Bowel Incontinence: Another Embarrassing Casualty Of Pd
Fecal Incontinence is where you lose control of your bowels. This blog post explains the primary cause of this in Parkinsons disease. Problems reaching the toilet in time because of mobility, abdominal bloating or cramping compound the problem. Dr. De León has included a check list of things to help minimize occurrences and embarrassment, even to the point of surgery, if necessary.
Why Do Some People With Parkinson’s Disease Experience Urinary Incontinence
Parkinson’s is best known for its effects on balance and movement, but it impacts the autonomic nervous system as well. The autonomic nervous system controls specific bodily functions, like heart rate, blood pressure, libido, and urine production.
Over time, changes to the autonomic nervous system affect your bladder’s ability to store and release urine. That means you might have trouble making it to the bathroom on time or need to urinate more frequently.
Parkinsons And Urinary Incontinence
Parkinsons causes problems with automatic bodily functions, such as breathing, heart rate, and urinary function. Urinary incontinence is much different than fecal incontinence and usually doesnt start to occur until the later stages of the disease. Urinary incontinence due to Parkinsons is a two-fold problem. The bladder has trouble holding urine in, but, at the same time, its difficult to control the release of urine, leading to some serious discomfort and emergency bathroom visits.
Urinary incontinence problems can come in many forms:
A person with Parkinsons may have to urinate very frequently, complicated by an increasingly difficult time with movement. Once they sit down, they may find it difficult to let go of the urine and void their bladder. While nearly 40% of Parkinsons patients may experience some level of urinary incontinence, only 15% of patients should develop a serious urinary condition.
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Addressing Practical Aspects Of Eating And Drinking
Some people with Parkinsons have problems chewing and swallowing. This can make it difficult to eat a diet with plenty of fibre. A speech and language therapist can give advice about this. Ask your GP, specialist or Parkinsons nurse for a referral. If it takes a long time to eat and your meal goes cold, eat smaller portions and go back for seconds that have been kept warm. You can also get special plates that keep your meals hot the Disabled Living Foundation has more information.
An occupational therapist will also be able to give you some tips and practical advice.
Bladder And Constipation Problems
Parkinsons commonly leads to problems with constipation and bladder control, including urinary urgency, frequency, retention and nocturia.
These problems add to the challenge of living with Parkinsons and can have a negative effect on a persons quality of life. It is important to seek help in managing these problems, as both issues can be effectively managed.
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What You Can Do To Help
- Discuss bladder problems with your family doctor or neurologist, who may perform some tests to rule out urinary tract infection or other problems.
- Speak with your family doctor or neurologist about a referral to a urologist . The urologist will be able to look into any bladder symptoms and provide treatment plans.
- Be aware that bladder difficulties can be a sign of wearing off. Wearing off is where some of the symptoms of Parkinsons occur or worsen between doses of medication and are related to the level of medication becoming too low. Taking your medication on time every time helps reduce fluctuations and that will help reduce bladder difficulties.
- Managing constipation and making sure that you have regular bowel movements will also assist in minimising bladder problems.
Other Symptoms Of Parkinsons Affecting Continence
Urinary incontinence can be a common symptom of Parkinsons, but you are also likely to see symptoms that affect your loved ones muscles and movements.
One of those will often be a tremor in someones arm or hand when theyre sitting down or relaxing, while it is also likely that someone with Parkinsons will not be able to move around particularly freely. Walking can become more challenging while your muscles can become stiff.
So its particularly important that you make the route to the toilet as clear and easy as possible. That way, your loved one will have a better chance of getting to the loo when the urge to urinate arises.
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How Can Parkinsons Disease Cause Incontinence
Individuals with Parkinsons Disease can develop incontinence when the communication between the brain and the bladder becomes faulty. The bladder is a muscle that expands gradually as urine collects. At the opening of the bladder, there is a muscle called the sphincter. This muscle is usually closed except during urination. The brain controls both the bladder and the sphincter muscle. Under normal circumstances, the bladder begins to have small contractions that alarm the brain when 1-2 cups have been collected in the bladder. In Parkinsons Disease, however, the brain lacks complete control over the sphincter. Parkinsons disease attacks the brain, focusing on dopamine-producing cells. These cells are vital in maintaining brain health, as they deal with signals controlling muscle movement. In patients with Parkinsons disease, the bladder becomes overactive and has unwanted contractions which can be impossible to stop. This miscommunication and lack of control can cause a person with Parkinsons Disease to feel the need to empty their bladder even when there is just a small amount of urine present. Sufferers can also often find themselves finding it difficult to eliminate urine.
Parkinsons Disease can affect the brain and spinal cord
Causes Of Constipation In Parkinsons Disease
The ways in which Parkinsons disease can increase the risk of constipation include:
- lack of dopamine in the brain impairs control of muscle movement throughout the body. Bowel muscles can become slow and rigid
- uncoordinated bowel motions the bowel muscles may be weak and unable to contract, or they may clench instead of relaxing when trying to pass a motion
- eating problems dietary fibre containing insoluble fibre adds bulk to your bowel motions and can help prevent constipation. However, if a person with Parkinsons disease finds it difficult to chew or swallow, they may avoid eating fibrous foods
- drinking problems you need water to plump up the dietary fibre in your bowel motions. Swallowing difficulties may discourage a person with Parkinsons disease from drinking enough fluids
- sedentary lifestyle lack of exercise slows the passage of food through your intestines. Parkinsons disease reduces muscle control, so lack of exercise is common
- medications many different medications can cause constipation. Medications used in the treatment of Parkinsons disease may slow bowel movements or cause a decrease in appetite.
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Parkinsons And Fecal Incontinence
Did you know that 65% of Parkinsons patients are affected by constipation, and, many times, the constipation is severe? The beginning stages of fecal incontinence start to occur immediately due to behavioral changes that can even preclude a diagnosis. For example, when someone starts to notice that their hand is shaking a little, they may be nervous about spilling something and reduce their intake of fluids. The trembling hand may be what causes you to call the doctor, but the bowel problems have already begun.
Fecal incontinence also comes in several forms, including:
Parkinsons Disease slows down our gastric motility function, which means that our ability to digest food and move waste through our system has slowed way down. When you mix this with all the medication that a person with Parkinsons has to take and the fact that they arent always getting enough water or movement, constipation is an unfortunate side effect.
This means that a person with Parkinsons can suffer from bowel impaction that needs to be removed or experience a loss of muscle control that can lead to accidents, and near-accidents, that can keep someone with the disease from living their best life. What can be done to treat incontinence in Parkinsons patients?
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Diagnosis Of Constipation In Parkinsons Disease
Diagnosis of constipation may include:
- medical history
- detailed description of symptoms
- physical examination.
Medical problems other than Parkinsons disease can also cause constipation. Your doctor may wish to do tests to rule out other possible causes. The tests depend on the medical condition under investigation.
What Causes Constipation In People With Parkinson’s Disease
In some people with Parkinson’s disease, constipation may occur due to the improper functioning of the autonomic nervous system. The autonomic nervous system is responsible for regulating smooth muscle activity. If this system is not working properly, the intestinal tract may operate slowly, causing constipation.
Also, medications used to treat Parkinson’s disease can cause constipation.
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What Is The Bladder
The bladder is a hollow organ located in the pelvis, or lower abdomen. The bladder has two important functions:
- It stores urine.
- It removes urine from the body through a complex communication circuit in the spinal cord and brain.
Urinary incontinence occurs when a person cannot control the flow of urine. The storage of urine can be a problem if the bladder is unable to empty fully or if it begins to empty itself before the person reaches the bathroom . Leakage can occur if the bladder cannot empty , if the sphincter controlling urination doesnt work , or if bladder spasms cause the bladder to shrink before the person reaches the toilet .
Tips For Living With Faecal Incontinence
If you have faecal incontinence, its important to use the toilet properly. Sit with your knees higher than your hips, lean forward and put your elbows on your knees. Push your tummy out, straighten your back and dont strain.
To prevent the problem getting worse:
- Dont go to the toilet just in case only go when you have a strong urge.
- Dont go to the toilet too often.
- Exercise your pelvic muscles.
- Check your diet and lifestyle, and make changes if necessary.
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How Does Parkinson’s Affect The Bowel
Two out of three people with Parkinson’s disease suffer from constipation, and the symptom can occur long before the diagnosis is made. Constipation is one of the most common non-motor symptoms of this condition.
Many patients find it embarrassing to talk about their bowel problems, but it is important to seek help in managing constipation. Left untreated, constipation can lead to other problems. You may feelunwell and nauseous, exacerbating the constipation as you dont feel like eating or drinking.Constipation can also cause overactive bladder and urinary incontinence due to mechanical pressure on the bladder. Sometimes constipation makes it difficult to empty your bladder, and when urineremains in the bladder there is a risk of urinary tract infections.
We spoke to Ethan and Susan about their symptoms and how they manage it – here’s an excerpt from our free guides: “Bladder and Bowel dysfunction when you have Parkinson’s Disease”
Ethan’s story
Susan’s story
Female and male anatomy are different, and the effects of Parkinson’s disease may have different effects when it comes to bladder and bowel dysfunction.
The bladder and bowel also interact and effect the functioning of these processes. In these free guides, we look at the symptoms, effects and therapies available to manage this condition.
Bladder and Bowel dysfunction when you have Parkinson’s Disease
Extraenteric Nervous System And Dopamine
Whereas small intestine and ascending colon are innervated by the vagus nerves originating in the medulla, extraenteric innervation of descending colon, sigmoid colon, and rectum primarily shares that of the LUT . LUT and LGIT perform the similar function of storage and emptying. However, there are also profound differences with regard to physiology . In addition, while the LUT requires intact neuraxis for storage and emptying , it has not been entirely clear to what extent LGIT needs extra-ENS.
The basal ganglia modulate the bowel motility , with the main action apparently being inhibitory . However, under stress conditions, facilitatory responses were also observed . Although the connection is not fully clarified, bowel function seems to be modulated by the higher brain structures . Most areas activated in functional neuroimaging by bowel distention strikingly overlap the area activated by bladder distention .
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How Does Fibre Help
Fibre works by absorbing fluid as it moves through the bowel, forming a soft stool that can be passed more easily. But too much bulk can increase constipation, especially if the person does not drink enough.
Make sure your client drinks at least eight to ten cups of fluid a day. Any fluid is suitable, including water, fruit juice, milk, tea, coffee and squash.
People with Parkinsons can increase their fibre intake by doing the following:
- Choosing a breakfast cereal containing wheat, wheat bran or oats such as Weetabix, porridge or bran flakes.
- Eating more vegetables, especially peas, beans and lentils.
- Eating more fruit fresh, stewed, tinned or dried such as prunes or oranges.
- If your patient has difficulty with chewing high-fibre food, there are soluble varieties available and even some high-fibre drinks.
- Loose, extra bran that can be added to food is not recommended by dietitians. This can lead to bloating and can reduce the absorption of vitamins and minerals by the body.
When increasing a persons fibre intake, it is important to do so gradually to avoid bloating or flatulence . Introduce one new source of fibre every three days.
Remember that some people with Parkinsons may have problems chewing and swallowing, which can make it difficult to eat a diet with plenty of fibre. A dietitian or speech and language therapist can give advice about this.
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Toilet Habits And Constipation In Parkinsons Disease
Suggestions for good toilet habits include:
- Go to the toilet as soon as you feel the urge to pass a bowel motion. Hanging on can contribute to constipation.
- Use the correct posture on the toilet to help you pass a bowel motion place your elbows on your knees, bulge out your stomach, straighten your spine and put your feet on a footstool.
- Avoid holding your breath and dont strain when you are on the toilet. Allow yourself plenty of time.
- Use a warm washcloth pressed against your back passage or gently massage with one or two fingers to help to relax the muscles.
- Talk to your doctor or pharmacist about medicines to help soften your bowel motions.
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Fecal Incontinence In Advanced Parkinsons Disease
Fecal incontinence is a very debilitating symptom that can occur in advanced PD and refers to the involuntary release of fecal matter.
Once again, fecal incontinence, especially if it is a new symptom, should be fully evaluated to determine if there is a cause unrelated to PD. Diseases of the gut such as inflammatory bowel disease or compression of the lower spine cord can be the reason.
If related to PD, there are typically two situations to consider. One possibility is that severe constipation with impacted bowel movement allows loose stool from higher up in the gastrointestinal tract to escape around the edges of the obstruction. In this situation, fecal incontinence could be a harbinger of bowel obstruction. Aggressive and continuous treatment of constipation can help avoid this potential scenario.
As with urinary incontinence, frequent and rapid exchange of dirtied incontinence products can keep skin intact and prevent infection.
Tips and Takeaways
Treatment For Over Active Bladder In Parkinsons
Overactive bladder affects up to 27% of men and 43% of women of the global population. Now, add a neurological condition and the problem becomes more challenging. First, there is a list of medications which make the problem worse, so should be avoided. Then, a thorough evaluation and physical exam. Treatment depends on the cause, but evaluating all medications and an adjustment of dopamine medication is often necessary. If you are still having problems, five further treatment options are included.
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Urinary Incontinence In Parkinsons Disease
The most common urinary difficulty experienced by people with PD is a frequent and urgent need to urinate. This may occur even when the bladder is not full. Recent research studies estimate approximately 27-39% of people with PD experience urinary difficulties, although urinary incontinence only develops in about 15% of those with PD. Bladder issues are more common in the later stages of PD.2
Treating And Managing Bowel Problems
The first step in dealing with bowel disorders is to talk to your doctor. He or she will probably review your medication to see if this is a contributory factor. Whilst it is usually possible to control any difficulties with diet, fluid intake and exercise, your doctor, or Parkinsons nurse specialist if you have one, will be able to advise further, and may, for example, prescribe laxatives in severe cases of constipation. If you have any alarm features such as unintentional weight loss or rectal bleeding, then you may need to be referred for specialist assessment.
The following healthcare professionals can also advise on aspects of bowel care:
- A dietician will be able to advise on diet and fluid.
- A physiotherapist may be able to help with advice and abdominal exercises which will help in passing stools.
- A speech and language therapist can help with swallowing problems. They may be able to advise on ways of relaxing your throat, and give guidance on posture and exercises to help overcome any difficulties you have.
- An occupational therapist may also be able to suggest practical ways to overcome any difficulties you have with eating and drinking.
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