Tuesday, April 23, 2024

Parkinson’s And Bladder Control

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Urinary Issues In Advanced Parkinsons Disease

Parkinson’s Disease and the Bladder

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.

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.

How Parkinsons Disease Affects Your Bladder Control

If you have Parkinsons disease, its notuncommon for you to develop bladder control problems at some point. This canfurther complicate your life by disrupting your sleep and affecting your sociallife. Its important to be aware of this common Parkinsons symptom andunderstand how to recognize and manage it with appropriate treatments anduseful products.

Parkinsons disease carries a long list ofpossible symptoms often categorized as either motor or nonmotor. This isbecause its a disease of the nervous system and is considered a degenerativebrain disorder originating from the basal ganglia. This part of your brainslowly loses proper function and decreases dopamine output. The end result isthe impairment of many physical movements, mood, thinking, sleep, and automaticfunctions.

In short, Parkinsons can affect almost everyarea of your life including your bladder control, which means understanding andpreparation are critical.

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Difficulty Emptying The Bladder

  • Some people with Parkinsons find it difficult to pass urine if the bladder fails to contract when required, or because the sphincter does not let urine out or a combination of the two. This is a result of reduced dopamine levels interfering with the efficiency of the bladder muscles and causing a residual amount of urine to be left in the bladder. This reduces the total amount the bladder can hold and creates a feeling of wanting to empty the bladder very often. Unfortunately, there is an increased risk of urinary infection if the bladder is not emptied completely.
  • In some older people, constipation which is often associated with Parkinsons can result in faeces collecting in the rectum. This can result in difficulties in bladder emptying, which may be because of pressure on the urethra, or mediated by the nerves in the region. The bladder is then unable to empty and may continue distending, causing dribbling incontinence.
  • Anticholinergic medications can also make emptying problems worse.

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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Urinary Complaints And Abdominal Ultrasound

Eighteen patients had a complaint of nocturia, , which was found to be the most common urinary complaint. This was followed by the complaints of urgency with or without urge incontinence, which was noted in 16 patients. Three patients had obstructive urinary complaints in the form of hesitancy and straining to void and retention. Three patients had mixed urinary complaints.

Ultrasound was suggestive of significant PVR in three patients. No patient was reported to be showing back pressure changes in the form of hydroureter or hydronephrosis. Out of 12 males, 1 patient was observed to be having prostate enlargement.

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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Other Formats

Bladder And Bowel Problems

Parkinsons and incontinence

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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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

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!

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Problems Caused By Limited Mobility

Some people with Parkinsons might soil their underwear. This is because mobility problems can make it difficult to wipe after using the toilet. If this is the case, it might help to use wet wipes, a bidet, or an adapted bottom wiper. An occupational therapist or the Disabled Living Foundation can offer further advice.

Bowel problems are common. But you should tell your GP if there are any changes in your bowel habits, particularly if you see blood in your stool. Some problems are difficult to avoid, but there are things you can do to make them less likely to happen.

Management Of Incontinence In Patients With Parkinsons Disease


It is estimated that two-thirds of all patients with PD have some degree of bladder problems ranging from complete inability to empty the bladder to the more common problem of urinating too often and to the ability to make it to the bathroom in time . Common dysfunctions are bladder overactivity, causing urinary urgency, frequency, and incontinence . Getting up at night to use the bathroom is the most prevalently reported non-motor symptom with PD, reported by more than 60%. Weak voiding is also a common dysfunction. Patients may feel like they must go frequently, but when they go it may take longer than average to void. Constipation is another common issue that may arise and being constipated can affect medication absorption. Some studies suggest that 80% of people who have Parkinsons Disease report constipation.

Patients with Parkinsons Disease may also have difficulty eliminating urine. This can be caused by a sphincter that wants to close when the bladder is ready to empty or by a bladder muscle that is too weak to expel urine. This is a concern because incomplete bladder emptying can cause accumulation of urine and the growth of bacteria. The latter can result in an infection. The symptoms of difficulty eliminating urine include weak urinary stream, dribbling or leaking, and feeling that the bladder has not completely emptied.

Patient should be educated to alert their health care provider is they have any of the following signs:

  • Leakage of urine
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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

    Balance Impairment And Falls In Parkinsons Disease

    One of the most challenging symptoms of Parkinsons disease that fundamentally affects quality of life is balance impairment that can lead to falls.

    Falls are one of the major causes of emergency room visits and hospitalizations for people with PD, so finding ways to prevent as many falls as possible is a high priority for people with PD. Thankfully there are things you can do to improve your stability and decrease the likelihood of falling, and well share some helpful tips and advice below.

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    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.

    How Might Parkinsons Affect Bladder Problems

    Parkinsons Disease | Overactive Bladder Relief With Natural Treatment

    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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    What Are The Natural Causes Of Bladder Problems

    Age is the main factor in these disorders, which affect men and women differently.

    Around the age of 50, women can develop urinary incontinence disorders mainly due to a change in pelvic musculature following pregnancy. In these cases, the muscles that allow the valve to properly close the bladder may be damaged. Coughing, laughing or pressure on the stomach can lead to slight urine leakage.

    In men, urinary problems are linked to an enlarged prostate, which then crushes the duct that connects the bladder to the outside. This makes it harder to urinate.

    How Common Are Bladder Problemswith Parkinsons Disease

    Your risk of developing bladder symptoms orloss of bladder control increases as the disease progresses. According to mostresearch, 30-40% of all Parkinsons patients experience some type of urinarydysfunction.

    The bladders two primary functions are tostore urine and empty it, and Parkinsons can affect your bladder in both ways.The most common bladder symptoms for Parkinsons sufferers are:

    • Frequent urination
    • Urgency

    This usually means the disease has affectedyour bladder nerves and theyre over signaling, telling your brain your bladderis full when it isnt. This is often referred to as a neurogenic bladder, acondition associated with any disease that affects bladder nerves.

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    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.

    Bladder Problems Are A Common Non

    Figure 5 from Bladder, Bowel, and Sexual Dysfunction in Parkinson

    When we asked people affected by Parkinsons what their research priorities were for improving everyday life, reducing urinary problems emerged in the top ten.

    Bladder problems can have a significant impact on peoples quality of life.

    Lets hear Pauls story

    I was diagnosed with Parkinsons about two years ago, but I can now look back and see that Ive had symptoms for five years or so, and this includes problems with the waterworks. My problem is not an inability to go, but if I need to go, I need to go now.

    It really affects me, my first thought when planning a trip is when am I going to be able to go to the toilet. My life is controlled by where my nearest toilet is. Its a very embarrassing situation to be in. My doctor has given me pills for an overactive bladder, which help a bit. But they dont make the problem go away. Although my other Parkinsons symptoms can be frustrating at times, if I could control my bladder problems it would be life changing for me.

    It has taken me some time to accept that my condition is a disability and as such I can access disabled facilities. The Radar Key Scheme allows me to access over 10,000 disabled facilities across the UK and you dont need to have a blue badge to use one. The scheme has given me much more confidence. If like me you are struggling with bladder incontinence then you should consider getting yourself a Radar Key, it can be a lifesaver!

    Paul, Patient and Public Involvement Volunteer

    Ongoing research

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    In a 2019 article for the University of Michigans health blog, author Jane Racey Gleeson noted that For PD patients, bladder issues are often due to fluctuations in dopamine levels affecting the bladder muscles and nerves, which are critical to how it functions. PD is also thought to impact the nerve pathway between the bladder and the area of the brain that controls bladder function.

    My sister says that her bladder medication helps with her urgency issues most of the time, but not always. She wears incontinence pads, especially at nighttime.

    All of this is so embarrassing, Bev said. I never thought this would be such a problem for me.

    In addition to medication, other treatments for bladder control include deep brain stimulation and kegel exercises, which help strengthen the pelvic floor muscles that surround the bladder. Implants and percutaneous tibial nerve stimulation are also options.

    Managing bladder problems can pose additional challenges for people with PD. Complicating the urgency issue are Bevs mobility problems. She cant always move quickly enough to get to the bathroom in time. I know that this is very frustrating for her.

    Although this was a sensitive topic to write about, both Bev and I wanted others who may be experiencing the same issues to know theyre not alone.

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