Diabetes and bowel incontinence: understanding the connection

Diabetes and bowel incontinence may seem unrelated, but some patients experience both and delay seeking help because of embarrassment or limited understanding. The original article describes elevated glucose damaging small blood vessels and the nerves they supply. Impaired autonomic nerves can prevent the anal sphincter from responding normally; reduced muscle function over time may lead to leakage. Sudden glucose rises may also temporarily disrupt sphincter and rectal function.

There may also be an association with irritable bowel syndrome (IBS), characterised in the article by abdominal pain at least one day a week, an urge to pass stool with pain, and changes in stool frequency or form. The source reports chronic diarrhoea in about one fifth of diabetes patients and a similar proportion with IBS, while noting that the relationship has not been firmly established.

Anal itching or stool leakage can be mistaken for haemorrhoids until examination identifies sphincter weakness. Treatment first requires identifying the cause. If diabetes contributes, glucose control and reducing vascular damage are important. The article mentions newer glucose-lowering medicines such as SGLT-2 inhibitors, or insulin, as options discussed by doctors.

A case example Mr. Ng, a pseudonym for an overweight man in his fifties with diabetes, sought help for itching he thought was caused by haemorrhoids. Examination found poor sphincter function and suboptimal glucose control. He was advised to take medication, exercise to lose weight and practise pelvic-floor contractions. Initially he relied on medication without changing diet or exercise, and his symptoms did not improve over roughly nine months. After committing to lifestyle changes, he reported no further incontinence six months later.

Information supplied by surgeon 張浩然醫生. Original reference: https://hd.stheadline.com/news/columns/131/20190125/736330/專欄-為生命護航-糖尿與失禁-原來息息相關