Diabetic cystopathy

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 6, 2016
StartDiseasesDiabetic cystopathy

Diabetes is one of the most common health issues in developed nations, and it occurs when the body can no longer balance blood sugar levels. Excessive amounts of glucose in the bloodstream (hypoglycemia) can be very damaging, so diabetes tends to cause many health problems. Diabetic cystopathy is one such condition that is very common among older diabetic patients with diabetes.

Contents

Definition & Facts

Diabetic cystopathy causes dysfunction in the lower urinary tract among patients who have diabetes. Roughly 32 to 45 percent of all elderly people who have diabetes mellitus type 1 or diabetes mellitus type 2 also suffer from diabetic cystopathy.

This type of cystopathy causes many issues with bladder function and health, so it can be very uncomfortable and unpleasant to deal with. Diabetic cystopathy causes symptoms that fall into the category of autonomic neuropathy, which are disorders or syndromes caused by damaged nerves responsible for bodily functions.

Symptoms & Complaints

There are a wide variety of urinary symptoms associated with diabetic cystopathy. In the early stages, diabetic cystopathy most often causes abnormal urinary frequency. Patients may not feel like they have to urinate for a while, and then they will suddenly be struck with an intense desire to urinate. These urges are often strong enough to wake a patient up and make them get up to go to the bathroom.

The primary symptom of diabetic cystopathy is urinary incontinence due to bladder overflow. This results in a weak urine stream, persistent dribbling, and occasional leaking.

People who have diabetic cystopathy tend to get urinary tract infections more often because they cannot properly empty their bladder. These infections cause abdominal pain, back pain, or pelvic pain, and people also tend to have bloody urine (hematuria) or cloudy urine that hurts when it is passed. If the urinary tract infection spreads into the kidneys, it can also cause high grade fevers, nausea, and vomiting.

Causes

The basic cause of diabetic cystopathy is having diabetes which tends to damage the central nervous system. Excessively high blood sugar levels cause inflammation and gradual damage to nerves throughout the body. This happens because all of the sugar in the bloodstream interferes with a nerve's capability to transmit signals, and the excessive levels of blood sugar also harm the capillaries that normally supply the nerves with oxygen-rich blood.

If the nerves near the bladder are harmed, the body cannot properly tell when the bladder is full. This makes it hard for patients with diabetic cystopathy to urinate regularly and promptly. Over time, all of the nerves and muscles used to control urination gradually worsen. When the bladder is constantly overfilled, urinary tract infections become more likely and it is harder for people to maintain continence.

This chronic degeneration tends to gradually increase the issues associated with diabetic cystopathy. Senior women have a particularly high risk of getting diabetic cystopathy if they have diabetes. This seems to occur because weakened pelvic muscles are already so common among older women. 

Diagnosis & Tests

When diagnosing diabetic cystopathy, there are three main signs that physicians look for. A person with diabetic cystopathy will have lowered bladder sensation, poor contractility, and increased levels of urine left in the bladder after voiding. To examine a patient for these hallmark issues, a doctor will conduct several tests.

Gynecological examinations and prostate examinations can be used to measure the muscle tone of the pelvic muscles needed to control urination. Patients are encouraged to keep a bladder diary that shows when they urinate, so doctors can compare this diary to regular urination habits. Residual urine amounts can be measured with either an ultrasound or a brief period of catheterization, and any amount of leftover urine above 50 mL is considered abnormal.

Normally, these tests are enough to diagnose diabetic cystopathy, but further urodynamic studies can be used to measure bladder function. Once it is determined that a patient is both diabetic and having issues with urinary dysfunction due to damaged nerves, they are diagnosed with diabetic cystopathy.

In rare cases, it may go undiagnosed for a while because the patient has not been diagnosed with diabetes. When this happens, a patient will have to go through the blood sugar tests for diabetes before being diagnosed.

Treatment & Therapy

A lot of the treatment strategies for dealing with diabetic cystopathy rely on managing diabetes symptoms. Patients who have diabetic cystopathy are encouraged to exercise regularly, lose weight until they reach a healthy weight, increase fiber in their diet, and eat foods with a low glycemic index. These methods of diabetes treatment seem to be better at controlling diabetic cystopathy than methods that just rely on insulin injections.

Lifestyle changes seem to be more helpful because they increase muscle tone and remove excess fat that can put pressure on the bladder. Lowering blood pressure by quitting smoking cigarettes or never starting to begin with and avoiding secondhand smoke will help reduce symptoms and complications of diabetes. Taking angiotensin converting enzyme (ACE) inhibitors can help reduce blood pressure and provide some relief from diabetic cystopathy.

To avoid worsening urinary retention or urinary tract infections, patients with diabetic cystopathy are advised to urinate every two to four hours even if they do not feel an urge to go. During bathroom trips, double voiding techniques, which require a person to urinate once and then attempt to go again, can help to fully empty the bladder. Practicing Kegel exercises and other exercises designed to strengthen the pelvic floor can help to reduce incontinence.

Prevention & Prophylaxis

The best preventative method is maintaining a healthy weight and eating healthy to avoid getting diabetes.

However, if a patient already has diabetes, it is still possible to reduce diabetic cystopathy risks. Nerves only get damaged from consistently high blood glucose levels, so monitoring and controlling blood sugar levels is very important. By managing diabetes symptoms, a person may be able to prevent complications such as diabetic cystopathy or prevent such complications from worsening.