Parkinson's disease is the second most common age-related degenerative brain disease in the world. And although the exact cause is unknown, there does seem to be a genetic link. Regardless, while people understand the effects of Parkinson's because they're able to see the tremors or decline in mobility, there's a lot more to this condition than meets the eye. Here, we'll talk about the link between Parkinson's disease, urinary incontinence, and other bladder dysfunctions.
What is Parkinson's Disease?
Parkinson's disease (PD) is a progressive neurological condition that occurs when certain neurons within the brain become impaired or start to die. These neurons are responsible for producing dopamine, which helps your brain send and receive messages regarding movement and coordination. As the neurons start to fail, the neurotransmitters responsible for muscle movements and autonomous systems are imbalanced or impaired. This is what causes Parkinson's symptoms in affected individuals. The longer someone has PD, the more neurons die, and the worse the symptoms become.
Although the most well-known symptoms of Parkinson's affect motor skills (e.g., tremors, rigidity, instability, and slowness of movement), non-motor symptoms can also occur. These include cognitive changes, mood disorders, problems with sleep, and autonomic dysfunction (e.g., issues with digestion or blood pressure regulation).
Common Bladder Problems in People with Parkinson's
Another lesser-known complication of PD is urinary dysfunction. This tends to occur in more advanced stages of the disease, as more neurons fail and communication between the brain and the body becomes increasingly difficult. The nerve pathway between the bladder and the brain becomes ineffective, which is when problems with bodily functions occur.
Although not as common as the motor symptoms, about 30% of people with PD will experience one or more urinary problems, such as the inability to urinate on their own, urinary retention, or urinary incontinence. An even higher number of individuals will experience more general lower urinary tract symptoms that may contribute to these issues.
So, yes, Parkinson's causes incontinence issues and other bladder symptoms, but it's usually not until later in the disease. It's also important to understand that urologic issues generally become more common as an individual ages, and not everyone with Parkinson's will experience them.
Still, to help you prepare, here's some information on some of the urinary dysfunctions caused by Parkinson's.
- Increased Frequency — Increased urinary frequency is a common issue in which individuals feel the need to urinate more often than usual. This can disrupt daily activities and sleep, leading to frustration and fatigue. The frequent urge to urinate is due to overactivity of the bladder muscles, a condition often exacerbated by the impaired communication between the brain and the bladder caused by Parkinson's.
- Urge Incontinence — Urge incontinence involves a sudden, intense urge to urinate followed by an involuntary loss of urine. It typically occurs when the brain's signals to the bladder are disrupted, causing the bladder muscles to contract uncontrollably.
- Nocturia — Nocturia is the need to wake up multiple times during the night to urinate. It can severely disrupt sleep and is common in Parkinson's patients due to bladder overactivity or reduced bladder capacity. The decline in sleep quality associated with nocturia may also worsen other Parkinson's symptoms over time.
- Urinary Retention — Urinary retention is the inability to fully empty the bladder. It can lead to discomfort, a sense of incomplete urination, and an increased risk of urinary tract infections. In PD, it may result from weakened bladder muscles or issues with how the bladder contracts.
- Urinary Tract Infections — People with PD may experience a higher rate of UTIs due to the combination of urologic issues above.
Unfortunately, some treatment options (e.g., certain medications) can also disrupt the communication between an individual's brain and bladder, resulting in a condition known as neurogenic bladder. This can cause individuals to experience bladder contractions that don't align with the liquid inside or your need to void.
In addition to bladder issues, later stages of the disease may be associated with bowel dysfunction. The two most common include constipation and fecal incontinence.
- Constipation — Constipation tends to be an earlier symptom of PD but can continue into more advanced stages.
- Fecal Incontinence — This is the involuntary loss of fecal matter and can severely impact an individual's quality of life. It occurs when nerve dysfunctions reach the anal sphincter, but there are some treatment options available.
If you or a loved one has PD and is experiencing bladder and bowel conditions, it's important to talk to your doctor to learn about your treatment options.
How to Treat Bladder and Bowel Problems When Living with Parkinson's
Lifestyle Adjustments
One of the first steps in managing bladder and bowel problems in Parkinson's disease is making lifestyle changes. This might include scheduling regular bathroom breaks, limiting fluid intake before bedtime, and adjusting your diet to help manage constipation.
It's also important to manage and treat any underlying conditions that could exacerbate bladder function issues. There are ways to manage neurogenic bladder and other conditions, so talk to your doctor if you or your loved one are experiencing any symptoms.
Bladder Training
Bladder training involves creating a schedule for urination and gradually increasing the time between bathroom visits to improve bladder control. This method can help reduce the frequency of urination and the urgency associated with urge incontinence.
Use of Medical Equipment and Bathroom Adaptations
Sometimes, the slowness of movement in individuals with PD can make it difficult to get to a toilet in time. This can make bladder or bowel symptoms worse and increase the risk of accidents. However, several products are available that can help individuals go to the toilet with fewer challenges.
Medical equipment like raised toilet seats, a footstool, and a railing can make it easier to empty your bladder in time or empty your bowels more efficiently. Your urologist can give you more information on these products to modify your bathroom and maintain independence.
Wearing Appropriate Clothing
Additionally, it's important to carefully consider your clothing options. Choosing clothes that are easy to remove can help make it easier to get to the bathroom in time. For example, pants with elastic waistbands will be easier to manage than small zippers or troublesome clasps. To help prevent accidents, buttons, zippers, and anything too tight should be avoided.
Pelvic Floor Exercises
Pelvic floor muscles weaken as we age, which can cause further issues in individuals with Parkinson's. However, pelvic floor exercises like Kegels can strengthen the muscles that control urination and bowel movements. Regularly practicing these exercises can help reduce incontinence and improve bladder control.
Botox Injections
Another surprising treatment option for urgency and incontinence is Botox. Injections made directly into the bladder can help relax the muscles and reduce instances of overactivity. However, Botox in the bladder typically lasts only six to nine months, so the treatment must be repeated regularly.
Oral Medications
Using medications to treat urinary issues caused by Parkinson's can be a bit tricky. In some instances, the medications may actually worsen the problem. In others, they may be dangerous to mix with medications used to treat motor symptoms. Still, some options that your doctor may recommend trying include:
- Mirabegron — This relaxes the bladder muscle, allowing it to store more urine, which can help reduce symptoms of urgency and frequency.
- Antimuscarinic Medications — These drugs, such as oxybutynin and tolterodine, help to reduce bladder muscle contractions, thereby controlling urge incontinence. However, they must be used cautiously, as they can cause side effects like dry mouth and constipation.
Nerve Stimulation
Some individuals also found that nerve stimulation techniques improved bothersome symptoms. However, this is not usually the first approach to treatment. Your doctor may recommend it only if other options have failed.
Incontinence Products
For those who continue to experience incontinence despite other treatments, various incontinence products are available, such as absorbent pads, adult diapers, and waterproof bedding. These products can help manage symptoms discreetly and improve quality of life by reducing the anxiety associated with accidents.
If you or a loved one is experiencing incontinence from PD or other underlying causes, it's important to seek help from your urologist.
In the meantime, Byram Healthcare is committed to providing support, information, and solutions for individuals with urologic issues. We understand the challenges of these conditions and strive to empower our customers with the knowledge and resources they need to manage their health effectively. We offer several high-quality incontinence products to help manage symptoms and improve your quality of life.
