Parkinson’s Frequent Urination At Night

How Can Parkinsons Disease Cause Incontinence

Individuals with Parkinsons Disease can develop incontinence when the communication between the brain and the bladder becomes faulty. The bladder is a muscle that expands gradually as urine collects. At the opening of the bladder, there is a muscle called the sphincter. This muscle is usually closed except during urination. The brain controls both the bladder and the sphincter muscle. Under normal circumstances, the bladder begins to have small contractions that alarm the brain when 1-2 cups have been collected in the bladder. In Parkinsons Disease, however, the brain lacks complete control over the sphincter. Parkinsons disease attacks the brain, focusing on dopamine-producing cells. These cells are vital in maintaining brain health, as they deal with signals controlling muscle movement. In patients with Parkinsons disease, the bladder becomes overactive and has unwanted contractions which can be impossible to stop. This miscommunication and lack of control can cause a person with Parkinsons Disease to feel the need to empty their bladder even when there is just a small amount of urine present. Sufferers can also often find themselves finding it difficult to eliminate urine.

Parkinsons Disease can affect the brain and spinal cord

Nocturia Or Frequent Urination At Night

Dr. Abhinav Singh, Sleep Physician

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Millions of Americans are affected by a frequent need to urinate during the night. This is known as nocturia, and it is often cited as a cause of sleep disruptions. Though frequently thought of as a problem in elderly people, it can impact people of all ages.

Trips to the bathroom can cause fragmented sleep, excessive daytime sleepiness, and an elevated risk of dangerous falls. Nocturia has numerous potential causes and can be connected to a range of serious health issues.

Although nocturia is common, it shouldnt be accepted as inevitable. In many cases, steps can be taken to reduce bathroom trips and improve sleep. Understanding the basics about frequent nighttime urination, including its causes, consequences, and treatments, can be a first step for people of any age to sleep better and with less bothersome nocturia.

Rem Sleep Behavior Disorder

REM sleep behavior disorder is common in people with Parkinsons disease, says Horvat. REM stands for rapid eye movement, and REM sleep is a stage of sleep associated with dreaming.

People with RBD can have very vivid dreams in which they are defending themselves or a loved one from being attacked or are being chased by animals, insects, or people, said Joohi Jimenez-Shahed, MD, a neurologist at Mount Sinai Health System in New York City, in a caregiver presentation sponsored by the Houston Area Parkinson Society.

During these episodes, people with RBD will start acting out their dreams, usually in the last half of the night, says Horvat. Shouting, swearing, grabbing, punching, jumping, and kicking while asleep are all symptoms of RBD.

Ill have patients tell me, I was fighting someone in my dream, I woke up punching, and I hit my significant other who was in bed next to me, she says. This can be very dangerous for both the person with PD and their partner, says Horvat. It can cause someone to fall out of bed Ive had patients suffer brain bleeds because of this.

There are treatments that can help, such as melatonin or benzodiazepines , she says. We also look for other sleep disorders because they can make RBD worse: I actually have a patient where we resolved these episodes by treating their sleep apnea, says Horvat. If youre experiencing these types of dreams, you need to discuss this with your doctor, she adds.

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Tips For Better Sleep

• Keep a regular sleep schedule go to bed at the same time and get up at the same time.
• Choose your bedtime based on when you want to get up. Plan to spend seven to eight hours a night in bed.
• Make a bedtime routine for example, snack, evening medication, tooth-brushing, using the restroom and follow it every evening.
• Spend time outdoors and exercise every day, in the morning if possible. Avoid exercise after 8:00 p.m.
• If you cant get outdoors, consider light therapy sitting or working near a light therapy box, available at drug stores and department stores.
• If you nap, try to do so at the same time every day, for no more than an hour, and not after 3:00 p.m.
• Sleep in a cool dark place and use the bed only for sleeping and sexual activity.
• Do not read, watch television, or use electronic devices in bed.
• If turning in bed is difficult: use a satin fitted sheet and pajamas use a light quilt instead of an easily tangled bedsheet.
• Minimize drinking liquids for three hours before bedtime to avoid frequent nighttime urination.
• Go to the bathroom immediately before retiring.
• Consider a soft, rather than bright, light to illuminate your path to the bathroom.
• Place a portable commode next to the bed to minimize effort, if needed.

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.

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Cognitive And Psychiatric Symptoms

• depression and anxiety
• mild cognitive impairment slight memory problems and problems with activities that require planning and organisation
• dementia a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there and believing things that are not true

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.

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Options For Overactive Bladder In Patients With Parkinsons Disease

Dr. Brucker also led two retrospective studies investigating alternative treatments for OAB in patients with Parkinsons disease. Patients with overactive bladder often have distressing urinary incontinence. When patients have a neurological basis for their bladder dysfunction, the efficacy of available treatments can be difficult to assess.

To shed light on the efficacy and safety of potential treatments, Dr. Bruckers team examined two therapies that have been used in OAB patients without Parkinsons disease one study investigated mirabegron, a novel Beta adrenoceptor agonist approved for OAB in 2012 the other examined onabotulinum toxin A injections . While both treatments have been shown to be safe and effective for OAB, anticholinergic drugswhich increase the risk of cognitive dysfunction and adverse eventsremain the standard of care for patients with Parkinsons disease due to lack of clinical studies.

In the first study, investigators examined records of 50 Parkinsons patients who received daily doses of mirabegron between 2012 and 2017. After 6 weeks of treatment, 50 percent of patients experienced improvement, and 11 percent reported complete resolution of their OAB symptoms. The therapy was well tolerated, and median time to discontinuation was longer than that observed in other OAB patients.

The study findings were published in Neurourology and Urodynamics and Parkinsonism and Related Disorders, respectively.

Causes Of Frequent Urination At Night

• Chronic Conditions

Nocturia is the medical term used to describe the need to get up frequently at night to urinate. It is a condition that people commonly attribute to older age, but there are other reasons why it can occur. Some causes are benign and readily resolved with lifestyle changes others may be persistent or signs of a serious illness.

Chronic nocturia can significantly affect a person’s well-being and quality of life, causing sleep deprivation, daytime fatigue, impaired concentration, depression, and a loss of productivity.

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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 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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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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Evaluating And Treating Urinary Issues In Parkinsons 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.

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If You Are Experiencing Sleep Problems You Should Avoid:

• Alcohol, caffeine and other stimulants such as nicotine
• Heavy late-night meals
• Heavy exercise within six hours of bedtime
• Thoughts or discussions before bedtime about topics that cause anxiety, anger or frustration
• Clock watching
• Screen time television, phones, tablets one or two hours before bed.

Certain antidepressants, such as mirtazapine may help with sleep while others the SSRIs can make other sleep symptoms worse. Also, if you are unsure, check with your doctor or pharmacist to ensure alerting medications are being taken in the morning and sedating medications are being taken at night.

If urinary frequency keeps you up at night, be sure your doctor rules out causes other than PD. In addition, there are several medications that can be helpful, including oxybutynin , tolterodine , trospium , tofenacin succinate , darifenacin , mirabegron and phenoperidine fumarate . You may be referred to a bladder specialist .

How To Prevent It

There are steps you can take to lessen the impact of nocturia on your life.

Reducing the amount you drink 2 to 4 hours before going to bed can help prevent you from needing to urinate at night. Avoiding drinks that contain alcohol and caffeine may also help, as can urinating before you go to bed. Some food items can be bladder irritants, such as chocolate, spicy foods, acidic foods, and artificial sweeteners. Kegel exercises and pelvic floor physical therapy can help strengthen your pelvic muscles and improve bladder control.

Pay close attention to what makes your symptoms worse so you can try to modify your habits accordingly. Some people find it helpful to keep a diary of what they drink and when.

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Treating And Managing Bowel Problems

The first step in dealing with bowel disorders is to talk to your doctor. He or she will probably review your medication to see if this is a contributory factor. Whilst it is usually possible to control any difficulties with diet, fluid intake and exercise, your doctor, or Parkinsons nurse specialist if you have one, will be able to advise further, and may, for example, prescribe laxatives in severe cases of constipation. If you have any alarm features such as unintentional weight loss or rectal bleeding, then you may need to be referred for specialist assessment.

The following healthcare professionals can also advise on aspects of bowel care:

• A dietician will be able to advise on diet and fluid.
• A physiotherapist may be able to help with advice and abdominal exercises which will help in passing stools.
• A speech and language therapist can help with swallowing problems. They may be able to advise on ways of relaxing your throat, and give guidance on posture and exercises to help overcome any difficulties you have.
• An occupational therapist may also be able to suggest practical ways to overcome any difficulties you have with eating and drinking.

Drugs Used To Treat Parkinsons Disease

The common Parkinsons disease medication of carbidopa and levodopa can contribute to insomnia for some people, says Horvat. Thats because its replacing the dopamine that youve lost in Parkinsons disease, she says. Research has shown that dopamine receptors play a role in wakefulness.

Sometimes when people are first started on this medication, they will take a dose right before bed rather than closer to their dinner, says Horvat. Then theyre not able to get to sleep because the dopamine affects the reward center in the brain and gives people a high, she says.

Besides timing the medication further from bedtime, your doctor may suggest taking an extended-release capsule of carbidopa and levodopa, says Horvat. That has a lower peak dose effect, so the stimulation is milder, and it lasts a little longer. It can allow patients to have more of a baseline rather than a peak at night, which can cause the insomnia, she says.

If you suspect your medication is making sleep difficult, tell your doctor dont stop taking the medicine as prescribed, says Horvat. Sometimes we can time the medication in a different way or in some cases we do change the medication but this is not something to try to figure out on your own.

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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

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.

When Should I Tell My Doctor About These Problems

Generally speaking, people urinate 4 to 7 times a day and once a night. If you urinate more or less often than this and you have some of the symptoms identified above, you should talk to your doctor.Age is the main factor in bladder problems. Other conditions, such as a urinary tract infection, certain medications or prostate problems in men can also cause urinary problems.A complete urological examination will help rule out other potential causes. Your doctor may ask you to keep a voiding diary to assess your bladders storage capacity. To keep this diary, you will need to collect your urine in a measuring cup for a few days and record the amount you urinate and the time of day.

Here is some advice that could help you:

• Try to go to the bathroom at set intervals
• Plan your trips based on bathroom accessibility
• Go to the bathroom before the urge to urinate becomes overwhelming
• Avoid drinking coffee, or any other diuretic drink
• Limit water intake before bedtime
• Do not reduce the amount of water you drink during the day, you may become dehydrated. Split your water intake
• Try doing pelvic muscle strengthening exercises

Consult a physiotherapist, kinesiologist or nurse continence advisor. These specialists can recommend exercises to strengthen the muscles around the bladder.If you suffer from incontinence, you can use protective underwear. There are several models available to suit your needs. Your doctor or pharmacist can help you make the right choice.

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