Dear Readers,

Sixty five-year-old Marlon S is a man who suffers from diabetes. More recently, he has had problems holding his urine and says he is suffering from a weak bladder.

He finds that he goes to urinate very often - as often as every five minutes. Another embarrassing problem that is occurring is that he is experiencing urinary urgency. When he feels the need to pass urine, he has to go immediately or risk wetting himself. This sometimes occurs in public. Because of this, Marlon has drastically decreased his intake of water to only two glasses per day. Marlon asks Lifeline to help him overcome his problem.

Diabetes and bladder problems are common health issues that increase in incidence, with advancing age. When diabetes is present, the person is more likely to experience an increase in the severity of bladder and kidney disease, which can result in bladder dysfunction, urinary tract infections, and sexual and erectile dysfunction in both men and women.

This can have a very negative effect on the quality of life. Statistics show that more than 50 per cent of men and women with diabetes experience bladder dysfunction as a progressive disorder, which includes many symptoms such as:

Urinary urgency

Urinary frequency

Passing urine with increased frequency at nights

Urinary incontinence

Straining to pass urine

Dribbling after finishing urination

Weak urinary stream.

Obesity has been also identified as a significant risk factor for urinary incontinence in diabetes, and weight loss is the best way to reduce the incidence of this problem.

Bladder dysfunction occurs secondary to loss of the nerves supplying the bladder, as well as poor detrusor muscle (bladder wall muscle) contractility. Older men also tend to have enlarged prostrates present, which will also contribute to the above symptoms.

Erectile dysfunction is also very common in diabetic men who may also experience a reduction in their libido, difficulty with reaching an orgasm, and retrograde ejaculation. Women with diabetes can also experience reduced sexual desire and painful intercourse.

In diabetics, urinary tract infections are associated with an increased risk of complications such as pyelonephritis and renal abscesses. A persistent bacteremia (bacteria in the urine) is also a problem experienced by diabetics. Diabetic women tend to experience more fungal genital infections than found in the regular non-diabetic females.

Bladder problems can go unsuspected for months, and even years, in a diabetic before suddenly manifesting symptoms. Because of the diabetic nerve injury to the bladder, it tends to become stretched with urine to a much greater extent before pain or discomfort is experienced. When bladder problems are identified early, they can be treated before permanent injury occurs.

People with diabetes should become educated about the neurogenic bladder. Nerve damage causes the bladder to lose its sense of being full. Because it can no longer sense when it is full, the bladder tends to become distended with urine. The bladder stretches and gradually loses its tone and becomes stretched out of shape. Over time, the bladder muscles lose tone and strength. This loss of tone causes the bladder to retain urine after passing urine. When this occurs, the person is susceptible to urine infections.

TREATMENT

In order to prevent a urinary infection in diabetics, the bladder must be emptied often and completely, which will allow it to regain its normal function over time. This is usually possible, but requires time, effort and patience. At times, catheterisation (tube in the bladder) is necessary for a few days, to ensure full voiding of urine and encourage recovery of intrinsic bladder-wall function.

Another recommendation is to double void. That is, to void urine, then return 15 minutes later - after every voiding occurs - and attempt to pass more urine. In the diabetic, more urine will be passed on the second time. This is post-residual urine and voiding it keeps the bladder and kidneys healthier. Women can also practice pelvic wall muscle training (Kegel's exercises) and take medications to help reduce the symptoms, as well as schedule surgical correction.

People with a diabetic bladder should, in fact, drink plenty of water and visit the bathroom every two hours on a schedule, whether they feel the need to go or not. Sometimes applying pressure to the lower abdomen helps initiate urine flow and ensure more complete bladder emptying.

Drugs such as Hytrin (Terazocin), and Cardura (doxazocin) relax the urinary sphincter and allow the urine to pass more freely.

Write to:

LIFELINE,

P O Box 1731,

Kgn 8.

AJM