Diabetes involves problems with blood sugar control and causes a range of symptoms. A common symptom is urinary incontinence, which can lead to leaking urine and an overwhelming urge to pee.

With diabetes, a person is unable to control their blood glucose levels. This typically relates to insulin, which is a hormone that allows cells to draw glucose from the blood and use it for energy.

Type 2 diabetes mellitus (T2DM) typically occurs due to insulin resistance. This is when the body does not respond enough to insulin to reduce blood glucose levels.

The raised glucose can cause a range of damaging effects on the body, including an increased risk of heart disease and stroke, vision problems, nerve issues, and also urinary incontinence.

Urinary incontinence describes frequent urges to pass urine or leaking urine during daily activities. People with urinary incontinence may pass urine without feeling an urge, wet the bed, or not reach a toilet in time.

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Diabetes can cause urinary incontinence. According to a small 2019 study, 15.4% of 123 males with poorly controlled T2DM experienced moderately severe urinary incontinence.

The National Association for Continence estimates that 40% of females with diabetes have incontinence and that preventing T2DM might prevent roughly half of all severe incontinence cases in females.

According to the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK), people with T2DM may experience a feeling of needing to pee regularly and urgently, including at night, and leaking urine.

T2DM can contribute to incontinence in four main ways:

Nerve damage

Around 60% of those with diabetes experience some degree of nerve damage. This is known as diabetic neuropathy. This can include damage to the nerves that control the bowel and bladder. If a person is unable to control blood glucose levels, this can lead to the following effects:

  • overflow incontinence
  • not being able to empty the bladder completely
  • needing to pee often
  • needing to pee more than once during the night
  • feeling an overwhelming urge to pee

Another effect of uncontrolled blood glucose is overactive bladder, which refers to increased urinary urgency, frequency, and tendency to pass urine during the night. Overactive bladder was twice as common in people with T2DM as in the general population, according to a 2017 study.

Overweight and obesity

According to a 2023 review, obesity accounts for 44% of all T2DM diagnoses. Obesity can lead to increased pressure on the pelvic floor and bladder, which can reduce a person’s ability to control urine.

In a 2020 study of females from Palestine, those with a body mass index (BMI) of 30 or higher had a risk of urinary incontinence that was 1.5 times as high as those who had a BMI under 30.

Reduced immune activity

Diabetes can reduce the effectiveness of a person’s immune system. This is because high blood sugar levels can add additional stress that weakens the immune system.

Along with reducing the ability to clear the bladder of urine, this can increase a person’s risk of urinary tract infections (UTIs). People with UTIs may feel pain and experience an overwhelming urge to pass urine that sets in suddenly.

Increased risk of constipation

A 2022 study suggests that 11% to 56% of those living with diabetes had constipation. This might occur due to nerve damage. Additionally, some diabetes medications, such as opioids and anticholinergics, may slow the speed at which food travels through the gut.

According to the United Kingdom’s National Health Service (NHS), constipation can lead to both urge and overflow incontinence. Overflow incontinence occurs when a blockage prevents a person from completely emptying the bladder. Constipation can trigger this by leaving stools to take up too much space in the gastrointestinal (GI) tract.

Urge incontinence may lead to the detrusor muscles contracting too often. These are muscles in the wall of the bladder that relax to let the bladder fill up and contract to empty it. Constipation can cause detrusor muscles to contract too often.

People who experience the following may wish to consult a doctor about the cause of their urinary incontinence:

  • frequent, overwhelming urges to pee during the day or night
  • involuntarily urination while laughing, coughing, or having sex
  • pain while peeing

A doctor may ask about how often a person drinks fluids such as alcohol or caffeine. They might also recommend keeping a bladder diary to track:

  • the types and amount of fluid a person consumes
  • how often a person pees
  • how much pee they produce
  • how often a person experiences incontinence
  • how many times they feel the urge to pee

The doctor will test blood glucose for people with known diabetes, use blood and urine tests to rule out other conditions, and test for UTIs. They might also carry out urodynamic testing to measure the pressure, volume, and flow of urine.

Treating diabetic urinary incontinence largely involves controlling diabetes. However, treatments are available to restore bladder control, reduce urges, and limit overflow incontinence. This might include certain medications and devices, depending on symptoms.

Medications might include:

  • anticholinergics
  • beta-3 agonists
  • tricyclic antidepressants
  • botulinum toxin A (Botox) injections directly into the bladder

The use of devices and medical procedures may depend on which type of incontinence a person has:

  • People with overflow incontinence may need a catheter. This involves emptying the bladder through a tube.
  • Females with stress incontinence, or leaking, may benefit from a pessary or a newer tampon-like device. The individual inserts this into the vagina, where it pushes against the wall of the urethra to reduce leaking.
  • A healthcare professional may inject a paste or gel known as a bulking agent into the urinary sphincter. This closes the bladder opening and reduces leaking.
  • Electrical nerve stimulation uses electrical pulses to alter the bladder’s stimulation.

Surgery might also be necessary to:

  • remove a blockage
  • insert materials to strengthen the vagina and urethra in females
  • implant an artificial urinary sphincter in males
  • enlarge the bladder

People can take several steps to manage urinary incontinence, including:

  • Controlling blood glucose and cholesterol: Good blood glucose, cholesterol, and pressure control with T2DM can reduce can reduce the risk of urinary incontinence.
  • Timing fluid consumption: A healthcare professional may recommend drinking less fluid throughout the day. They may also advise how much to drink and when. Stopping drinking several hours before going to sleep may help prevent night-time urination. A person should only change drinking habits on a physician’s advice.
  • Managing body weight: People with obesity and who have diabetic urinary incontinence should discuss weight management measures with a physician. Managing obesity can reduce leaks. This might also involve being more physically active.
  • Eating a diet that reduces constipation risk: Eating more fiber can help reduce constipation. Discuss consuming more fluids with a physician. If medications for urinary incontinence, such as anticholinergics, are making constipation worse, discuss changing to an alternative.

Pelvic floor muscle exercises can also help strengthen the pelvic floor muscles. Using exercises such as Kegels may help an individual retain bladder control and reduce leaks.

Some products can also help reduce the impact of urinary incontinence on daily life, including:

  • washable, waterproof incontinence underwear
  • adult incontinence briefs
  • disposable pads
  • large disposable pads for protecting chairs and furniture
  • skin cleaners and creams to help prevent urethra irritation and clean the skin
  • urine deodorizing tablets

Type 2 diabetes can lead to urinary incontinence. This can be due to nerve damage around the bladder. Other possible causes can include obesity, constipation, and a higher risk of UTIs.

Tips to manage and prevent urinary incontinence typically involve controlling blood sugar levels. This can include strategies such as making dietary changes and exercising. In some cases, a doctor may be able to recommend medications, devices, surgeries, and incontinence products to reduce the burden of incontinence on daily living.