Bladder Problems: Is it Me or the PD?

by Norika Malhado-Chang, MD, Associate Professor of Neurology, UC Davis School of Medicine

Nobody likes to talk about it, but urinary symptoms are so common in Parkinson’s, it’s no coincidencewe call it “Pee-D.”

The truth is, up to 83% of people with Parkinson’s experience trouble controlling urine. This is not only an inconvenience, but a major detriment to quality of life. When we have to remain within a few yards of a bathroom, chances are that we may pass up an outing with friends or a family vacation. And road trips? Out of the question.

Talking to your Parkinson’s physician about bladder symptoms is the first step in getting your life back!

Just like the motor symptoms of PD, bladder dysfunction in PD is related to the loss of dopamine. When we lose this all-important chemical messenger, signals from the brain to the bladder get mixed up. This confuses the bladder as to when it should empty, and when it should retain fluid. Therefore, the first question to answer is: are we talking about difficulty holding urine, or difficulty eliminating urine?

Trouble holding urine is the more common problem. The bladder becomes overactive and wants to empty, even if there is only a small amount of urine inside. Nocturia (urinating at night), frequency (having to go all the time), urgency (having to go immediately), and incontinence (loss of control) are extremely common. A urinalysis helps to rule out bladder infection. We try to avoid drinking fluids after 6 pm to limit nocturia. Timed voiding, where we use the bathroom on a set schedule, helps to minimize accidents. Improving dopamine therapy helps our bodies move faster, to get us to the bathroom easier. Medications might include anticholinergics (ex., Detrol or Vesicare) which lower stimulation to the bladder, or agents such as Myrbetriq, which help to relax the bladder muscle. The older agents may worsen cognition and hallucinations but the new medications are somewhat safer. Other treatments include tibial nerve stimulation and botulinum toxin injections into the bladder muscle. It’s important to remember that any treatment that relaxes the bladder can result in unintentional urinary retention.

The less common problem is difficulty eliminating urine. Incomplete bladder emptying is confirmed by checking a “post-void residual” via ultrasound in the office. Urinary retention is important to treat, because stagnant urine in the bladder is susceptible to bacterial infection. Weak bladder muscle is managed with intermittent catheterization. Your physician may recommend referral to a urologist or urogynecologist, who may perform urodynamic testing to determine the underlying bladder disorder.

I recommend high absorbency pads at night. Briefs with elastic around the legs and tabs on the sides work well, and gel briefs can hold more liquid than cellulose. During the daytime, Depends-type undergarments or shields can help provide security and confidence to go out and live life.