Diabetes And Bowel Control: Why Do Leaks Happen?

Most people think of diabetes as a disease that can cause heart, kidney, eye or foot problems. One of the most under-recognized complications, however, is bowel dysfunction, especially anal incontinence.

“Many patients suffer in silence, too embarrassed to talk about it, believing it’s just a part of growing old. In fact, the cause may stem from diabetes itself,” says Dr. Rajiv Kovil, Diabetes and Obesity Specialist at Zandra Healthcare.

Long-standing diabetes can cause nerve damage throughout the body. Most people know about peripheral neuropathy that can affect the feet, but diabetes can also damage the autonomic nervous system, which controls involuntary functions such as bowel movement, bladder function, heart rate and digestion. This condition is called diabetic autonomic neuropathy.

Causes Of Diabetic Autonomic Neuropathy

“For normal bowel control, communication between the rectum, anal sphincters, pelvic floor muscles and the brain must be intact. Patients with autonomic nerve damage will have decreased sensation of rectal fullness, delayed recognition of stool, decreased sphincter tone and poor coordination of defecation. The end result may be urgency, leakage of stool or complete loss of bowel control,” explains Dr. Kovil.

Chronic diarrhoea, another common consequence of diabetic autonomic neuropathy, further aggravates anal incontinence. These problems together have a great effect on quality of life. They lead to anxiety, social withdrawal, depression and loss of confidence.

Importantly, anal incontinence should be viewed as a marker of generalized autonomic dysfunction rather than as a local bowel problem. Bowel symptoms are often associated with bladder dysfunction, erectile dysfunction, abnormal sweating, dizziness upon standing and gastrointestinal motility disorders. Recognition of these associated features enables the clinician to make an early diagnosis of autonomic neuropathy.

Tips To Manage It

The management must be comprehensive. Dr Kovil says the best way to prevent additional nerve damage is to keep blood sugars stable through good glucose control. Important first steps are diet changes, regulation of the bowel, adequate fiber, hydration, and treatment of diarrhoea.

Pelvic floor rehabilitation is also important. Kegel exercises are strengthening exercises for the pelvic floor muscles and improving sphincter strength and bowel control. Treatment has progressed further with the use of modern technology in the form of High-Intensity Focused Electromagnetic (HIFEM) therapy, which can induce thousands of supramaximal pelvic floor contractions in one treatment. These contractions cannot be voluntarily achieved and help to strengthen the pelvic floor muscles, improving continence without surgery or medications.

Dr Kovil concludes that patients need to understand that leaking bowels are not a part of getting old. It is a treatable complication of diabetes and should not be ignored, but treated medically.

Also read:

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3. How Women Can Take Charge Of Their Blood Sugar Before Diabetes Strikes
4. Diabetes Emerging As Key Factor Behind Rising Early Cataract Cases In India, Say Eye Doctors This Cataract Awareness Month