Tuesday, May 14, 2024
Tuesday, May 14, 2024
HomeUpdatesParkinson's And Urinary Tract Infections

Parkinson’s And Urinary Tract Infections

Confusion And Urinary Tract Infections: The Living With Parkinson’s Tip Of The Day

Urinary Dysfunction and Parkinson’s with Arun Mathur

Artwork by Jonny Acheson

My spouse or family member has Parkinsons and has suddenly become confused.

This is one of the most common calls we receive in the Parkinsons clinic and on the 18004PDINFO Parkinsons Foundation helpline.

Some of the callers are frightened because there may also be coexisting hallucinations or paranoia.

Here are a few tips to remember:

  • This confusion could be caused by a urinary tract infection, even without a fever or other symptoms .

  • Urinary tract infections can occur in both men and women with Parkinsons.

  • Untreated a urinary tract infection can lead to sepsis and if you get septic there is a high chance of death or other bad outcome. The infection can start in the bladder and travel up to the kidneys and even enter into the bloodstream. Immediate treatment is important.

  • Sometimes doctors call urinary tract infections, UTIs for short.

  • A urinalysis and culture of the urine is important. The culture will hopefully grow the specific bacteria so that an appropriate antibiotic can be chosen for treatment.

  • Urinary tract infections can lead to confusion, thinking problems, illusions, hallucinations and paranoia.

  • We should have a low threshold for checking for the presence of a urinary tract infection if there is sudden onset confusion.

How Can I Prevent Utis

Prevention is key to avoiding UTIs and the complications that may arise from them. Fortunately, there are several actions you can take right away to keep your urinary tract flowing correctly.

  • Drink plenty of water. Drinking water dilutes your urine and makes you urinate more often. This keeps bacteria moving steadily through your urinary tract before they can multiply and cause infection.Suzette Sutherland, MD, director of female urology at the University of Washington School of Medicine, says that one of the top reasons people develop urinary tract infections is simply not drinking enough fluids and keeping their urinary tract flushed.
  • Track your symptoms. Use our bladder worksheet to track your urinary symptoms and help you plan a conversation with your physician about any urinary concerns.
  • Visit a physical therapist. A physical therapist can teach you pelvic floor exercises, such as Kegels, that can help you manage incontinence or other urinary challenges. Regular pelvic floor exercises can help strengthen and retrain the muscles associated with urination and defecation.
  • Take preventative measures regarding sexual activity. Sexually active women can minimize their risk of developing UTIs by urinating soon after intercourse and avoiding birth control methods like diaphragms, unlubricated condoms, and spermicidal agents.
  • 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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    What Are The Symptoms

    The most common urinary symptoms people with Parkinsons experience include:1

    • Frequent need to urinate
    • Trouble delaying urination once aware of the need, creating a sense of urinary urgency
    • Less frequently, difficulty initiating a stream or emptying the bladder

    I have experienced the first 2 symptoms listed, along with leaking or sputtering. Not all the time, but episodically and almost every day.

    Institutional Characteristics And Patient Selection

    Parkinson

    This study was approved by the institutional review board at Yale University School of Medicine. Subjects were selected from patients followed by 1 physician at the Yale Urology Medical Group Clinic. All patient visits at the clinic are logged by the Patient Financial Services Department under corresponding diagnosis codes. Follow-up notes from clinic visits or phone calls are recorded in patient charts by the same physician after each encounter.

    Inclusion criteria for the study were as follows: neurogenic bladder dysfunction stable traumatic SCI at least 1 year after injury bladder management with CIC minimum of 1 year follow-up by the same physician at the Yale Urology Clinic seen between the 2000 and 2010. Exclusion criteria were other etiology for neurogenic bladder such as multiple sclerosis, Parkinson disease, spina bifida, or diabetes other methods of bladder management, including other catheterization methods or Crede maneuver or had undergone urinary diversion.

    Age, years

    Note: Data presented as mean ┬▒SD, unless noted otherwise data in parentheses are percentages. PRx = prophylaxis UTI = urinary tract infection.

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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 To Do About It

    Be honest with your doctor and report any urinary tract issues ASAP. Your next step will most likely be with a urologist. Your urologist will perform tests and examinations to rule out other problems. My doctor looked for benign prostatic hyperplasia and prostate cancer.

    There are medications and surgery methods to treat these conditions. I have had surgery for benign prostatic hyperplasia. Barring any of these conditions, your symptoms related to Parkinsons may be treated by medications. Your doctor may also recommend exercises such as kegels.1

    For those with leakage issues, absorbent pads are available for both bedding and clothing. I take medications and episodically used pads. I encourage you to stay socially active, even it it means wearing pads.

    What Damages Brain Cells And Nerves

    Parkinson’s Disease and the Bladder

    Damage to brain cells can occur in many ways, including:

    • Alzheimers disease the most common cause of dementia in seniors. For yet unknown reasons, victims develop clumps and tangles of proteins in their brain.
    • Frontotemporal dementia nerve cells associated with behavior, language, and personality have degenerated.
    • Lewy body dementia clumps of protein called Lewy bodies damage the victims brain. Lewy bodies are also part of Alzheimers and other diseases.
    • Vascular dementia damaged blood vessels are no longer able to supply the brain with nutrition. The blood vessels can be damaged in a variety of ways, including from a stroke.
    • Certain diseases such as Parkinsons.

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    Risk Stratification Of Pd Patients With Serious Infection

    Table 4 shows that patients with renal insufficiency and cancer were at a higher risk of mortality. Elderly patients with lower blood pressure at the ED were also prone to bad outcomes. Respiratory tract infection carried a higher risk of mortality than other infection sites in contrast, urinary tract infection carried the lowest risk of mortality. After we adjusted for age and sex for all significant comorbidity and infection focus factors, we found that age , female sex , respiratory tract infection , cancer , and renal insufficiency were significant risk factors of sepsis-related mortality, whereas urinary tract infection carried a higher chance of survival.

    Epidemiology And Clinical Impact

    Patients with PD are twice as likely to be admitted for UTI compared to non-PD controls . Although the risk of UTI increases with age and is generally more common in women, PD-associated UTI occurs in relatively equal proportions between older men and women, consistent with the notion that PD, and the secondary effects inherent to the disease, supersede sex as a risk factor for UTI . PD-associated UTI is likely under-reported, as it is often classified as a urinary disorder rather than as an infection . Furthermore, the reason for hospitalization in patients with PD and UTI may be categorized under a related incident, such as a fall secondary to UTI, rather than the UTI itself , thus underestimating the actual incidence and significance of PD-associated UTI. PD is the second most common neurodegenerative condition after Alzheimers disease and is the fastest growing neurologic condition overall . With PD cases expected to double by 2030 , PD-associated UTI is expected to only increase in importance to health care providers and planners in the coming decades.

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    Management Strategies To Prevent Uti In Pd

    Although there is little in the way of high-quality data to prevent UTI in PD, several measures can be considered as part of a multifaceted approach. In general, all patients with PD and urinary retention should be counseled on maintaining adequate hygiene including perineal cleanliness and, if required, aseptic catheterization techniques . In addition, regular scheduled bladder and bowel emptying should be encouraged to reduce urinary retention and inadvertent fecal contamination from stool incontinence. There should be a low threshold to treat comorbid medical conditions that increase the risk of urinary retention and UTI, such as benign prostatic hyperplasia or diabetes, and adjustment of medications that promote urinary retention . More PD-specific research is urgently needed to address this important issue.

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    Shingles And The Bladder

    When a nerve is irritated, as with a shingles infection, it becomes inflamed, which affects the function of the nerve and all structures attached to the nerve. In some instances, nerves become hyperactive and overstimulate the structure. In the case of the detrusor muscle, which controls contraction and emptying of the bladder, overstimulation will result in frequent urination , a sudden need to urinate and leakage associated with urgency –all symptoms of an overactive bladder. In other instances, nerve inflammation can disrupt signal transmission, preventing the structure from functioning properly. If inflammation disrupts transmission to the sphincter muscles, the muscles may no longer contract fully, resulting in urine leakage. Or, the muscles may not fully relax, resulting in difficulty urinating. If inflammation disrupts the signals to, or from, the brain the bladder may retain urine, leading to overflow incontinence, infection and even kidney damage.

    • When a nerve is irritated, as with a shingles infection, it becomes inflamed, which affects the function of the nerve and all structures attached to the nerve.
    • In the case of the detrusor muscle, which controls contraction and emptying of the bladder, overstimulation will result in frequent urination , a sudden need to urinate and leakage associated with urgency –all symptoms of an overactive bladder.

    How Does Parkinson’s Affect The Bladder

    In the second out of two posts, we explore how Parkinsons Disease affects bladder and bowel function, and hear from those who eventually found effective ways to manage their symptoms.Bladder difficulties are common when you have Parkinson’s disease, particularly in the later stages of the condition. The symptoms differ from person to person, but the most common are:

    We spoke to Mary and Jerry, who both have Parkinson’s disease. In these excerpts from our free guides – Bladder and Bowel dysfunction when you have Parkinson’s Disease, they describe how the progression of the disease led them to seek out effective bladder management routines.

    To learn more about how Parkinson’s affects bladder and bowel function, and effective therapies for managing these symptoms and functions, we’ve made these free guides available for download.

    Jerry’s story

    Female and male anatomy are different, and the effects of Parkinson’s disease may have different effects when it comes to bladder and bowel dysfunction.

    The bladder and bowel also interact and effect the functioning of these processes. In these free guides, we look at the symptoms, effects and therapies available to manage this condition.

    Bladder and Bowel dysfunction when you have Parkinson’s Disease

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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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    Treatment For Over Active Bladder In Parkinsons

    Urinary or Urologic Issues in Parkinson’s Disease and Parkinsonism

    Overactive bladder affects up to 27% of men and 43% of women of the global population. Now, add a neurological condition and the problem becomes more challenging. First, there is a list of medications which make the problem worse, so should be avoided. Then, a thorough evaluation and physical exam. Treatment depends on the cause, but evaluating all medications and an adjustment of dopamine medication is often necessary. If you are still having problems, five further treatment options are included.

    Eating the right amount of fibre and drinking enough fluids can help if you have constipation.

    To get more fibre in your diet:

    • choose a breakfast cereal containing wheat, wheat bran or oats, such as Weetabix, porridge or bran flakes.
    • eat more vegetables, especially peas, beans and lentils.
    • eat more fruit fresh, stewed, tinned or dried. High fibre fruits include prunes or oranges.
    • drink plenty of fluids throughout the day to avoid dehydration. Lots of fluids are suitable, including water, fruit juice,
    • milk, tea and squashes. Cut out caffeine to avoid overstimulation of your bladder.

    If you find it difficult chewing high-fibre food, you can get some types which dissolve in water. You can also get drinks which are high in fibre.

    Try to increase how much fibre you get gradually to avoid bloating or flatulence .

    A dietitian can give you further advice. Ask your GP, specialist or Parkinsons nurse for a referral.

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    Inflammatory Biomarkers In Pd Patients

    The presentation of infectious biomarkers among PD patients with or without mortality is shown in Table 5. Serum C-reactive protein , bandemia, and lactate levels were good indications for prediction of 28-day in-hospital mortality of infected PD patients. On receiver operating characteristic curve analysis, CRP, bandemia, and lactate had areas under the curve of 0.648 , 0.656 , and 0.653 , respectively, with different enrolled case numbers.

    Urinary Retention And Stasis

    As previously mentioned, advanced PD may predispose to urinary retention through a variety of mechanisms. One Korean study of 197 PD patients found that 8.9% had increased post-void residual volumes over 100cc, a well-established risk factor for UTI . Another potential mechanism involves motor dysfunction itself, as patients with advanced PD may have severe rigidity/akinesia preventing access to toileting. Additionally, as PD patients may be at higher risk for urinary incontinence, they may be prescribed anticholinergics, which may independently contribute to an increased risk of UTI . Caution should be taken when titrating antimuscarinic agents on patients with advanced PD and PD dementia to avoid the risk of drug-induced urinary retention. PD patients with cognitive impairment and spastic bladder may benefit from timed or prompted voiding to prevent episodes of urinary incontinence and avoid the need for antimuscarinic therapy, as discussed in further detail below under Management strategies to prevent UTI in PD.

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    What Treatments Are Available For Utis

    The first line of treatment for many people who develop UTIs is a course of antibiotics. Often, this is the only treatment needed. Several different antibiotics can treat UTIs, and your provider will use results from a urine sample to determine which is right for you.

    If the UTI is considered complicated , your doctor might prescribe a higher dose of antibiotics. If the infection is severe or in your kidneys, your physician may refer you to the hospital for high-dose antibiotics administered through an IV.

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