Urinary Incontinence and Type 1 Diabetes: A Deeper Look at the Connection

Diabetes can impair lower urinary tract structures, including the bladder and prostate, leading to overactive bladder, stress UI, and other lower urinary tract symptoms. Alarmingly, urologic complications may be more prevalent than classic diabetic complications like neuropathy or retinopathy. However, male-specific research remains limited, and many studies group sexes together. This article focuses exclusively on male patients with T1DM, aiming to highlight the underrecognized connection between diabetes and UI in this population.

Prevalence of Urinary Incontinence in Men with Type 1 Diabetes

Urinary incontinence (UI) is notably prevalent among men with Type 1 diabetes mellitus (T1DM), though it remains under-recognized. Studies have shown that diabetes increases the risk of lower urinary tract symptoms (LUTS), including incontinence, with diabetic men experiencing a 25% to threefold greater likelihood of LUTS compared to non-diabetic counterparts.

In particular, men with fasting glucose levels ≥126 mg/dL or under treatment for diabetes were significantly more likely to report moderate to severe LUTS. This association is often attributed to diabetic cystopathy—bladder dysfunction caused by autonomic neuropathy, leading to poor detrusor contractility and/or detrusor overactivity.

Prevalence of UI increases with age, with studies reporting rates ranging from 11% among men aged 60–64 to over 30% in older men. 

Moreover, in men with T1DM from the UroEDIC cohort, the prevalence of moderate to severe LUTS remained significant despite intensive glycemic control.

Compared to non-diabetic men, those with T1DM show higher rates of UI even in younger populations, suggesting that factors beyond age—such as microvascular and neuropathic changes—play a crucial role in bladder dysfunction. Understanding these differences is essential for targeted management.

Risk Factors and Pathophysiology

Urinary incontinence (UI) in men with Type 1 diabetes (T1DM) often results from complex, interrelated pathophysiological mechanisms. Chronic hyperglycemia plays a central role by promoting oxidative stress and microvascular damage, which impair blood flow to the bladder and peripheral nerves. This contributes to autonomic neuropathy, a key driver of diabetic cystopathy, characterized by impaired bladder sensation, poor detrusor contractility, and eventually overflow incontinence. Additionally, hyperglycemia disrupts calcium homeostasis in smooth muscle and neural tissues, enhancing sympathetic nervous system activity, which may increase bladder outlet resistance and exacerbate voiding difficulties.

The longer the duration of diabetes and the poorer the glycemic control (indicated by elevated HbA1c levels), the greater the risk for bladder dysfunction. Studies show that men with elevated post-load glucose or high HbA1c experience more severe LUTS. Autonomic neuropathy, particularly affecting parasympathetic innervation of the detrusor, leads to reduced bladder contractility and increased residual volumes, fostering UI and urinary tract infections (UTIs). UTIs, common in diabetic individuals due to immune dysfunction and urinary stasis, further contribute to urgency and incontinence.

Prostate health is another critical factor. While benign prostatic hyperplasia (BPH) is common with aging, diabetes may exacerbate its development through insulin-related pathways that promote prostatic growth and inflammation. Elevated insulin levels may increase prostate smooth muscle tone via heightened sympathetic activity, worsening urinary flow obstruction and UI symptoms.

Gender-specific considerations include the added influence of prostate-related pathologies in men, which often co-exist with diabetic bladder dysfunction. The overlap of BPH and diabetic cystopathy complicates diagnosis and management. Therefore, a comprehensive assessment of metabolic control, prostate health, and urinary symptoms is essential for effective intervention in men with T1DM experiencing UI.

Types of Urinary Incontinence in Male T1DM Patients

In male patients with Type 1 diabetes mellitus (T1DM), several types of urinary incontinence (UI) may occur, each linked to distinct pathophysiological mechanisms. 

• Stress incontinence—involuntary leakage during physical activity—is less common but may appear if pelvic floor weakness coexists. 

• Urge incontinence, the sudden need to void due to detrusor overactivity, is commonly seen in T1DM and is strongly associated with autonomic neuropathy and impaired bladder sensation.

• Overflow incontinence arises from chronic urinary retention due to detrusor underactivity or bladder outlet obstruction, often resulting from diabetic cystopathy or concurrent benign prostatic hyperplasia (BPH).

• Mixed incontinence, combining urge and overflow elements, is also frequently reported, reflecting the complex interplay of neuropathic and structural changes in long-standing diabetes.

In clinical practice, urge and overflow incontinence are most prevalent among male T1DM patients, necessitating individualized evaluation and management.

Impact on Quality of Life

Urinary incontinence (UI) significantly diminishes the quality of life (QoL) in men with Type 1 Diabetes, affecting multiple domains—physical activity, sexual function, social interaction, sleep, and emotional wellbeing. The unpredictability of leakage often leads to a sedentary lifestyle, avoiding physical exertion that may trigger episodes. Sexual intimacy may suffer due to embarrassment or fear of accidents, further impacting relationships. Sleep quality is commonly disrupted by nocturia or anxiety about nighttime incontinence. Emotionally, many men experience stigma, shame, and lowered self-esteem, which may result in social withdrawal and depression.

According to research, men with moderate UI experience impairment across all three QoL domains: “Being” (self-perception and mental wellbeing), “Belonging” (relationships and community involvement), and “Becoming” (goals and aspirations). Notably, the “Becoming” domain—reflecting future goals and self-fulfillment—was more severely affected in men, especially in cases of overflow incontinence. Additional factors such as higher BMI, comorbidities, use of diuretics, or multiple absorbent aids further compromise QoL.

Another study found a strong association between higher BMI and increased symptom burden, as reflected in IIQ-7 scores, while regular exercise correlated with reduced symptom severity. These findings highlight the need for holistic, multidisciplinary, and patient-centered care approaches to manage UI effectively in men with diabetes.

Diagnosis and Clinical Assessment 

An accurate diagnosis is critical in managing urinary incontinence (UI) in men with Type 1 Diabetes. Urodynamic testing is the cornerstone of evaluation, helping to distinguish between stress incontinence, detrusor overactivity, and overflow incontinence. Filling and voiding studies, often with fluoroscopy, simulate leakage scenarios and detect bladder dysfunctions that may go unnoticed during standard assessments. Importantly, up to 60% of incontinent men have a bladder dysfunction component, necessitating comprehensive testing.

Bladder diaries provide valuable insight into voiding patterns and fluid intake, while blood sugar levels must be closely monitored, as poor glycemic control can exacerbate bladder dysfunction. Prostate-specific antigen (PSA) testing and digital rectal exams are essential to rule out prostate enlargement or malignancy—common confounders of UI in diabetic men. A thorough urological exam, including neurological assessment of the S2–S4 spinal segments, ensures no neurological or structural abnormalities are overlooked. Ruling out alternative causes is vital for tailoring effective treatment.

Management Strategies

Effective management of urinary incontinence in male patients with T1DM requires a multifaceted, individualized approach. Lifestyle interventions are a critical first step. These include adjusting fluid intake—limiting fluids in the evening and avoiding bladder irritants such as caffeine and alcohol—to reduce nocturia and urgency. 

Weight loss has been shown to significantly improve urinary symptoms, especially in overweight individuals.  Bladder training and pelvic floor exercises (e.g., Kegel exercises) are also beneficial for improving bladder control and promoting complete emptying, with double voiding techniques aiding those with incomplete bladder emptying. Glucose control remains foundational, as hyperglycemia exacerbates polyuria and neurogenic bladder dysfunction.

Pharmacological therapy is often needed for symptom control. Antimuscarinic agents such as tolterodine, solifenacin, and oxybutynin reduce detrusor overactivity by blocking muscarinic receptors. Extended-release forms offer better tolerability and adherence. β3-adrenoceptor agonists like mirabegron provide an alternative with fewer anticholinergic side effects. Trospium chloride and fesoterodine are options with favorable pharmacokinetics and safety profiles.

Emerging therapies offer promise for refractory cases. Neuromodulation—such as sacral nerve stimulation—modulates reflex pathways to restore bladder function. Intravesical botulinum toxin injections have shown efficacy in detrusor overactivity by inhibiting acetylcholine release.

Ultimately, treatment must be individualized based on urodynamic findings, symptom severity, comorbidities, and patient preferences. The goal is to relieve symptoms, prevent infections, and promote quality of life in men with diabetic cystopathy.

Conclusion

Urinary incontinence in men with Type 1 diabetes is a complex and often underdiagnosed condition with far-reaching impacts on quality of life. As this article highlights, the interplay between diabetic neuropathy, glycemic control, bladder dysfunction, and prostate health makes individualized care essential. Despite available treatment strategies, incontinence can persist—and that's where reliable, comfortable daily protection becomes crucial.

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References:

1. Anger, J. T., Saigal, C. S., Stothers, L., Thom, D. H., Rodríguez, L. V., & Litwin, M. S.; Urologic Diseases of America Project. (2006). The prevalence of urinary incontinence among community dwelling men: Results from the National Health and Nutrition Examination survey. The Journal of Urology, 176(5), 2103–2108; discussion 2108. https://doi.org/10.1016/j.juro.2006.07.029

2. Biastre, K., & Burnakis, T. (2009). Trospium chloride treatment of overactive bladder. Annals of Pharmacotherapy, 43(2), 283–295. https://doi.org/10.1345/aph.1L160

3. Blair, Y., Wessells, H., Pop-Busui, R., Ang, L., & Sarma, A. V. (2022). Urologic complications in diabetes. Journal of Diabetes Complications, 36(10), 108288. https://doi.org/10.1016/j.jdiacomp.2022.108288

4. Braffett, B. H., Wessells, H., & Sarma, A. V. (2016). Urogenital autonomic dysfunction in diabetes. Current Diabetes Reports, 16(12), 119. https://doi.org/10.1007/s11892-016-0824-5

5. Brown, J. S., Wing, R., Barrett-Connor, E., Nyberg, L. M., Kusek, J. W., Orchard, T. J., Ma, Y., Vittinghoff, E., & Kanaya, A. M.; Diabetes Prevention Program Research Group. (2006). Lifestyle intervention is associated with lower prevalence of urinary incontinence: The Diabetes Prevention Program. Diabetes Care, 29(2), 385–390. https://doi.org/10.2337/diacare.29.02.06.dc05-1781

6. Brown, J. S., Wessells, H., Chancellor, M. B., Howards, S. S., Stamm, W. E., Stapleton, A. E., Steers, W. D., Van Den Eeden, S. K., & McVary, K. T. (2005). Urologic complications of diabetes. Diabetes Care, 28(1), 177–185. https://doi.org/10.2337/diacare.28.1.177

7. Chapple, C. R., Fianu-Jonsson, A., Indig, M., Khullar, V., Rosa, J., Scarpa, R. M., Mistry, A., Wright, D. M., Bolodeoku, J.; STAR study group. (2007). Treatment outcomes in the STAR study: A subanalysis of solifenacin 5 mg and tolterodine ER 4 mg. European Urology, 52(4), 1195–1203. https://doi.org/10.1016/j.eururo.2007.05.027

8. Corrado, B., Giardulli, B., Polito, F., Aprea, S., Lanzano, M., & Dodaro, C. (2020). The impact of urinary incontinence on quality of life: A cross-sectional study in the metropolitan city of Naples. Geriatrics (Basel), 5(4), 96. https://doi.org/10.3390/geriatrics5040096

9. Daneshgari, F., & Moore, C. (2006). Diabetic uropathy. Seminars in Nephrology, 26(2), 182–185. https://doi.org/10.1016/j.semnephrol.2005.09.009

10. Daniels, D. H., Powell, C. R., Braasch, M. R., & Kreder, K. J. (2010). Sacral neuromodulation in diabetic patients: Success and complications in the treatment of voiding dysfunction. Neurourology and Urodynamics, 29(4), 578–581. https://doi.org/10.1002/nau.20791

11. Golbidi, S., & Laher, I. (2010). Bladder dysfunction in diabetes mellitus. Frontiers in Pharmacology, 1, 136. https://doi.org/10.3389/fphar.2010.00136

12. Liu, G., & Daneshgari, F. (2014). Diabetic bladder dysfunction. Chinese Medical Journal (Engl), 127(7), 1357–1364. PMID: 24709194

13. Moore, K. C., & Lucas, M. G. (2010). Management of male urinary incontinence. Indian Journal of Urology, 26(2), 236–244. https://doi.org/10.4103/0970-1591.65398

14. National Institute of Diabetes and Digestive and Kidney Diseases. (2021, July). Diabetes, sexual, & bladder problems. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/sexual-bladder-problems

15. Parsons, J. K., Carter, H. B., Partin, A. W., Windham, B. G., Metter, E. J., Ferrucci, L., Landis, P., & Platz, E. A. (2006). Metabolic factors associated with benign prostatic hyperplasia. The Journal of Clinical Endocrinology & Metabolism, 91(7), 2562–2568. https://doi.org/10.1210/jc.2005-2799

16. Qasrawi, H., Tabouni, M., Almansour, S. W., Ghannam, M., Abdalhaq, A., Abushamma, F., Koni, A. A., & Zyoud, S. H. (2022). An evaluation of lower urinary tract symptoms in diabetic patients: A cross-sectional study. BMC Urology, 22, 178. https://doi.org/10.1186/s12894-022-01133-1

17. Rohrmann, S., Platz, E. A., & Giovannucci, E. (2005). Lifestyle and benign prostatic hyperplasia in older men: What do we know? The Journal of Men’s Health & Gender, 2(2). https://doi.org/10.1016/j.jmhg.2005.04.010

18. Sarma, A. V., Burke, J. P., Jacobson, D. J., McGree, M. E., St Sauver, J., Girman, C. J., Lieber, M. M., Herman, W., Macoska, J., Montie, J. E., & Jacobsen, S. J. (2008). Associations between diabetes and clinical markers of benign prostatic hyperplasia among community-dwelling Black and White men. Diabetes Care, 31(3), 476–482. https://doi.org/10.2337/dc07-1148

19. Sarma, A. V., Townsend, M. K., Grodstein, F., Breyer, B. N., & Brown, J. S. (2018). Urologic diseases and sexual dysfunction in diabetes. In C. C. Cowie, S. S. Casagrande, A. Menke, M. A. Cissell, M. S. Eberhardt, J. B. Meigs, E. W. Gregg, W. C. Knowler, E. Barrett-Connor, D. J. Becker, F. L. Brancati, E. J. Boyko, W. H. Herman, B. V. Howard, K. M. V. Narayan, M. Rewers, & J. E. Fradkin (Eds.), Diabetes in America (3rd ed., Chap. 28). National Institute of Diabetes and Digestive and Kidney Diseases (US).

20. Shamliyan, T. A., Kane, R. L., Wyman, J., & Wilt, T. J. (2008). Systematic review: Randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Annals of Internal Medicine, 148(6), 459–473. https://doi.org/10.7326/0003-4819-148-6-200803180-00211

21. Shamliyan, T. A., Wyman, J. F., Ping, R., Wilt, T. J., & Kane, R. L. (2009). Male urinary incontinence: Prevalence, risk factors, and preventive interventions. Reviews in Urology, 11(3), 145–165. PMID: 19918340

22. St Sauver, J. L., Jacobson, D. J., McGree, M. E., Girman, C. J., Lieber, M. M., & Jacobsen, S. J. (2008). Longitudinal association between prostatitis and development of benign prostatic hyperplasia. Urology, 71(3), 475–479. https://doi.org/10.1016/j.urology.2007.11.155

23. Van Den Eeden, S. K., Sarma, A. V., Rutledge, B. N., Cleary, P. A., Kusek, J. W., Nyberg, L. M., McVary, K. T., & Wessells, H.; Diabetes Control and Complications Trial/Epidemiology of Diabetes Research Group. (2009). Effect of intensive glycemic control and diabetes complications on lower urinary tract symptoms in men with type 1 diabetes: DCCT/EDIC study. Diabetes Care, 32(4), 664–670. https://doi.org/10.2337/dc07-2375