Urinary tract problems are common among people with type 2 diabetes, affecting everything from frequency and urgency of urination to sexual function to kidney health. The most significant causes include damage to nerves (autonomic neuropathy) that support the structures of the urinary tract and the effects of high levels of glucose (sugar) in the blood.
Because of differences in anatomy, the ways in which type 2 diabetes affects the urinary system can differ between men and women, but regardless of a person's sex, diabetes-related urinary tract problems can dramatically affect their quality of life on a daily basis.
What's more, the constellation of potential urinary tract complications linked to diabetes can be complicated. There can be a great deal of overlap among them in terms of causes and symptoms. One way to make sense of them is by grouping them into four categories: bladder dysfunction, urinary tract infections, sexual dysfunction, and kidney disease.
More than half of adults with type 2 diabetes have bladder problems. Studies have shown that the most common of these, which often are interrelated, are:1
- Overactive bladder: When bladder muscles spasm or contract even when they contain very little urine. This leads to urinary urgency—the feeling of needing to pee now.
- Polyuria: The excessive production of urine, generally more than 2.5 to 3.0 liters per day
- Nocturia: Waking up frequently during the night with the need to pee
- Incontinence: Leakage of urine
There are two common causes of bladder dysfunction due to diabetes. The first is nerve damage—not only of the bladder itself, but also of the urethral sphincter. This structure, composed of two muscles, opens and closes in order to allow urine to leave the bladder and flow into the urethra, the tube through which urine leaves the body. When this muscle isn't functioning properly, urine can leak out involuntarily.
Elevated blood sugar levels can be responsible for a cascade of problems that ultimately contribute to polyuria.2 When there's extra sugar in the blood, the body siphons fluid from tissues in the body to help remove it. The excess sugar is filtered by the kidneys, which pulls water with it into the urine, leading to polyuria.
Treatment options for bladder dysfunction include medication, bladder training methods such as timed voiding, electrical stimulation, Kegel exercises, and surgery. Another option, injections of Botox (onabotulinumtoxin A), which frequently are prescribed to treat overactive bladder in people with multiple sclerosis, have been found helpful for those with bladder problems due to diabetes. The drug has been approved for this use by the U.S. Food and Drug Administration (FDA).3
Urinary Tract Infections
Diabetes-related urinary tract infections (UTIs) can affect the urethra, bladder, or kidneys. Research shows these infections are more severe, more common, and have worse outcomes for people with type 2 diabetes.4 They also may be caused by bacteria that are especially resistant to treatment.
Symptoms of such infections include frequent urination, pain or burning with urination, and urine that is reddish or cloudy. Women may experience a sensation of pressure above the pubic bone. Men may feel fullness in the rectum. If the kidneys are involved, additional symptoms may occur, including nausea, back or side pain, and fever.https://human.biodigital.com/widgets/verywell?be=2fGI&s=female&camera=-31.026,89.287,5.631,0.307,91.048,5.748,-0.056,0.998,0&ui-fullscreen=false&ui-zoom=true&ui-share=false&ui-info=false&dk=4fe0224bd35a140d5939ab43b60fcaf6ca90e954 A urinary tract infection can cause painful urination.
Autonomic neuropathy can play a role in UTIs associated with diabetes. As explained by the American Diabetes Association, "Paralysis of the bladder is a common symptom of this type of neuropathy. When this happens, the nerves of the bladder no longer respond normally to pressure as the bladder fills with urine. As a result, urine stays in the bladder, leading to urinary tract infections."5
High blood sugar levels also can create a fertile breeding ground for bacteria and lead to urinary tract infections. To cure a UTI, a course of antibiotics is necessary.
The urinary tract and the organs and structures that support sexual performance and desire are intricately linked, and so when diabetes takes a toll on the former, the latter often are impacted as well. This is true for both sexes but in somewhat different ways.
These problems are related to damage to nerves and blood vessels that supply the reproductive organs and/or surrounding structures, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).6
Treatment for sexual dysfunction caused by type 2 diabetes will largely depend on the nature of the problem. For example, a woman who experiences pain during sex might get relief by using a lubricant, while a man struggling with erectile dysfunction may benefit from medication.
Kidney Disease (Diabetic Nephropathy)
Along with hypertension, diabetes is among the leading causes of chronic kidney disease (CKD). About one in four people with diabetes develop kidney disease, also called diabetic nephropathy.7
Diabetic nephropathy develops over a long period of time due to progressive damage to the functional structures of the kidney—the nephrons. There are more than a million nephrons in each kidney, each containing a cluster of blood vessels called glomeruli into which blood flows and is cleaned of waste and fluids. When the nephrons are unable to do this properly, the waste and fluids build up in the blood rather than leave the body.
CKD causes few (if any) obvious symptoms until it has progressed to the point of near kidney failure—a potentially fatal complication. According to the National Kidney Foundation, type 2 diabetes and high blood pressure are the leading causes of kidney failure in the United States.8
For this reason, it's vital for people with type 2 diabetes to undergo regular tests for signs of kidney dysfunction. The tests used are the ACR (albumin to creatinine ratio) and the GFR (glomerular filtration rate) tests.
ACR is a urine test to see how much albumin (a type of protein) is in your urine: High levels are an early sign of kidney damage. GFR is a measure of kidney function based on a blood test. Your GFR will determine which of the five stages of kidney disease you have.
Dealing with diabetic nephropathy starts with managing the disease that causes it. This includes controlling blood glucose and blood pressure, cutting back on dietary protein, and taking medication as prescribed by your healthcare provider.
In fact, taking these measures, as well as making other key lifestyle changes such as losing weight, increasing activity, and quitting smoking, can help to prevent and/or treat all urinary tract problems that may be caused by type 2 diabetes.