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Patient: 46-year-old female

Chief Complaint: 10 out of 10 coccyx pain that increases with sitting, or transfer to standing; no trauma

Past Medical History: Surgical block and injection to coccyx with only temporary relief

Urinary incontinence exists at higher levels in patients with Type I or II diabetes than in those without diabetes, according to new research. Another article from the National Association for Incontinence (NAFC) website states that 50% of men and women with diabetes have incontinence. It describes how sugar can get into the urine and irritate the bladder. This creates urinary urgency, frequency, and incontinence, symptoms that could be mistaken for a urinary tract infection.

The article also notes that persistent bacteria in the bladder can lead to symptoms of overactive bladder (OAB), which results in the neurologic dysfunction of incomplete bladder emptying. Consequently, the patient becomes more susceptible to urinary incontinence and infections.

In addition, fluid retention can be associated with other conditions of the diabetic patient. Extra fluid in the legs can be moved into the patient’s system when lying down. This often leads to urinary frequency at night, which interrupts sleep and puts patients at risk for falls.

Some easy solutions include having the patient do ankle “pumps” (bending the foot back and forth) before bedtime to move fluids out of the legs earlier. If a diuretic is being taken, altering the dose or timing may also help. The literature suggests that physicians should screen for incontinence in diabetic patients, as they may not share this information by themselves.

Elser D, Diabetes and Urinary Incontinence. Quality Care. 2011 Nov

Phelan S et al., Clinical Research in Diabetes and Incontinence: What We Know and Need to Know. J Urol. 2009 Dec