Urinary Incontinence: A Non
While most people think of Parkinsons disease as a motor disease, it is also a neurodegenerative disease affects the CNS and the ability for the messages from the brain to get to the muscles and nerves. While the motor issues of PD are well known, the non-motor issues are often overlooked – including urinary incontinence.
Voiding Symptoms In Pd
The pooled prevalence of voiding symptoms was 24%. Prolongation was the most prevalent type of voiding symptoms in PD followed by the intermittency , urinary retention , dysuria , weak stream , and hesitancy . Some studies found that subclinical detrusor weakness during voiding may also occur in PD . These findings revealed that PD patients had both subclinical and clinical voiding symptoms. There was substantial heterogeneity in prevalence of voiding symptoms and its subtypes among studies. The source of heterogeneity could be the limited number of articles, diverse diagnostic tools and different characteristic of participants.
Urinary retention is the most disabling voiding symptoms and often used to differentiate Parkinsons disease from multisystem atrophy. Previous studies have shown that the prevalence of urinary retention and large PVR was 43 and 14% in MSA and PVR volume 100 ml might be an effective indicator to differentiate PD from MSA . Unexplained voiding difficulties with PVR volume 100 ml was one of the core clinical features to identify the clinically established MSA . Furthermore, severe urinary retention in the first 5 year of disease is a red flag according to MDS clinical diagnostic criteria for PD.
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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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First Line: Cholinergic Drugs With Care For Cognitive Function
Anticholinergics are generally used as a first-line treatment for OAB. However, it is important to balance the therapeutic benefits of these drugs with their potential adverse effects. When the dose of drug increases, post-void residuals might appear. Dry mouth and constipation are common.
In elderly patients who have both overactive bladder and dementia , treatment of dementia and the bladder is a matter of controversy. However, it is known that once cholinergic drugs penetrate the BBB, cholinergic agents within the brain are thought to ameliorate bladder storage function., Although with extreme caution, patients with both overactive bladder and dementia could be managed, with a combination of centrally-acting cholinergic agent and peripherally-acting anti-cholinergic agent., This treatment requires close observation of patients with the assistance of caregivers.
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Addressing Practical Aspects Of Eating And Drinking
Some people with Parkinsons have problems chewing and swallowing. This can make it difficult to eat a diet with plenty of fibre. A speech and language therapist can give advice about this. Ask your GP, specialist or Parkinsons nurse for a referral. If it takes a long time to eat and your meal goes cold, eat smaller portions and go back for seconds that have been kept warm. You can also get special plates that keep your meals hot the Disabled Living Foundation has more information.
An occupational therapist will also be able to give you some tips and practical advice.
What Causes Neurogenic Bladder
Neurogenic bladder can be congenital . Birth defects that can cause neurogenic bladder include:
- Spina bifida : This disorder occurs when the spine doesnt completely develop during the first month of pregnancy. Babies born with myelomeningocele often have paralysis or weakness that affects how their bladder works.
- Sacral agenesis: This is a condition in which parts of the lower spine are missing.
- Cerebral palsy: Cerebral palsy refers to a group of chronic disorders that weaken a person’s ability to control body movement and posture. These disorders result from injury to the motor areas of their brain. The problem causing cerebral palsy may occur while during development or after birth. Cerebral palsy isnt always found during a child’s first year of life.
Medical conditions that involve the nervous system can cause neurogenic bladder. Common causes include:
- Trauma/accidents.
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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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What Is Parkinsons Disease
Parkinsons disease is a progressive neurological disorder that affects how your muscles move. In the beginning stages, it can be easy to miss the early signs and symptoms of Parkinsons disease. The most common ones include:
- Tremors, usually starting with the fingers or hand
- A noticeable change in handwriting
- Walking is slower, movement is stiffer
- Stiff, rigid muscles
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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Assignment Of Interventions: Blinding
Who will be blinded
Due to the nature of the intervention, the research team delivering the intervention will not be blinded to the treatment received however, we have designed several different mechanisms by which participant allocation will be concealed. Participants will be blinded to group allocation. Outcome measures are primarily self-reported and submitted anonymously. Those involved in the data analyses and statistics will be blinded to the group allocation.
Procedure for unblinding if needed
Clinical staff are not blinded. At 6 weeks, the participant will be asked to which group they thought they had been allocated to assess the success of blinding. Data will be analysed by a statistician who is blinded to group allocation. At this stage, it they so wish, participants will be told to which group they had been assigned.
Urinary Issues In Advanced Parkinsons Disease
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.
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Prevalence Of Luts Subtypes In Pd
Storage symptoms
The pooled prevalence of storage symptoms was 59% .
Table 3. Prevalence of LUTS subtypes in PD.
Incontinence
The pooled prevalence of urinary incontinence was 30% . The pooled prevalence of urge incontinence was 32% .
Using urodynamic tests, the pooled prevalence of urinary incontinence was 21% , with significant heterogeneity . Using clinical scales, the pooled prevalence of urinary incontinence was 34% , with significant heterogeneity The pooled prevalence of urinary incontinence was 28% using questionnaires and 28% using definition in one study.
The pooled prevalence of urinary incontinence was 20% in PD with H& Y stage < 3, whereas 48% in PD with H& Y stage 3. The pooled prevalence of urinary incontinence was 20% in PD with age < 65 years, whereas 37% in PD with age 65 years .
OAB The pooled prevalence of OAB was 62% .
Urinary urgency
The pooled prevalence of urgency was 46% .
Urinary frequency
The pooled prevalence of frequency was 52% . The pooled prevalence of daytime frequency was 41% . The pooled prevalence of nighttime frequency was 53% .
Nocturia
The pooled prevalence of nocturia was 59% .
Pollakiuria
The pooled prevalence of pollakiuria was 65% .
Voiding symptoms
Retention
A total of 14 studies investigated the prevalence of retention in 1,991 patients with PD ranging from 8 to 76% and yielding a pooled prevalence of 27% . The pooled prevalence of PVR volume 100 ml was 4% .
Dysuria
The pooled prevalence of dysuria was 22% in PD .
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.
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Treatment For Genitourinary Dysfunctions
Unlike the motor symptoms of PD, genitourinary dysfunctions do not respond to levodopa therapy, and other treatments must be used. There are several medications that can help manage urinary difficulties, including Detrol® , Ditropan® , Enablex® , and Vesicare® . These medications work to block or reduce overactivity in the bladder. Treatments for sexual dysfunction include counseling or talk therapy, treating erectile dysfunction with Viagra® or Cialis® , and the use of lubricants in women.1,3-5
Whats Next For Those Suffering From Urinary Incontinence
I decided I did not want to add another medication to the medicine bag. I was trying to see if there was something I could do besides resigning myself to wearing pads or some other incontinence protection all the time. At 53 years old, I wanted to see if there was a way I could help myself.
Part 2 of this article will address my experiences. I plan to discuss what I lovingly refer to as PEE PEE PT physical therapy to help treat urinary incontinence.
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Why Do Some People With Parkinson’s Disease Experience Urinary Incontinence
Parkinson’s is best known for its effects on balance and movement, but it impacts the autonomic nervous system as well. The autonomic nervous system controls specific bodily functions, like heart rate, blood pressure, libido, and urine production.
Over time, changes to the autonomic nervous system affect your bladder’s ability to store and release urine. That means you might have trouble making it to the bathroom on time or need to urinate more frequently.
How Common Is Neurogenic Bladder
Neurogenic bladder dysfunction is very common among people with spinal cord injuries, affecting more than 90% of them. About 95% of people with spina bifida have neurogenic bladder dysfunction. The condition also affects 50% to 80% of people who have multiple sclerosis. Neurogenic bladder affects people with stroke and Parkinsons disease and many other types of nervous system conditions. Conditions that damage nerves like advanced diabetes can also cause neurogenic bladder.
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Prevalence Of Luts In Pd
The pooled prevalence of LUTS was 61% .
Figure 2. Forest plot showing the prevalence of LUTS , urinary incontinence , urinary retention , and post-void residual volume 100 ml in PD patients.
Figure 3. Frequency of LUTS or its subtypes in PD patients. The x-axis shows different kinds of LUTS while the y-axis shows the percentage.
For subgroup analyses, we found that H& Y stage, gender, and different diagnostic tools may be cause of heterogeneity related to the prevalence of LUTS . The pooled prevalence of LUTS was 59% in PD with H& Y stage < 3, whereas 70% in PD with H& Y stage 3. The pooled prevalence of LUTS was 62% in male PD patients, whereas 54% in female PD patients.
Table 2. Prevalence of LUTS or subtypes: results of the subgroup analysis.
No significant publication bias was found by Begg’s funnel plot .
Urinary Incontinence In People With Parkinsons Disease: Part 1
Incontinence Hotlineâ¦Can you please hold?â
Lately, I have seen television ads for bladder control medications that are proudly showing some woman roaming around with a nagging bladder always bugging her. I think it is about time that I wrote an article about the subject of urinary urgency/incontinence in Parkinsons disease. This article does NOT just apply to the women out there with Parkinsons it applies to the men as well!
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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.
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Parkinsons Disease And Incontinence: Why It Happens And How To Cope
Constipation is a common side effect of Parkinson’s disease, but about 30-40% of patients also experience urinary difficulties, according to the Parkinson’s Foundation. A sudden or immediate urge to urinate is more than annoying. Without diagnosis and treatment, accidents may prevent you from running errands, visiting friends, or doing other activities you enjoy.
Fortunately, there are things you can do to reduce accidents, strengthen your pelvic floor, and improve your quality of life. In this article, we highlight symptoms to watch out for, discuss healthy lifestyle changes that you can make, and feature some of our best-selling products.
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Data Collection And Management
Plans for assessment and collection of outcomes
Data will be collected via participant-completed questionnaires at baseline and at 6 and 12 weeks. A 3-day bladder frequency diary will be completed prior to baseline, at 6 and 12 weeks. Completed outcome data are retuned by post. Relevant demographic and medical history information will be collected at baseline.
Patient resource use questionnaires will also be completed by participant at home at 6 and 12 weeks.
Plans to promote participant retention and complete follow-up
Nothing beyond normal encouragement to continue to use as prescribed. All participants will be offered help with setting the parameters of a stimulation unit should they purchase one.
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