Coping with Urinary Problems in Parkinson's Disease

Common Urinary Conditions and Treatment with Parkinson's Disease

male executive running to the toilet
What urinary problems are common with Parkinson's disease and how are they treated?. Credit: Peter Cade / Getty Images

If you have Parkinson's disease, you may eventually have to deal with urinary problems—studies show that urinary concerns are common in addition to the other symptoms of Parkinson's. Since urinary symptoms can lead to other problems, such as interrupted sleep and interference with social activities, it important to be aware of these concerns and learn what can be done to help.

Incidence of Urinary Problems in Parkinson's Disease

As your Parkinson's gets worse, your risk of having urinary problems will increase.

Overall, up to 39 percent of people with Parkinson's disease experience some issues with their urinary function. Fortunately, your risk of outright urinary incontinence is small—only about 15 percent.

Nighttime Urination (Nocturia)

By far the most common urinary symptom for those with Parkinson's disease, affecting at least 60 percent of people (along with many other people in the same age group) is the need to urinate at night, also called nocturia. This symptom, in turn, can have several different causes and mechanism with Parkinson's disease.

Urge Incontinence in Parkinson's Disease

The next most common urinary problem is the urge to go frequently—for some people, extremely frequently. This urge happens because the nerve signals between your bladder and your brain aren't getting through properly.

This need to urinate frequently can cause all kinds of inconveniences. One of the most troublesome is incontinence, which can occur when you feel like you just can't wait to get to the bathroom and the sudden urge to urinate is followed by involuntary emptying of the bladder.

Obviously, this can be embarrassing.

Urge incontinence may occur suddenly during the daytime, or cause nighttime awakening or bed-wetting. It may be precipitated by drinking water, or especially, hearing water running in the bathroom or kitchen.

There's a variety of different medications that may help to address this problem of needing to go too frequently.

If you're having this problem, talk to your doctor about it so that he can help you address it.

Sleep Problems Stemming from Urinary Issues

Another problem with frequent urination in Parkinson's disease is that it disrupts your sleep. Needless to say, people with Parkinson's have enough problems with sleep without having to wake up and go to the bathroom every couple of hours!

So what can you do about this urge to go frequently at night? Most doctors recommend reducing your evening fluid intake and emptying your bladder immediately before going to bed. Setting up a bedside commode so that when you need to go in the night all you have to do is sit or stand next to the bed may also help. Finally, you can consider using disposable undergarments such as Depends at night to avoid multiple trips to the bathroom.

Incomplete Bladder Emptying

Parkinson's disease also may make it more difficult for you to empty your bladder completely. This occurs less frequently than the need to urinate frequently, but it still affects plenty of people with Parkinson's.

Your muscles are to blame for this problem. When you urinate, you relax certain muscles, and Parkinson's can make it difficult for you to relax these muscles. Sometimes, it takes a long time to relax enough to go, people may not stay in the bathroom long enough to empty their bladders.

Unfortunately, medications aren't always as helpful with incomplete bladder emptying in Parkinson's disease, although the medication Urecholine (generic name: bethanechol) or other drugs aimed at treating urinary retention may make a difference.

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

Treatments for Urinary Symptoms with Parkinson's Disease

The specific treatments for urinary symptoms in Parkinson's disease depend on the underlying mechanisms. Some options (depending on the cause and mechanism) include:

  • Medications - Drugs, especially antimuscarinic drugs such as the older drug Ditropan (oxybutyrin) may be helpful for some people, but a difficulty with using medications for urinary symptoms with Parkinson's disease is that many of these drugs can worsen other symptoms.
  • Bladder training
  • Botulinum toxin placed into the bladder
  • Catheters
  • Conservative measures such as a commode at the bedside and Depends.

Bottom Line with Urinary Symptoms with Parkinson's Disease

Urinary symptoms are very important to evaluate in those with Parkinson's disease. In other words, they are not just a nuisance. Combined with mobility problems due to the disease, nighttime urination and urge incontinence can raise the risk of falls, and all that goes along with falls. The treatments we have for urinary symptoms may be effective for some people, but also have the potential for worsening other symptoms of Parkinson's disease. If you are living with the disease, consider asking for a consult with a urologist who specializing in the treatment of urinary symptoms in those who are also coping with Parkinson's disease.

Sources:

McDonald, C., Winge, K., and D. Burn. Lower Urinary Tract Symptoms in Parkinson’s Disease: Prevalence, Aetiology, and Management. Parkinsonism and Related Disorders. 2016 Nov 1. (Epub ahead of print).

Sakakibara, R., Panicker, J., Finazzi-Agro, E. et al. A Guideline for the Management of Bladder Dysfunction in Parkinson’s Disease and Other Gait Disorders. Neurourology and Urodynamics. 2016. 35(5):551-63.

Yeo, L., Singh, R., Gundeti, M., Barua, J., and J. Masood. Urinary Tract Dysfunction in Parkinson’s Disease: A Review. International Urology and Nephrology. 2012. 44(2):415-24.

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