Diabetes is a metabolic/endocrine disorder where the glucose metabolism of the body is disturbed. There is either insufficient production of insulin or body cells become resistant to existing insulin. Uncontrolled diabetes mellitus as such affects all parts of body due to high levels of blood glucose. The genitourinary system is worst affected causing much suffering. From genital itching, discharge to frequency and urgency of urination, a wide range of symptoms can occur. Damage to the nervous system, caused by diabetes mellitus leads to multitude of urinary problems. An individual can develop frequency of urination, i.e. passing urine many times in small quantities. Retention of urine can also occur. One can also have urinary incontinence (loss of voluntary control over passing urine) at times. This is a very embarrassing situation for any grown up person. Patients with diabetes are highly prone to develop urinary tract infections because high levels of sugar in the blood provide a rich medium for infectious microbes to grow. Women are more prone to this problem as short length of urethra (tube connecting bladder to outside for voiding urine), facilitates more easy entry of germs. Infection of the urinary tract also leads to increased frequency and urgency of urination, i.e., once the urinary bladder is full, there is an intense urgent desire to pass urine immediately. Repeated and persistent urinary tract infections can lead to chronic infection of the kidneys which can result in chronic kidney failure. Diabetic women are known to give birth to large babies. Thus during delivery, they can have injuries to the perineum and urinary bladder, particularly the sphincter controlling the mouth of the bladder. This manifests as retention of urine or incontinence. In men diabetic autonomic neuropathy can lead to sexual impotence, whereas in women it can cause frigidity which is very disturbing for the affected person. Both men and women are susceptible to develop fungal infections of the genital parts and anus due to diabetes. Women have more chances of developing this problem. Fungal infections manifest as itching over the genital parts which is intermittent and troublesome. Secondary bacterial infection can set in due to scratching resulting in single or multiple boils. These infections may subside temporarily with treatment to resurface again after some time under favorable conditions. Therefore to obtain a complete cure in fungal infections it is imperative that the individual takes treatment without interruption for 6 to 12 weeks and keeps sugar well controlled. All these problems can be avoided if a diabetic individual keeps his sugar well controlled. Strict adherence to a diabetic diet, regular physical exercise and taking medication regularly helps in keeping diabetes well controlled. Avoidance of alcohol and smoking is also helpful in this regard. Good control of diabetes can delay or retard diabetic neuropathy and associated sexual impotence. But once erectile dysfunction develops, there is unfortunately no cure for it. Drinking water in good quantities throughout the day flushes the urinary system very well and helps in preventing settlement of germs there. Thus it prevents development of urinary tract infections. Good perineal hygiene helps in preventing infection of the genital parts. One should always try to wash genital parts after intercourse to wash out the germs settled there. Women should be careful about personal hygiene during their menstrual cycles. These small measures keep away infections and prevent the resultant embarrassing problems. Dr Rachna Pande specialist – internal medicine
