Is There A Connection Between Diabetes and Incontinence?

Author| Dr. Maureen O’Keefe, DPT pelvic floor specialist

Is there a connection between diabetes and incontinence?

At Purple Mountain PT, we are pelvic floor physical therapists and we help people overcome stress urinary incontinence and any other bladder control problem. Today, we share various details about the connection between diabetes and incontinence. Your blood glucose levels are crucial numbers to know. Just as you should know your blood pressure, you should know your blood glucose levels and be on the look-out for them being too high. We know there is a connection between diabetes and incontinence as well as other diabetic bladder dysfunction (DBD); in fact, up to 50% of diabetics experience DBD. If you are interested in learning more about our physical therapy, or if you have questions about cost and availability, reach out to us at (616) 516-4334 or contact us here. 

Type I diabetes, Type 2 diabetes and Prediabetes all have higher rates of incontinence. Diabetic bladder dysfunction (DBD) affects up to 50% of all diabetic patients and is well-known in the medical field. 

There have been numerous studies investigating if there is a connection between diabetes or prediabetes and urinary incontinence and the results have consistently shown that the answer to be yes. Diabetic bladder dysfunction is a condition with a broad range of symptoms. The temporal theory of diabetic bladder dysfunction has identified that problems with bladder function begin one way and as time passes and your diabetes advances, your bladder problems will change. In the early phases of diabetes, the bladder may experience urgency, frequency and urge incontinence. In later phases of diabetic bladder dysfunction, a person experiences a sluggish bladder, causing incomplete emptying, loss of an urge to urinate, difficulty voiding and possibly overflow incontinence (literally your bladder is so full, the urine just overflows). Our licensed physical therapists help people who experience any bladder symptoms across the spectrum of problems that diabetic bladder dysfunction causes. Feel free to reach out and ask questions about our services, call us at (616) 516-4334 or contact us here. 

Numerous papers have confirmed that incontinence rates are elevated in women with type 2 diabetes.

Type 1 diabetics and people with prediabetes also have higher rates of urinary incontinence. There is some research that suggests that weight loss may reduce incontinence in women with prediabetes. Also, as a pelvic PT, we know that weight loss helps most people who experience incontinence to reduce their unexpected loss of urine, even when you are non-diabetic. This is because excess weight in the abdomen or trunk places greater strain through the genitourinary system and renders it easier to lose control of urine. If you are struggling with fitness and weight, in part because of bladder control issues, and you also have diabetes or prediabetes, we can help you. Feel free to reach out and ask questions about our services, call us at (616) 516-4334 or contact us here. 

At Purple Mountain PT, we specialize in providing pelvic PT for all bladder function disorders, including diabetic bladder dysfunction, urinary incontinence and painful bladder syndrome

Our licensed physical therapists are specifically trained in rehabilitation for pelvic floor dysfunction, urinary incontinence bladder, bowel and intimacy related pelvic health problems. Our experience includes helping individuals who are prediabetic and diabetic overcome their bladder problems. By providing comprehensive and whole-body therapy to address urinary incontinence and pelvic floor dysfunction, we help you get control over your bladder again. Our post-doctoral training specific to bladder function, optimization and control helps individuals resolve urinary incontinence, neurogenic bladder, urgency and frequency, nocturia and interstitial cystitis (bladder pain syndrome), constant urinary urge, incomplete bladder emptying, post-prostatectomy incontinence and other bladder related disorders. If you would like to learn more about our therapy for people who experience diabetes or prediabetes and also have urinary incontinence or other bladder dysfunction, call us at (616) 516-4334 to have your questions answered or contact us here.

What You Can Do if you have Diabetes and Stress or Urge Urinary Incontinence

First, you must be working diligently on optimizing blood glucose levels. We can provide you recommendations on exercise and diet to help you and we also advise you to work with a dietician, functional medicine practitioner and your physician to get the right medical management in place.

Pelvic floor physical therapy is a proven method of resolving stress and urge urinary incontinence, including in people who are prediabetic or diabetic. In most cases, the cause of the incontinence is more than the diabetes and prediabetes. Our PT works to address all the causes that we commonly find in patients. This may include weak core, diastasis recti abdominis, pelvic organ prolapse, improper breathing patterns, deficient glutes and leg strength, pelvic floor weakness, pelvic floor stiffness, pelvic floor high tone or another pelvic floor dysfunction. Feel free to reach out and ask questions about our services, call us at (616) 516-4334 or contact us here. 

Stress Urinary Incontinence is Associated with Elevated Blood Glucose Levels

Stress Urinary Incontinence affects about half of all women. It may be surprising that it is associated with elevated blood glucose level, but if you think about how diabetes affects everything in your body, it should not be surprising. However, we want to point out that most of our patients who have stress incontinence are not diabetic or prediabetic; there are so many contributions to stress incontinence that have nothing to do with blood glucose. Feel free to reach out and ask questions about our services, call us at (616) 516-4334 or contact us here. 

In a 2022 study, completed by Ying, et al, they examined stress urinary incontinence rates in 10,771 women and also monitored their blood glucose. 

They found that people who experience weekly stress urinary incontinence had blood glucose levels that were consistently higher than the blood glucose levels of people who had less stress incontinence, experience it just monthly (not weekly).

The participants were divided into 3 groups, based on blood glucose:

*<86 mg/dl

*>86 to 98 mg/dl

*>98 mg/dl

What they found was the higher the blood glucose, the more prevalent stress incontinence was. 

In fact, the people in the group >98 mg/dl had a 15.2% higher risk of stress urinary incontinence (SUI) being present and also a 12.5% higher risk of the stress urinary incontinence happening more frequently than the people whose blood glucose was <86 mg/dl. This is one more reason to better manage your blood glucose levels. Exercise is one pathway to improving your blood glucose. The more muscle you have in your body, the better your blood glucose can be. Our licensed physical therapists can help you start and develop a safe, effective workout routine if you are diabetic or prediabetic and if you have any bladder issues, including incontinence. Feel free to reach out and ask questions about our services, call us at (616) 516-4334 or contact us here. 

Stress incontinence is the involuntary loss of urine when you laugh, cough, sneeze, jump or otherwise perform an action or movement that strains your bladder and causes unwanted leakage of urine. 

In women, stress incontinence is known to be multifactorial in nature, so don’t assume you have diabetes or prediabetes if you experience stress incontinence. Contributions to developing stress incontinence include:

• The anatomy of the bladder and urethra render it more difficult for women to generate force closure pressure to stop the involuntary loss of urine
• The urethral closure mechanism often is defective, even when your bladder (detrusor muscle) is not contracting. Thus, your bladder muscle may be appropriately quiet, but your urethra is open, instead of closed and you leak urine.
• The loss of support of the urethra or neuromuscular defects in the urethra are thought to contribute to stress incontinence.
• Pelvic floor dysfunction characterized by insufficient strength, length, timing and coordination of the pelvic floor muscles when necessary to stop the loss of urine.
• Diabetes and prediabetes are risk factors for developing stress urinary incontinence.
• Pregnancy and number of pregnancies is a risk factor for developing stress incontinence.
• Girth of your abdomen is a risk factor for developing incontinence.

If you have urinary incontinence and would like to get care from our licensed physical therapists who specialize in pelvic health and resolving urinary incontinence, we are here to help you. Feel free to reach out and ask questions about our services, call us at (616) 516-4334 or contact us here.

The connection between diabetes and incontinence is clear when you look at the rates of incontinence within the diabetic community.

Just a glance at the rates of incontinence within the diabetic community across 3 studies illustrates the point:

• 50.5% of women who were diabetic reported urinary incontinence.
• 38% of American women who have diabetes mellitus were found to have urinary incontinence.
• 28.8% of Norwegian women who are diabetic were found to also experience stress incontinence.

In diabetics, stress incontinence has a higher rate of problems than other types of incontinence (urge incontinence, for example). We also know that people can experience stress incontinence and have normal blood sugar levels. So, while there is a connection between diabetes and incontinence, you should not assume that if you are having incontinence, that you have elevated blood glucose levels. We work with people who have incontinence, whether you have diabetes or excellent blood sugar control. If you would like to ask questions about our services, call us at (616) 516-4334 or contact us here. 

23% of diabetics have reduced detrusor (bladder muscle) contractility, consistent with diabetic bladder dysfunction (DBD).

A person who experiences diabetic cystopathy has a gradual change in the urinary patterns and development of a decreased need to urinate. When the bladder muscle doesn’t contract and generate a signal that you need to urinate, you may go long hours without feeling an urge to urinate. When this is the case, a person may experience trouble starting their urinary stream or keeping the urine flowing to fully empty their bladder. The natural reflexes that should be occurring to allow for healthy urination are sluggish and urinary retention occurs. If a person is not emptying their bladder regularly, they may develop overflow urinary incontinence, another connection between diabetes and incontinence. If you are experiencing bladder control issues that you suspect are related to your prediabetes or diabetes, we are here to help you. Feel free to reach out and ask questions about our services, call us at (616) 516-4334 or contact us here. 

The Unique Risks that Women Experience Related to Blood Glucose

As women progress through perimenopause, their hormones change and insulin resistance tends to occur. Women who have PCOS are also found to have insulin resistance and high blood sugar. Unfortunately, diabetes effects women in ways that are truly dangerous.

How’s Your Glycemic Control? Ask your doctor for bloodwork

Worsening glycemic control is associated with an increased risk for stress incontinence for women with relatively controlled diabetes. For those either below the diagnostic threshold or with poorly controlled diabetes, the risk may be driven by other factors. Further prospective investigation of HbA1c as a modifiable risk factor may motivate measures to improve continence in women with diabetes.

-Quote from Wang, Rui BA et al Diabetes, Glycemic Control, and Urinary Incontinence in Women, Female Pelvic Medicine & Reconstructive Surgery: September/October 2015 – Volume 21 – Issue 5 – p 293-297

See your doctor and ask for blood work, at the minimum, for Hemoglobin A1C and fasting blood glucose.

This is the minimum blood work, because a comprehensive panel should also look into your triglycerides, cholesterol and fasting insulin. You may also benefit from labs to look into your female hormone levels and thyroid levels. We also recommend that you discuss your urinary incontinence with your medical provider, especially because there is a connection between diabetes and incontinence.

We also help people who experience pelvic pain, including diabetic neuropathy

At Purple Mountain PT we are known for helping individuals overcome complex pelvic pain conditions. We recognize that individuals who have diabetes or prediabetes may also experience chronic pelvic pain as a result of the changes that can occur in the nerves of the pelvis. Our licensed physical therapists have experience and training specific to rehabilitating the neuroanatomy of the abdomen and pelvis. We have written about our PT for pelvic pain here and welcome you to call us at (616) 516-4334 or contact us here for more information.

If You Are Interested in Improving Your Urinary Incontinence and Blood Glucose Levels, we are Here to Help!

Our licensed physical therapists have advanced training specific to exercise rehabilitation for urinary incontinence, blood glucose optimization and bone health. As pelvic floor physical therapists, we commonly help women overcome bladder control problems at all stages of their life. We know there is a connection between diabetes and incontinence. We also know there is a strong connection between bladder problems, including urinary incontinence and a weak core, pelvic floor muscle dysfunction, hip and gluteal deficiencies, improper breathing patterns, postural mal-alignment and more. If we can help you to build more muscle, to strengthen your entire core and to optimize your posture and breathing strategies, your incontinence and diabetes can both improve. We work in partnership with you to identify the numerous causes of your incontinence and help you to resolve these. If you are looking for expert help for your urinary incontinence, blood sugar control problems, bone health, back pain, hip pain or postpartum recovery, call us at (616) 516-4334 to get your questions answered or reach out to us here and we will be happy to connect!

Peace,

Dr. Maureen O’Keefe, DPT

Founder of Purple Mountain Physical Therapy. Specialist in pelvic floor dysfunction, voiding dysfunction, bowel disorders, pregnancy and postpartum recovery, intimacy pain, TM joint disorders, perimenopause and menopause health, bone health, neck, back and hip problems.

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Van Poppel, H., Stessens, R., Van Damme, B., Carton, H., and Baert, L. (1998). Diabetic cystopathy: neuropathological examination of urinary bladder biopsies. Eur. Urol. 15, 128–131

Wang, Rui BA; Lefevre, Roger MD; Hacker, Michele R. ScD, MSPH; Golen, Toni H. MD Diabetes, Glycemic Control, and Urinary Incontinence in Women, Female Pelvic Medicine & Reconstructive Surgery: September/October 2015 – Volume 21 – Issue 5 – p 293-297

Ying, Youyou BS^∗; Xu, Linlin BS^∗; Huang, Ruofei BS^∗; Chen, Tianxi BS^†; Wang, Xinghong BS^‡; Li, Ke BS^∗; Tang, Lixia BS^∗ Relationship Between Blood Glucose Level and Prevalence and Frequency of Stress Urinary Incontinence in Women, Female Pelvic Medicine & Reconstructive Surgery: May 2022 – Volume 28 – Issue 5 – p 304-310 doi: 10.1097/SPV.0000000000001112

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