopy might be performed.
Early diagnosis and treatment are important to prevent more serious infections. To clear up a urinary tract infection, the health care provider will probably prescribe antibiotic treatment based on the type of bacteria in the urine. Kidney infections are more serious and may require several weeks of antibiotic treatment. Drinking plenty of fluids will help prevent another infection.