Urinary Symptons & PD

Urinary Symptons & PD

By Michelle Spicka

How the bladder normally works:

The bladder is a muscle which gradually expands as urine collects.  At the opening there is a muscle called the sphincter which is closed except when urinating; this muscle, as well as the bladder, is controlled by the brain.  When the bladder has filled to a certain level, the bladder may begin to have small contractions that signal the brain that the bladder is filling up.  The brain can suppress the contractions until it is convenient for the person to go to the bathroom.  At that time, the brain allows the bladder to contract while the sphincter relaxes, thereby allowing the urine to leave the bladder.

Types of urinary disturbances in Parkinson’s Disease:

  • Urinary frequency

Urinary frequency is the urge to empty the bladder at very frequent intervals, even when the bladder is not full.  The normal voiding interval is every 2-3 hours but depends on fluid intake and age.  People with Parkinson’s disease may have problems holding urine, thus creating significant frequency of urination.  Normal control from the brain is disturbed and the bladder becomes overactive, wanting to empty even when there is just a small amount of urine present.

  • Urinary urgency

Urinary urgency is the need to empty the bladder immediately; without much warning the urge occurs and is very strong.

  • Adult-onset nocturnal enuresis

Bed wetting when asleep may occur due to lack of sensation and bladder dysfunction.

  • Incomplete emptying

Feeling the bladder is not empty right after urination is incomplete emptying.  This sensation can increase if anticholinergic medication is being taken.  Incomplete emptying is a concern because if urine accumulates in the bladder, bacteria will grow and there is an increased risk of infection.  Due to muscle rigidity in the pelvic floor, the urethral sphincter may not relax quickly or completely which decreases the ability of the bladder to empty.

  • Hesitancy

Hesitancy is the difficulty in starting and then maintaining the flow of urine.  Difficulty eliminating urine can be caused by a sphincter closing when the bladder is ready to empty, or by a bladder muscle that is too weak to expel urine.

Causes, Effects and Differential Diagnosis:

  • The main function of the bladder is to store urine and then empty it at a suitable time and place but due to degenerative chances in the basal ganglia in Parkinson’s disease, there is interference with the nerve signals responsible for bladder control, resulting in an overactive or irritable bladder.
  • Sometimes side effects from medications taken can cause urinary symptoms.
  • Urinary disturbances occur both in the daytime and at night, resulting in insomnia and sleep deprivation, leading to extreme fatigue.
  • Mobility problems may be aggravated due to reduced dopamine levels at night, making it more difficult to reach the toilet.
  • Prostate enlargement is a common problem in men as aging occurs and causes difficulty in emptying the bladder, so specific tests may need to be done to distinguish urinary problems due to an enlarged prostate from symptoms due to Parkinson’s disease.
  • Stress incontinence (leakage of urine while sneezing, coughing or laughing) is common in women after menopause and has to be distinguished from that due to Parkinson’s disease.
  • To identify the cause of bladder and urinary dysfunction, a full evaluation of the individual needs to be done by their physician.

Management of urinary symptoms:

  • Avoid food or drinks containing caffeine.  Caffeine can act as a diuretic causing increased urine production.  Alcohol also is a bladder irritant as is artificial sweeteners, spicy or citrus foods.
  • Regulate the amount of liquids taken in the evening, especially 4 to 5 hours before going to bed.
  • Pelvic floor strengthening exercises are utilized for strengthening the pelvic musculature to provide better support to the bladder.
  • Wear easy to remove clothes with few fastening.
  • Use incontinence aids such as high absorbency pads to keep the skin dry.
  • Medications that work to block or reduce bladder overactivity can be useful in treating this particular bladder dysfunction in specific individuals.

The following signs of bladder problems should be reported to your health care provider:

  • Leakage of urine significant to cause embarrassment
  • Inability to urinate when the bladder is full (this requires immediate attention)
  • Unusually frequent urination without a proven bladder infection
  • Needing to rush to the bathroom or losing urine if you do not get to the toilet in time
  • Pain related to urination
  • Progressive weakness of the urinary stream which may be accompanied by a feeling that the bladder is not completely empty