Wednesday, September 21, 2022

Parkinson’s Urinary Incontinence Treatment

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Evaluating And Treating Urinary Issues In Parkinsons Disease Multiple System Atrophy And The Other Atypical Parkinsonism Disorders

In this hour-long webinar, neuro-urologist Ekene Enemchukwu, MD focuses on urinary incontinence, overactive bladder, urinary retention, and other urinary issues in PD, MSA, and the atypical parkinsonism disorders. Following the presentation, moderator Candy Welch, Brain Support Networks MSA caregiver support group leader, asks Dr. Enemchukwu many questions submitted by webinar participants.

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What Is Parkinsons Disease

Parkinsons disease is a progressive neurological disorder that affects how your muscles move. In the beginning stages, it can be easy to miss the early signs and symptoms of Parkinsons disease. The most common ones include:

  • Tremors, usually starting with the fingers or hand
  • A noticeable change in handwriting
  • Walking is slower, movement is stiffer
  • Stiff, rigid muscles

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Symptoms Of Urinary Retention

The symptoms of urinary retention are not always obvious but may include

  • Hesitancy really having to strain to pass urine
  • Strong feelings of urgency and frequency and when passing urine only a small amount comes out
  • A urinary stream that is very weak and intermittent

Whilst your bladder is not emptying properly there is a risk that the residual urine in the bladder will become infected. This could cause further complications and problems if it isnt removed regularly. It is important to seek help if you experience any of the above symptoms.

It is a good idea to keep a record of your bladder activity in a bladder diary for a few days before your appointment with your doctor or nurse.

Your Doctor or Healthcare Professional may recommend the following tests:

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Sexual Dysfunction In Parkinsons Disease

Many people with Parkinson

People with PD may experience sexual dysfunction, including loss of desire, inability to orgasm, erectile dysfunction in men, decreased lubrication in women, or pain with intercourse in women. Some studies have found that sexual dysfunction may occur in 60-80% of men and women with PD. Older patients with PD have more sexual dysfunction than younger patients, although sexual dysfunction is also greater in older adults who do not have PD. In addition to age, conditions such as diabetes, hypertension, and depression can factor into sexual dysfunction.3,4

There are several factors that can lead to sexual dysfunction in people with PD. In addition to the motor symptoms of PD, which may create practical barriers to engaging in sexual activity, non-motor symptoms like depression, anxiety, or sleep disturbances can also impact a persons sex drive. Many people with PD express dissatisfaction with their sexual life.3,5

Some people with PD who are treated with dopamine agonists develop impulse control disorders, like hypersexuality. Hypersexuality can lead to unusual or increased sexual behavior, which may have devastating effects on relationships. Changing medications or reducing the dose of medication can help, and people who experience any side effects such as impulse control disorders should bring it to the attention of their doctor.3

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Diagnosing A Urinary Tract Infection In Older Adults

Vague, uncommon symptoms such as confusion make UTIs challenging to diagnose in many older adults. Once your doctor suspects a UTI, its easily confirmed with a simple urinalysis.

Your doctor may perform a urine culture to determine the type of bacteria causing the infection and the best antibiotic to treat it.

There are home UTI tests that check urine for nitrates and leukocytes. Both are often present in UTIs. Because bacteria are often in the urine of older adults to some degree, these tests arent always accurate. Call your doctor if you take a home test and get a positive result.

Antibiotics are the treatment of choice for UTIs in older adults and younger people. Your doctor may prescribe amoxicillin and nitrofurantoin .

More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin and levofloxacin .

You should start antibiotics as soon as possible and take them for the entire duration of treatment as prescribed by your doctor. Stopping treatment early, even if symptoms resolve, increases the risks of recurrence and antibiotic resistance.

Antibiotic overuse also increases your risk for antibiotic resistance. For this reason, your doctor will likely prescribe the shortest treatment course possible. Treatment typically lasts no more than 7 days, and your infection should clear up in a few days.

Its important to drink plenty of water during treatment to help flush out the remaining bacteria.

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What Are They Wearing

Although you should allow someone with Parkinsons Disease to assert their individuality, you can ensure they are not wearing awkward clothing. Unnecessary zips and buttons on clothing can make it difficult to remove clothing in time, resulting in leakages. Try and encourage them to wear simple clothing that is fast and efficient to remove.

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Assignment Of Interventions: Allocation

Sequence generation

Participants who provide written informed consent will be randomised using a computer generated system to either TTNS intervention or non-active stimulation arm and will be minimised on two factors: severity of urinary symptoms, as reported at study baseline by the IPSS in the Clinical Assessment Form, that is, mild, moderate or severe and status on antimuscarinic medication, that is, treatment naïve, failed or continuing such treatment.

Concealment mechanism

A web-based randomisation system will be used.

Implementation

Implementation will be by staff at the Centre for Healthcare Randomised Controlled trials Clinical Trials Unit at Aberdeen.

Parkinson’s Disease And The Bladder

What is urinary incontinence? Causes, symptoms and treatment explained

In this 30-minute video lecture Dr. Donna Deng explains the cause of bladder dysfunction and quality of life consequences. Treatment options include behavioral modification, pharmacologic, nerve stimulation , Implantable Impulse Generator, and Botox injections. Last line of treatment for older men with Parkinsons should be prostate surgical procedures.

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Clean Intermittent Self Catheterization

The finding of a high post-void residue is unusual in patients with PD. If the PVR volume is consistently more than 100 mL, clean intermittent catheterization has been advocated. Specific issues related to dexterity in PD may make this challenging. Experienced health-care professionals, such as a continence adviser, should be involved in teaching the technique and exploring possible barriers to successful catheterization. Complications include UTI and trauma .

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How Is Parkinsons Linked To Incontinence

People with Parkinsons disease are more likely to have incontinence because messages going from their brain to their bladder can be interrupted. This is due to Parkinsons being triggered by having fewer nerve cells which contain dopamine this is a chemical messenger which helps you to have coordinated movement.

As a result of this, the bladder will contract when its not even particularly full, meaning that your loved one may not have time to get to the toilet before urine leakage occurs.

The types of urinary incontinence most often experienced by those with Parkinsons will be nocturia and urge incontinence. It is also common for people with Parkinsons to suffer from bowel incontinence.

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Adverse Event Reporting And Harms

The STARTUP trial involves treatments that are well established in clinical practice therefore, AEs will be those observed in everyday practice associated with the condition. Expected AEs arising from the treatments are noted below and thus will not be collected as AEs but noted in the weekly follow-up data collection.

Urinary tract infection

All AEs and serious AEs will be assessed for seriousness, causality, severity and expectedness and will be reported to the relevant regulatory bodies.

How Might Parkinson’s Affect Bladder Problems

From Urinary Incontinence to Parkinson

Bladder difficulties can be common in Parkinsons, particularly in the later stages of the condition. The loss of dopamine and the resulting interruption of signals from the brain can mean that messages telling the bladder to retain or expel urine are disrupted.

However, it is important to stress that bladder problems are not inevitable in Parkinsons. If difficulties do arise, especially in older people, they may be caused by factors totally unrelated to the condition, so a thorough medical evaluation should be carried out with any appropriate tests.

Bladder problems associated with Parkinsons include:

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Bladder And Bowel Problems

Bladder and bowel problems are common in men and women of all ages, but people with Parkinsons are more likely to have these problems than people who dont have the condition.

If you have Parkinson’s, you may be more likely to have problems with your bladder or bowels than people of a similar age without the condition.

Some of these problems are common in men and women of all ages, whether they have Parkinson’s or not.

Bowel problems are very common in the general public. But any change in bowel habit, particularly if you see blood in your bowel motions, should be reported to your GP.

Whatever the reason for your bladder and bowel problems, you can usually do something to help. It may be that the problem can be cured completely. But if that isnt possible, there are many different ways of managing the symptoms so they dont rule your life.

Urinary Issues In Advanced Parkinsons Disease

Urinary dysfunction and symptoms in PD are most commonly caused by overactivity of the detrusor muscle, or the muscle of the bladder, which contracts excessively despite the fact that it is not filled with urine. This causes an increased urge to urinate and/or an increased frequency of urination, which can be especially prominent at night. In advanced PD, this could culminate in urinary incontinence, or involuntary release of urine. Mobility issues which make getting to the bathroom slower and more cumbersome, compound the problem.

Always remember that people with advanced PD may have other medical problems that affect their urination such as an enlarged prostate. Make sure to have a complete evaluation before assuming that the problem is only related to PD. It is also essential to keep in mind that if changes in urination occur suddenly, there could be a urinary tract infection present.

Once other medical issues and urinary tract infection are ruled out, there are a number of approaches to the issue of urinary incontinence in a person with advanced PD:

Unfortunately, for some, the above available options may not be sufficient to effectively treat urinary incontinence in advanced PD. If this is the reality, it becomes extremely important to keep the skin dry with frequent changes of incontinence products to prevent skin breakdown and the potential development of skin infection.

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Other Treatment Options To Strengthen The Pelvic Floor

There may be some alternative treatments available as well, including:

  • Yoga
  • Tai chi

All of these have the potential to assist with bladder/urgency issues.

The goal of this article was to open up a dialogue about incontinence and urgency and Parkinsons disease. It is one of those embarrassing non-motor issues that many of us, regardless of our age, have as a result of being diagnosed with Parkinson’s.

The good news is that there are things that can be done to help that do not necessarily include medication! Exercise, diet, therapy, and a willingness to open up about this common issue with those of us with Parkinsons disease is very important. We need to keep talking about it!

First Line: Cholinergic Drugs With Care For Cognitive Function

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Anticholinergics are generally used as a first-line treatment for OAB. However, it is important to balance the therapeutic benefits of these drugs with their potential adverse effects. When the dose of drug increases, post-void residuals might appear. Dry mouth and constipation are common.

In elderly patients who have both overactive bladder and dementia , treatment of dementia and the bladder is a matter of controversy. However, it is known that once cholinergic drugs penetrate the BBB, cholinergic agents within the brain are thought to ameliorate bladder storage function., Although with extreme caution, patients with both overactive bladder and dementia could be managed, with a combination of centrally-acting cholinergic agent and peripherally-acting anti-cholinergic agent., This treatment requires close observation of patients with the assistance of caregivers.

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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.

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.

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What Happens To Someone Who Has Urinary Incontinence

The pelvic floor consists of a hammock of muscles, ligaments, and connective tissue, which covers the bottom of the pelvic cavity and assists in supporting the abdominal and pelvic organs. The pelvic floor maintains continence of bowel and bladder and plays an important role in sexual function.

The pelvic floor muscle consists of three layers and has fast and slow-twitch fibers to assist with support and sphincter properties. The muscle is the same in women and men and both sexes benefit from maintaining good strength and tone of the pelvic floor muscle.

As we age and with certain diseases such as PD our muscles become weak and the signals do not always tell the muscles to tighten up when they need too. Add a few pounds to the belly region also and you have the perfect storm for Peezing, Peelaughing, as well as a host of other words for embarrassing moments due to urinary incontinence or urgency!

What Medications Help To Treat Urinary Incontinence

PPT

So back to the TV ads for urinary incontinence that have us adding MORE medication to our already full medication bag here are many medications that can help this problem. Medications include:

  • Oxybutynin
  • Mirabegron
  • Phenoperidine fumarate

Do we really want to add that medication to the already growing list to our medications? The answer is YES!

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Management Of Sexual Dysfunction

Management of sexual dysfunction in patients with PD includes both behavioural and pharmacological options depending on the nature of the sexual dysfunction. Behavioural therapy may be used to treat SD, if considered as a learned maladaptive behaviour and may involve the use of psychodynamic psychotherapy and cognitive behavioural therapy . Pharmacological treatment of SD, on the other hand, requires either the reduction or elimination of drugs interfering with the sexual function or the introduction of drugs that improves sexual function . Ultimately, treatment options for SD may require multidisciplinary input from neurologists and psychologists for optimum results . Although phosphodiesterase 5 inhibitors are standard treatment option for erectile dysfunction , intracavernosal alprostadil 1.2510 g injections can be used.

The management of hypersexuality as part of an impulse control disorder includes reduction/stopping of dopamine receptor agonist and practical therapeutic strategies including psychological therapies but not limited to counselling, psychotherapy, sex, couple and behavioural therapies . Hormonal treatment specifically testosterone has been tried in PD .

Why Do Urgency And Frequency Occur

Bladder difficulties in Parkinsons are related to changes in the level of dopamine affecting the function of the bladder muscle. Parkinsons is also thought to affect the nerve pathway between the bladder and the part of the brain controlling bladder function. Some of the symptoms that affect bladder control are related to the level of dopamine in your body which will rise and fall depending on your medication level.

Other conditions such as weak pelvic floor muscles or an enlarged prostate will contribute to bladder symptoms. Constipation can also worsen bladder symptoms by putting pressure on the bladder.

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Urinary Incontinence In People With Parkinsons Disease: Part 1

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Incontinence Hotline…Can you please hold?”

Lately, I have seen television ads for bladder control medications that are proudly showing some woman roaming around with a nagging bladder always bugging her. I think it is about time that I wrote an article about the subject of urinary urgency/incontinence in Parkinsons disease. This article does NOT just apply to the women out there with Parkinsons it applies to the men as well!

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