Tuesday, 5 July 2016

Neuropathy In The Genital/Urinary System

Today's post from blog.diabetv.com (see link below) looks at a subject that many neuropathy patients may literally keep 'below their belts' thanks to societal embarrassment but it's surprisingly common, especially with people living with autonomic neuropathy over which they have no control. It's about so-called genito-urinary neuropathy which basically means, dysfunction of your bladder, digestive system and sexual performance. It's a useful post especially if you're a bit older because many of you will put the symptoms down to ageing and normal reduction of function due to age. It may not be that, so it's worth talking to your doctor or neurologist to see what, if anything can be done. Worth a read for all neuropathy patients (men and women). By the way, the article suggests that it only affects those with diabetes - absolutely not true - it can apply to all people living with neuropathy.

Posted by Dr. Leonel Porta

  Genitourinary neuropathy is another major forms of Autonomic Neuropathy that occurs in men and women with diabetes mellitus. The exact prevalence is unknown but in most of these patients are asymptomatic, however it is believed that up to half of the diabetics suffering from complications can have it.

The involvement of the lumbo-sacral innervation alters the proper functioning of the urogenital system, causing manifestations such as Neurogenic Bladder and Sexual Dysfunction.

Neurogenic Bladder and Diabetic Cystopathy: It is characterized by the loss of sensation of a full bladder due to decreased sensitivity to bladder distention. One in every two diabetics suffer from it. Symptoms usually appear in a progressively unpleasant way. The main symptom is a decreased frequency of urination, especially at night, with an increased volume of the first morning urination above 400mL. Later manifestations are an incomplete emptying of the bladder, bladder distention, urinary stasis and, in rarer cases, urinary incontinence.

Neurogenic bladder is a hypotonic bladder, and the presence of residual urine in it , predisposes to recurrent urinary tract infections, which can lead to long-term kidney failure. Diagnosis can be made by an ultrasound that shows the residual urine or by Flow Cystometry, which evaluates the neural pathways. In many cases a mechanical voiding of the bladder using urinary catheters probes is advisable as a relief measure.

Male sexual dysfunction: This is one of the most common clinical signs of Genitourinary Neuropathy and it is often the first manifestation of Autonomic Neuropathy, being three times more likely to be occurring in diabetics. The cause is multifactorial and includes neuropathy, vascular disease, metabolic abnormalities, and psychological factors. It is based on the alteration of erection and ejaculation. Erectile Dysfunction is defined as the consistent inability to achieve and maintain an erection for a satisfactory sexual intercourse. It must happen repeatedly and never change during several months and occur in more than 50% of the sexual intercourse encounters to be considered as such. Impotence, as it is known colloquially, can progress from partial to total within a few years until it becomes familiarly irreversible.

Treatment for Erectile Dysfunction has been previously cited in DiabeTV. It includes dietary habits changes, psychological counseling, administration of drugs such as Sildenafil, Tadalafil or Vardenafil and, ultimately, to the placement a prostheses within the penis. On the other hand, ejaculatory disorders are less frequent. This is caused by alterations in the sympathetic nervous system and must be treated under strict medical supervision.

Female sexual dysfunction. It is a decreased sexual desire (libido), anorgasmia (lack of orgasm), and dyspareunia (painful intercourse) due to inadequate vaginal lubrication. We invite you to read the article about how to overcome vaginal dryness posted by DiabeTV.

Genitourinary Neuropathy is one of those complications of diabetes that can be prevented if the basic recommendations known by most diabetic patients are followed. A balanced diet, physical activity, and an adequate glycemic control, together with a routine medical evaluation can spare you from multiple diabetic complications. Those can make your life miserable, lower your self-esteem and affect your quality of life.


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