Urinary Problems In Parkinson’s Disease

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.

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.

Coping With Urinary Problems In Parkinsons Disease

If you have Parkinsons disease, you may end up having to deal with urinary problems which research shows are common in addition to other symptoms of Parkinsons disease.Since urinary symptoms can lead to other problems, such as disrupted sleep and disruption to social activities, its important to be aware of these problems and know what you can do to help with this

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Same Types Of Bladder Issues

The most common type of bladder problem has been difficulties in holding urine. As a result, individuals are unable to hold urine for sufficient lengths of time and this results in an increased frequency to urinate in the day and night. Individuals may need to rush to the toilet and this may sometimes lead to incontinence. Additionally, individuals may report problems with urination such as difficulties in starting their urinary stream, known as urinary hesitancy, a weak and interrupted urinary stream and, occasionally, may also experience retention of urine. Difficulties in urination are not as noticeable as problems with holding urine, and some individuals may unknowingly leave behind urine in their bladder after urinating. This is known as the post-void residual volume, and as a routine should be measured through a simple bedside ultrasound scan. Holding back a significant quantity of urine in the bladder after urinating can increase the risk for developing urinary tract infections.

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.

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Evaluating And Treating Urinary Issues In Parkinson’s 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.

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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Bladder Problems In Parkinsons

The primary function of the bladder is twofold to store urine as it is made and then to empty the urine. With Parkinsons, problems can emerge in both areas.

Recent studies suggest that 30-40% of people with Parkinsons have urinary difficulties. Despite the frequency of urinary dysfunction, actual urinary incontinence is relatively uncommon. Troublesome incontinence develops in only about 15% of people with Parkinsons.

The most common urinary symptoms experienced by people with Parkinsons are:

• The need to urinate frequently
• Trouble delaying urination once the need is perceived, creating a sense of urinary urgency

These symptoms usually mean you have an irritable or overactive bladder. Your bladder is signaling the brain that it is full and needs to empty when, in fact, it is not. This can happen at any time, so you might have to get up multiple times during the night to go to the bathroom.

Impairment of bladder emptying is a less frequent but still troublesome feature of urinary dysfunction in Parkinsons. This may be caused by delay or difficulty in relaxation of the urethral sphincter muscles. These muscles must relax for the bladder to empty. This can result in hesitancy in initiating urination, difficulty in generating a stream and incomplete emptying of the bladder. Dystonia involuntary muscle contractions of the urethral sphincter has also been described.

A New Toilet Or An Alternative

If you have real difficulties getting to the toilet, it may be possible to get a grant to build a new one, perhaps downstairs. An occupational therapist can advise you on this.

Not all homes are suitable for building new toilets, so a commode might be needed. A commode is a moveable toilet that doesnt use running water. It looks like a chair, with a container underneath that can be removed and cleaned after someone has used it. They can be very discreet.

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Parkinsons Disease And Your Bladder

Many diagnosed with Parkinsons disease experience urinary tract issues. A Michigan Medicine urologist discusses treatment options for patients to consider.

Anne Pelletier-Cameron, M.D., often jokes to her patients that shes a female plumber of the lower urinary tract. On a more professional note, however, shes a urologist in the Michigan Medicine Department of Urology.

In this role, Pelletier-Cameron treats patients with a variety of lower urinary tract symptoms. Some of her patients have been diagnosed with Parkinsons disease, a progressive nervous system disorder that impacts movement. But the breakdown of nerve cells that characterize Parkinsons disease can also cause non-movement symptoms, including bladder issues.

Half of all women and 17% of men will experience urinary incontinence, or the inability to hold urine, she says, noting that for Parkinsons disease patients, those numbers escalate.

Many of my PD patients end up having other bladder problems, including issues with urgency and frequency, says Pelletier-Cameron. Nocturia, or the need to urinate many times during the night, is also common, along with difficulty in emptying the bladder.

Pelletier-Cameron says the impact of bladder symptoms cant be ignored.

Treating And Managing Bladder Problems

It is important to discuss any bladder difficulties, including those listed below, with your doctor, even if this may appear embarrassing. Your doctor will then be able to properly assess and treat any problems, for example:

• inability or difficulty emptying the bladder even when it feels full
• significant, uncontrolled leakage of urine at any time
• unusually frequent urination
• an urgent, immediate need to urinate, or urine leaking if you do not immediately do so
• pain when urinating.

It may be helpful to write notes to discuss with your doctor, for example, the type of difficulties experienced, their frequency, when you first noticed a change, and your normal eating and drinking habits.

Bladder problems can occur for a number of reasons, so the first approach will be to eliminate causes other than Parkinsons, such as urinary infections and prostate problems in men.

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Parkinson’s Disease And The Bladder

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.

Urinary Dysfunction And Parkinsons

This one-page fact sheet explains that urinary dysfunction is one of several non-motor symptoms of Parkinsons disease that are the result of Parkinsons impairing proper function of the autonomic nervous system, especially in later stages of the disease process. Several types of urinary dysfunction and treatment options are outlined.

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Incomplete Emptying Of The Bladder

Parkinsons disease may also make it harder for you to empty your bladder completely. This occurs less frequently than the need for frequent urination, but it still affects many people with Parkinsons.

Your muscles are the culprit of this problem. When you urinate, you relax certain muscles, and Parkinsons can make it difficult to relax those muscles. Sometimes, it takes a long time to relax enough, and people may not spend long enough in the bathroom to empty their bladder.

Unfortunately, medications dont always help fully with bladder emptying in Parkinsons disease patients, although the drug urocholine or other medications designed to treat urinary retention may help. different.

Some people with urinary retention have to use a catheter to empty their bladder. If this is the case for you, your healthcare provider can instruct you on how to use the catheter.

Related To My Parkinsons Disease

Waking up at night with the need to urinate, known as nocturia, can occur in nearly 60% of individuals with Parkinson’s disease. This can result from either a small sized bladder or result from overactivity of the muscle lining the bladder wall called the detrusor , or it can occur from increased production of urine in the night . The assessment of nocturia may nececitate filling in a 3-day diary so that we can better understand the frequency of urination and volumes of urine voided. You may also need to undergo a test of bladder function called urodynamics. Having ankle swelling , medical conditions such as diabetes, heart failure or obstructive sleep apnoea, and alsosome types of medications such as diuretics can increase the chances for developing nocturia.

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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.

How Might Parkinson’s Affect Bladder Problems

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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Parkinson’s Disease And Voiding Dysfunction

In this 54-minute webinar, urologist Dr. Sidney Radomski explains how voiding function is affected by Parkinsons disease in both men and women. He discusses how an enlarged prostate contributes to voiding problems and management options of voiding dysfunction for those with Parkinsons disease and MSA.

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Increased Risk Of Overactive Bladder In Patients With Idiopathic Parkinsons Disease: Insight From A Nationwide Population

• Roles Conceptualization, Investigation, Methodology, Writing original draft

  Affiliation Department of Neurology, China Medical University Hospital, China Medical University School of Medicine, Taichung, Taiwan

• Affiliation Department of Neurology, China Medical University Hospital, China Medical University School of Medicine, Taichung, Taiwan

• Cheng-Li Lin,

  Roles Data curation, Formal analysis, Project administration

  Affiliations College of Medicine, China Medical University, Taichung, Taiwan, Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

• * E-mail:

  Affiliations National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan, Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan, Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Urinary Problems In Parkinsons Disease

This 1-hour webinar is an interview with Dr. Janis Miyasaki, Dr. Jorges Juncos, and retired movement disorder specialist and young onset Parkinsons patient, Dr. Maria De Leon. They discuss the effect of Parkinsons disease on the autonomic nervous system, which regulates many body functions, including bladder control. Urinary problem diagnosis, symptom management and ongoing research on the topic wrap up the hour.

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Sexual Dysfunction In Parkinsons Disease

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

Gastrointestinal Issues In Advanced Parkinsons Disease

Problems with motility of the gut can be a major source of difficulty throughout the disease course and can be particularly problematic in advanced PD as well. . Constipation, which can be one of the earliest symptoms of PD is a very common problem throughout the disease course. Two gut issues that tend to be particularly problematic in people with advanced PD are abdominal pain and fecal incontinence.

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Treatment For Genitourinary Dysfunctions

Unlike the motor symptoms of PD, genitourinary dysfunctions do not respond to levodopa therapy, and other treatments must be used. There are several medications that can help manage urinary difficulties, including Detrol® , Ditropan® , Enablex® , and Vesicare® . These medications work to block or reduce overactivity in the bladder. Treatments for sexual dysfunction include counseling or talk therapy, treating erectile dysfunction with Viagra® or Cialis® , and the use of lubricants in women.1,3-5

With My Bladder Problems

Signals from the brain may control bladder function, and dopamine plays an important role through exerting an inhibitory effect on the bladder reflex. When dopamine levels decrease in Parkinson’s disease, there may be a loss of control over the reflex meaning that the bladder is no longer inhibited and may take on a life of its own.” Once it takes on a life of its own it may begin to misbehave. It is likely that alterations in other chemicals in the brain may also contribute to the bladder problems in Parkinson’s.

There may be of course other causes for bladder symptoms in individuals with Parkinson’s and therefore it is important to investigate symptoms before concluding that they are Parkinson’s related.

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