The loss of bladder control, or urinary incontinence, is an embarrassing problem that is more common than you might think. It can range anywhere from occasionally leaking a few drops when you sneeze or cough to the complete inability to control your bladder.

Urinary incontinence is not a disease, it is a symptom. So, if urinary incontinence affects your day to day activities or social interactions it is important you speak to your doctor, as it could indicate there is a more serious, underlying issue.

A check up by your doctor can help to figure out what is causing the incontinence and what can be done about it. The good news is, that for most people, some simple lifestyle changes or medications can stop the urinary incontinence, or at least provide you with more comfort.

Categories of urinary incontinence

Did you know there are actually six main categories of urinary incontinence in adults? They are:

1. Stress Incontinence – which occurs when you apply pressure on your bladder through coughing, sneezing, exercising, lifting something heavy or even laughing. If you have stress incontinence your pelvic floor muscles may be weak.
2. Urinary Retention – sometimes also referred to as overflow incontinence, is the result of a bladder that does not empty properly. If you have urinary retention you may experience frequent constant leaking of small amounts of urine.
3. Urge Incontinence – if you have a sudden, intense urge to urinate, followed by involuntary loss of urine, this is called urge incontinence. You may need to urinate often, both throughout the day and night, and may be caused by an infection or as a result of nerve damage caused by diabetes.
4. Functional Incontinence – if you have either a physical or mental impairment that keeps you from making it to the toilet on time. For example if you have severe arthritis and cannot unbutton your pants quickly enough.
5. Nocturia – is when you wake up during the night or main sleep time because you have to pass urine (wee). It is a common problem that becomes more common as we get older and is often associated with diabetes.
6. Mixed Incontinence – as the name suggests, mixed incontinence is a mixture of 2 or more of the above.

Your symptoms will help your doctor determine which type you have and this will guide treatment decisions.

Temporary versus persistent urinary incontinence

Certain drinks, foods and medications may stimulate the bladder by acting as a diuretic. This increases the volume of your urine and may cause temporary incontinence. This includes alcohol, carbonated or caffeine containing drinks. Foods high in spice, sugar or acid like chillies, citrus fruits and chocolate. Some diabetes, heart and blood pressure medications, muscle relaxants and high dose vitamin C may also have the same effect. Other causes of temporary urinary incontinence are urinary tract infections (UTIs) and constipation, as the straining to empty your bowels can weaken the pelvic floor muscles.

Urinary incontinence can also be more persistent if caused by an underlying physical problem or changes to your body, such as:

In women

• Hormonal changes and increased foetal weight during pregnancy
• Weakened muscles and damaged bladder nerves after childbirth
• A dropped or prolapsed pelvic floor
• Any surgery that involves the woman’s reproductive system, including hysterectomy (removal of the uterus)
• Hormonal changes such as in menopause

In men

• Prostate enlargement which can affect the normal flow or the urine
• Prostate cancer (either due to the cancer itself or due to side effects of the treatments.)

In both women and men

• Age-related changes, including decreased storage capacity and involuntary contractions of the bladder
• Obstruction, for example kidney stones or a tumour that is blocking the normal flow of urine
• Neurological disorders, such as Parkinson’s disease, multiple sclerosis, stroke, spinal injury, or a brain tumour

Risk factors

Gender: Women are more likely to have stress incontinence due to pregnancy, childbirth, or menopause and the female anatomy. Men with prostate gland problems are at increased risk of developing overflow or urge incontinence.

Age: As we get older the muscles in our bladder and urethra may lose some of their strength and your bladder cannot hold the same volume of urine. Hence, with age, there is an increased chance of involuntary loss of urine.

Family history: If a close family member has urge incontinence your risk of developing it is increased.

Being overweight: Extra weight increases pressure on the bladder and surrounding muscles, which can weaken them and can cause stress incontinence.

Smoking: Tobacco use may increase your risk of urinary incontinence (and other health issues).

Diabetes and involuntary urine loss

Having diabetes can increase your risk of developing urinary incontinence as hyperglycaemia (high blood glucose levels) can cause urge incontinence.  When blood glucose levels rise above 15 mmol/L your body will want to get rid of some of the excess glucose. One way it will try to do that is by making you pee out some of the excess. This will lead to more urine production and, if your bladder cannot hold it, you may develop incontinence.

Autonomic neuropathy, is nerve damage associated with long term diabetes. It affects the abdominal nerves, including those around the bladder, resulting in bladder issues. Medications in a group called the SGLT-2 inhibitors, such Jardiance and Forxiga, are designed to lower blood glucose by increasing urinary glucose output. Many people report urinating more each day on this type of medication. SGLT-2 inhibitors can also increase your risk of developing urinary tract infections, and these can, in turn, also increase the risk of developing urinary incontinence.

Many people with diabetes also have to take blood pressure or heart medications, and some of these can also have a diuretic effect, thereby increasing the risk of involuntary urine loss.

As always, do not stop taking any of your medications. If you have any concerns talk to your doctor or healthcare professional for advice.

Complications of urinary incontinence

• Chronic urinary incontinence can cause skin problems such as rashes, skin infections and sores due to constantly wet skin
• Incontinence increases the risk of repeated or recurrent UTIs
• Incontinence can affect your personal relationships, social interactions and work

Preventative measures

Although urinary incontinence is not always preventable, there are some things you can do to reduce your risk of developing it and these include:

• Avoiding bladder irritants such as caffeine, alcohol and acidic foods
• Increase your fibre intake to reduce the risk of constipation
• Don’t smoke or seek help to quit smoking (QuitLine: 13 7848)
• Maintain a healthy weight by following a healthy lifestyle
• Pelvic floor exercises
• Keep your blood glucose levels within your target range
• Talk to your doctor if you have any concerns or to request a referral to a continence advisor

For more information on urinary incontinence and diabetes visit www.continence.org.au or call the National Continence Helpline on 1800 330 066.

By Carolien Koreneff, CDE-RN, FADEA