DR SATYENDRA PERSAUD
DIABETES is a disease in which there is too much sugar in the blood. In normal people, insulin is secreted from the pancreas, an organ in the tummy, to help move sugar you eat into the cell where it is used as fuel. In diabetics, there isn’t enough insulin or the insulin doesn’t work well at the cellular level to use up the glucose. This leads to the blood sugar being very high. This excess glucose can harm multiple organs in the body. We all know of someone who has lost a leg (or two) to diabetes or who has lost vision but what is not commonly discussed is the effect of diabetes on urinary and sexual health which may be life-altering. This is especially important in a time when we are seeing an increase in non-communicable diseases such as diabetes.
Diabetes can cause sexual dysfunction in both men and women. Understandably, it may be more difficult to diagnose in women but may include decreased desire as well as problems with orgasm and arousal. In men, in addition to decreased desire, erectile dysfunction (ED) is a major issue. The nerve and blood vessel damage caused by diabetes leads to an inability to have erections and this is usually seen after several years of high blood sugars. Some men may find benefit with ED medications. Others with more serious disease may have to consider penile injections or even an artificial implant.
Bladder dysfunction and urinary symptoms
Around half of all patients have some degree of bladder problems. There is a gradual increase in bladder capacity and increase in thickness of the bladder wall. With time, there is change in the composition of the bladder wall with more connective tissue being laid down. Along with nerve damage, this makes it hard for the bladder to contract. Collectively, these changes manifest in a number of ways. There may be decreased sensation, bladder overactivity, poor flow or emptying, urgency and even incontinence. This may lead to urine being held back in the bladder which predisposes to infections.
Additionally, diabetic patients may have increased urine output and may find themselves going often because of this. Going at night, called nocturia, is a particularly troublesome symptom.
In men, diabetes may also cause an increase in the size of the prostate. In patients with type 2 diabetes especially, the body produces a lot of insulin but cannot use it. All this insulin stimulates a chemical called insulin-like growth factor or IGF which can lead to prostatic growth. Diabetes may also cause problems with the relaxation of the muscles that hold the flow of urine. This can cause further problems with urination.
As previously mentioned, chronic retention of urine and stasis may predispose diabetics to urinary tract infections. Additionally, diabetics cannot fight off infections as quickly as everyone else, compounding the problem. Their defense cells get damaged and do not respond well to infections. They are prone to different types of urine infections of the prostate, bladder and kidneys and are also prone to recurrent infections as well. Their infections tend to be more severe and progress quickly making it much more life threatening. They also have an increased risk of a particular type of tissue infection of the privates called Fournier’s gangrene, where the tissues essentially die off and need to be removed surgically, a very morbid operation.
I urge you to get tested if you are at risk and if you already have diabetes, to strive for excellent blood sugar control. If you have urinary or sexual symptoms, please speak to a doctor.
Satyendra Persaud MBBS DM (Urol) FCCS FRCS (Eng) lecturer in urology/DM urology co-ordinator University of the West Indies
St Augustine, TT