The inability to control the release of urine from the bladder and involuntary leakage of urine is known as urinary incontinence. It is condition that affects millions of people throughout the world and is not unique to Parkinson’s patients. It can be both embarrassing and distressing to a person and for Parkinson’s patients who are bedridden or unable to attend to themselves, it can prove even more frustrating.

Types of Urinary Incontinence

• Stress incontinence. Any sort of stress such as coughing, sneezing, laughing or lifting heavy weights can cause leakage of small or large amounts of urine. Weakening of the sphincter muscle of the bladder brings on this type of incontinence which is usually seen in women after menopause. Prostate gland removal may cause stress incontinence in males.

• Urge incontinence. There is an intense desire to pass urine, with involuntary passage of urine if the person cannot reach the toilet in time. The frequency of urination is also increased and is particularly distressing because the patient has to get up often at night. Parkinson’s patients most commonly suffer from this type of incontinence.

• Mixed incontinence. Some patients may suffer from two or more types of urinary incontinence at the same time, such as stress and urge incontinence. This is known as mixed incontinence.

• Functional incontinence. This is a type of incontinence where a person with Parkinson’s diseases is unable to reach the toilet in time or unfasten or unbutton his/her garments either due to his/her physical or mental disability.

• Overflow incontinence. This can follow urinary retention. Urine may leak without the person feeling any urge to urinate.

Causes of Urinary Incontinence in Parkinson’s Disease

Overactivity of the detrusor muscle of the bladder is the main cause of urinary incontinence in elderly people. In Parkinson’s disease, there is interference with the nerve signals responsible for bladder control which results in an overactive bladder, leading to incontinence.

Detrusor underactivity, with urinary retention and overflow incontinence may occur in Parkinson’s disease patients too. In addition, since Parkinson’s disease is more often a disease of old age, other associated factors causing incontinence may be present, such as stress incontinence in menopausal women or prostate problems in men.

Impacted stool may be another cause of urinary incontinence, especially in the elderly. Certain drugs may also contribute to incontinence.

Treatment of Urinary Incontinence

Behavioral and exercise-based therapies are often quite effective in treatment of incontinence.

• Behavioral therapies include :
  • Bladder training to control incontinence.
  • Biofeedback to become more aware of signals from the body.
  • Scheduled visits to the toilet at set intervals.
  • Avoiding excessive alcohol and caffeine intake.
  • Reducing intake of liquids, especially in the evenings and before bed time.

• Exercise-based therapies include :
  • Taking adequate exercise.
  • Pelvic floor muscle exercises (Kegels).

• If these methods are not effective enough, medication may be used :
  • Anticholinergics such as oxybutynin, tolterodine, darifenacin, solifenacin and trospium are especially helpful in urge incontinence.
  • Topical estrogen creams.
  • Imipramine may be effective in mixed incontinence.

• Urethral implants or vaginal pessaries may be tried.

• Surgery may become necessary in certain cases, such as in stress incontinence.

• Other measures :
  • Wearing high absorbency pads.
  • Wearing clothes that can be easily removed.
  • Keeping a bedside commode.
  • Making the toilet more easily accessible.