Troublesome bladder symptoms and changes in sexual function (see Diabetes and Sex) are common health problems people encounter as they age. Having diabetes can mean early onset and increased severity of these problems.

Common bladder problems that occur more often in people with diabetes include:

* Overactive bladder
* Neurogenic bladder (bladder problems associated with nerve damage)
* Urinary tract infections (UTIs).

By keeping your diabetes under control, you can lower your risk of bladder problems.

Diabetes and Bladder Problems: Overactive Bladder

Bladder problems can have a profound effect on quality of life.

Diabetes can damage the nerves that control bladder function. Men and women with diabetes commonly have bladder symptoms that may include:

* A feeling of urinary urgency
* Frequency
* Getting up at night to urinate often
* Leakage of urine (incontinence).

These symptoms have been called overactive bladder (or urge incontinence).

Diabetes and Bladder Problems: Neurogenic Bladder
Less common, but more severe, bladder problems associated with diabetes include:

* Difficulty urinating
* Complete failure to empty (retention).

These symptoms can be caused by neurogenic bladder. Some evidence indicates that this problem occurs in both men and women with diabetes at earlier ages than in those without diabetes.

In neurogenic bladder, damage to the nerves that go to your bladder can cause it to release urine when you do not intend to urinate, resulting in leakage. Or, damage to nerves may prevent your bladder from releasing urine properly and it may be forced back into the kidneys, causing kidney damage or urinary tract infections.

Neurogenic bladder can be caused by:

* Diabetes or other diseases
* Accidents that damage the nerves
* Infections.

Symptoms of neurogenic bladder include:

* Urinary tract infections
* Loss of the urge to urinate when the bladder is full
* Leakage of urine
* Inability to empty the bladder.

To diagnose a neurogenic bladder, your doctor will check both your nervous system (your brain and the nerves of the bladder) and the bladder itself. Tests may include x-rays and an evaluation of bladder function (urodynamics).

Treatment for neurogenic bladder depends on the specific problem and its cause. If the main problem is retention of urine in the bladder, treatment may involve medication to promote better bladder emptying and behavioral changes to promote more efficient urination, called timed urination. Occasionally, people may need to periodically insert a thin tube called a catheter through the urethra into the bladder to drain the urine. Learning how to tell when the bladder is full and how to massage the lower abdomen to fully empty the bladder can help as well. If urinary leakage is the main problem, medications or surgery can help.

Diabetes and Bladder Problems: Urinary Tract Infections
Infections can occur in any part of the urinary tract. They are caused when bacteria, usually from the digestive system, reach the urinary tract. If bacteria are growing in the urethra, the infection is called urethritis. The bacteria may travel up the urinary tract and cause a bladder infection, called cystitis. An untreated infection may go farther into the body and cause pyelonephritis, a kidney infection. Some people have chronic or recurrent urinary tract infections.

Symptoms of urinary tract infections may include:

* A frequent urge to urinate
* Pain or burning in the bladder or urethra during urination
* Cloudy or reddish urine
* Fatigue or shakiness
* In women, pressure above the pubic bone
* In men, a feeling of fullness in the rectum.

If the infection is in your kidneys, you may:

* Be nauseous
* Feel pain in your back or side
* Have a fever.

Since frequent urination can be a sign of high blood glucose (high blood sugar), you and your doctor should also evaluate recent blood glucose monitoring results.

In order to make a urinary tract diagnosis, your doctor will ask for a urine sample, which will be analyzed for bacteria and pus. If you have frequent urinary tract infections, your doctor may order further tests. An ultrasound exam provides images from the echo patterns of sound waves bounced back from internal organs. An intravenous pyelogram (IVP) uses a special dye to enhance x-ray images of your urinary tract.

Another test, called a cystoscopy, allows the doctor to view the inside of the bladder.

Early diagnosis and urinary tract infection treatment are important to prevent more serious infections. To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic based on the bacteria in your urine.

Current recommendations are for a full seven-day course of antibiotic treatment in people with diabetes, instead of the shorter course used for other people. Kidney infections are more serious and may require several weeks of antibiotic treatment. Drinking plenty of fluids can help prevent another infection.

Will Diabetes and Bladder Problems Occur?
Diabetic neuropathy, including related bladder problems, appears to be more common in people who:

* Smoke
* Are overweight
* Are over the age of 40
* Have high blood pressure (hypertension)
* Have poor blood glucose control
* Have high cholesterol (hypercholesterolemia).

Preventing Bladder Problems Associated With Diabetes
Lower your risk of bladder problems by keeping your blood glucose, blood pressure, and cholesterol close to the target numbers your doctor recommends. Maintaining a healthy weight and being physically active can also help prevent long-term complications of diabetes.

Smoking is a risk factor associated with diabetes and bladder problems; quitting will improve your health in many ways. If you quit smoking, you can lower your risk not only for nerve damage, but also for kidney disease, heart attack, and stroke.