November 3, 2003
Other Illnesses
Question from Michigan, USA:
My 10 year old son was diagnosed with type 1 diabetes approximately nine months ago, and I am curious to find out if there is a possible link between his diabetes and ongoing bladder control issues which began years before his diagnosis. Since the age of three to four, he has experienced nighttime wetting, daytime incontinence and sudden urgency to urinate. For years, this was chalked up to “typical” boy behavior — delays in bladder control development, getting distracted by activities, emotional responses to stress, etc. The nighttime wetting was not the focus as it runs in both sides of the family and has been attributed to heavy sleep patterns.
From age eight to nine, he was given different medications for daytime incontinence, but one of the medications truly helped, and doctors suggested invasive tests just prior to his diabetes diagnosis. When my son was diagnosed and given insulin, his daytime bladder issues disappeared that day and this continued for several months. However, at this point in time, he does continue to have small urine stains in his underwear on a daily basis, there still seems to be a delay in his receiving the signal that he needs to urinate, and he is not dry at night (unless he has a fever or something causes him to sleep lightly).
Please note that I have not discounted the idea that this problem could be a combination of physical and emotional issues, and he has seen a therapist for several years to help him handle a variety of issues including inconsistent contact with his father who lives overseas, conquering reading delays while attending a school for the gifted, and the shame he feels regarding the bladder issues). It occurred to me that perhaps the shock of his diabetes diagnosis forced him to focus on getting to the bathroom on time and as he relaxed more about the diabetes, so did his bathroom focus.
However, I do still wonder if there is a possible link between his experiences with incontinence and diabetic autonomic neuropathy. I have read articles that discuss genitourinary effects post puberty, and I am wondering if there could be a link pre-puberty as well. Also, I am wondering if you have any advice as to helping my son achieve daytime and nighttime dryness. He feels that it is unattainable.
Answer:
I’m sorry that I cannot easily tie in your keen observations of your son’s bathroom habits years before his diagnosis of type 1 diabetes or why these issues improved following it. I presume that you have been working with a pediatric nephrologist or urologist given the medications prescribed, and the thought about more invasive tests (which I presume are urinary dynamic tests whereby fluid is instilled into the bladder via a catheter and the pressure in the bladder is measured. Children sometimes think these tests are torture!)
The daytime dribbling does suggest so-called bladder instability often empirically treated with antispasmodic medications. I presume that previous studies have noted otherwise — normal urinary tract anatomy with single, normally placed ureter draining each kidney connected appropriately to the bladder, etc.
DS
Additional comments from Dr. Donough O’Brien:
At this stage in his diabetes, it would be very unlikely indeed that his urinary problems are due to an autonomic nephropathy.
DOB
