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How Does Diabetes Affect My Pelvic Floor?

Hi friends! November is American Diabetes Month. In the United States, 34 million people have diabetes mellitus—that’s one in every ten people! (CDC, 2020). Another 88 million people have prediabetes and may develop diabetes (CDC, 2020). This week, we’re going to talk about how diabetes affects the pelvic floor and urinary incontinence.


Diabetes is a chronic health condition that affects how your body takes food and uses it for energy. As food is digested, it is broken down into sugar that is released into your blood and then either used or stored in your cells. With diabetes, the body has trouble managing the amount of sugar in your blood. When your blood sugar is too high, this can affect all the cells in your body. When poorly managed, diabetes often causes serious health problems like heart disease, vision loss, and kidney disease (CDC, 2020).


How does diabetes affect the pelvic floor? Diabetes has a direct impact on urinary incontinence and the pelvic floor muscles which can lead to overactive bladder and urinary incontinence (Barbosa, 2020; Smith, 2006). In fact, individuals with diabetes during pregnancy (gestational diabetes mellitus) were more likely to have urinary incontinence during pregnancy and up to 2 years postpartum than those individuals that did not have diabetes in pregnancy (Barbosa, 2020).


Because diabetes impacts all the cells in the body, there are several different ways that it can contribute to urinary incontinence and pelvic floor dysfunction:


  • When blood sugar is high, the body creates more urine resulting in more frequent urination (Smith, 2006). This habit of peeing more often can lead to overactivity of the bladder muscle called the detrusor (Smith, 2006). Learn more about overactive bladder and urge urinary incontinence here.

  • Diabetic neuropathy often affects the legs, but it can affect the urinary system, too. The bladder can start to lose the sensation that it is filing up, leading to the muscle being overstretched. Overtime this may cause a weak urinary stream, dribbling, incomplete bladder emptying, and frequent urination (Smith, 2006).

  • Constipation affects 60% of individuals with diabetes, and we know that constipation can contribute to urinary incontinence (Smith, 2006). Chronic straining with constipation can lead to other pelvic floor disorders like pelvic organ prolapse.


  • Medications, like diuretics or “water pills,” that are given for diabetes and related conditions may also increase the amount of urine the body produces, therefore increasing the risk of urinary incontinence and frequent urination (Smith, 2006).


How can we treat diabetes-related urinary incontinence and pelvic floor dysfunction? One study found that pelvic floor muscle exercises and 12 weeks of exercise training were effective for prevention and treatment of urinary incontinence (Barbosa, 2020). Training the pelvic floor muscles to do the right thing at the right time can help to treat incontinence and constipation. Strengthening the pelvic floor muscles can help with symptoms of pelvic organ prolapse and urinary incontinence.


Watch the video below for a 5 minute pelvic floor workout with Jeanice. As always, it’s important to see a healthcare provider for evaluation and treatment.



A pelvic floor physical therapist is a great resource to help improve symptoms of pelvic floor dysfunction. Ask your healthcare provider for a referral to a pelvic therapist, or find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.


Although, we cannot reverse some of the changes from diabetes, training the pelvic floor muscles to work optimally can help with symptoms of urinary incontinence, prolapse, and constipation.


Eating well and staying active can help to manage blood sugar to prevent further complications. A pelvic physical therapist can help to guide you in safe and effective exercises, while a registered dietitian can be a great resource for a healthy diet.


Here are some other great resources to help you manage urinary incontinence and pelvic floor dysfunction:

For providers, check our online courses to help your clients with urinary frequency and incontinence. Consider joining our Ambassador Program and most of our courses are included with your membership!


Written by Emily Reul, PT, DPT


References

1. Barbosa AMP et al. Effectiveness of pelvic floor muscle training on muscular dysfunction and pregnancy specific urinary incontinence in pregnant women with gestational diabetes mellitus: a systematic review protocol. PLoS One. 2020;7(12):e0241962.

2. National Diabetes Statistics Report, 2020. Centers for Disease Control and Prevention. Updated August 28, 2020. Accessed November 11, 2021. https://www.cdc.gov/diabetes/data/statistics-report/index.html

3. Smith DB. Urinary incontinence and diabetes: a review. J Wound Ostomy Continence Nurs. 2006;33(6):619-623.

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