Urinary Disturbance in Parkinson’s Disease – Overactive Bladder

Urinary disturbance or problems with urination is a common, though late, feature of Parkinson’s disease and may be the cause of much embarrassment to the patient. The main function of the bladder is to store urine and then empty it at a suitable time and place but due to degenerative changes 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. This causes symptoms of urinary dysfunction such as frequency of micturition, urgency, urinary incontinence, and incomplete emptying of the bladder.

Types of Urinary Disturbance in Parkinson’s Disease

  • Frequency is the urge to empty the bladder at very frequent intervals, even when the bladder is not full.
  • Urgency is the need to empty the bladder immediately.
  • Incontinence is the patient has no control over his bladder, causing small or large amounts of urine to leak out.
  • Adult-onset nocturnal enuresis which is bed wetting when asleep.
  • Feeling of incomplete emptying of the bladder which increases if the patient is on anticholinergic medicines.
  • Hesitancy is the difficulty in starting and then maintaining the flow of urine.

Causes, Effects and Differential Diagnosis

  • 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 for the patient to reach the toilet and it becomes more distressing if he has to empty his bladder many times during the night.
  • Prostate enlargement is a common problem in men in the older age group 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 that due to Parkinson’s disease.
  • Stress incontinence, or 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 patient needs to be done, including :

  • Medical history
  • Comprehensive physical examination
  • Urine tests
  • Ultrasonography
  • Urological examination and relevant tests
  • Neurological evaluation

Treatment of Urinary Disturbances in Parkinson’s Disease

Medicines to treat overactive bladder, causing urgency and frequency, are :

Oxybutynin

Tolterodine

Solifenacin

Darifenacin

These are anticholinergic drugs which act on the bladder wall or sphincter.

The above medicines do not help to treat problems with bladder emptying, such as hesitancy, and may aggravate the condition. Medicines such as bethanechol may help in these cases.

Management

Besides medicines, it may be useful to follow some simple procedures to help with the problem, such as :

  • Avoiding food or drinks containing caffeine such as certain soft drinks, coffee or chocolate, which act as diuretic.
  • Regulating the amount of liquids taken in the evening, especially 4 to 5 hours before going to bed.
  • Pelvic floor exercises for stress incontinence.
  • Wearing high absorbency pads may be useful, especially at night.
  • Wearing easy to remove clothes with few fastenings.

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