Your autonomic nervous system regulates your body’s automatic functions, such as controlling blood pressure, sweat and temperature, digestion, heart rate, and urination. In Parkinson’s, these are referred to as non-motor symptoms. And of these, one of the more common ones people with Parkinson’s face are those related to urination, such as urgency, frequency of urination, incontinence, and nocturia. Together, these symptoms put people with Parkinson’s at greater risk of developing urinary tract infections (UTIs).
Although UTIs are common, especially in women, people with Parkinson’s have a higher risk of these infections than people without Parkinson’s. UTIs can also significantly impact your Parkinson’s symptoms and increase your risks of falls, cognitive decline, and hospitalization. For this reason, you must understand the risk factors, symptoms, prevention strategies, and treatment options available. The good news is that there are numerous ways you can decrease your risk of developing a UTI and treat the infection if one occurs. In this post, we share information about the causes and symptoms of UTIs and how Parkinson’s increases your risk of developing one so you can recognize symptoms, get proper treatment, and prevent UTIs from developing in the first place.
A UTI is an infection in any part of your urinary system, which is made up of your kidneys, ureters, bladder, and urethra. Most UTIs impact the bladder and urethra.
UTIs occur when microorganisms (typically bacteria) enter the urinary tract and begin to multiply. Often, the bacteria that leads to the UTI enters the urinary system through the urethra, then multiplies in the bladder.
Often, Escherichia coli (E. coli), the well-known type of bacteria often found in the gastrointestinal tract, is the bacteria that leads to UTIs, though other pathogens can cause infections as well.
Women are much more likely than men to experience UTIs, with studies showing a ratio of eight to one. This is due to the female anatomy: the distance is short from a woman’s urethra to the anus (where E. coli bacteria are common) and from a woman’s urethral opening to her bladder. Because a woman’s urethra is shorter than a man’s, bacteria have better access to the bladder, where they can begin to multiply. A woman’s urethral opening is also close to sources of bacteria from the anus and vagina, putting women at higher risk than men of developing UTIs.
Although women are more likely to develop UTIs than men, all people can experience them. For example, anyone who frequently holds in urine for long periods is at higher risk of developing a UTI because this gives bacteria time to spread and multiply. Kidney stones can block urine from leaving the bladder and lead to a UTI; the same is true for enlarged prostates. People of any gender living with health conditions that affect their immune system, especially diabetes, are more susceptible to UTIs, as are people who regularly use a catheter to urinate.
Sometimes, you can have a UTI and feel no symptoms at all. However, UTIs often cause symptoms such as a burning pain during urination, strong-smelling urine, or a strong, persistent urge to urinate.
Other symptoms may include:
If the infection impacts your kidneys instead of your bladder and urethra, you may experience different symptoms, such as nausea, back or side pain, chills, and vomiting.
In Parkinson’s, the brain’s control of the urinary sphincter can become disrupted, leading to difficulty holding urine. As a result, people with Parkinson’s may experience storage symptoms, which can increase the frequency and/or urgency of urination and lead to nocturia when you wake up multiple times at night to go to the bathroom. Another set of urinary symptoms, called voiding symptoms, can cause urination hesitancy, straining, interrupted stream, and double voiding (urinating twice each time you go to the bathroom). You may experience symptoms in both sets, which puts you at a higher risk of developing a UTI.
Voiding symptoms often go unnoticed for longer than storage symptoms do, and they can play a significant role in the development of UTIs. For example, if they keep you from fully emptying your bladder each time you urinate or keep you from urinating as often as you should, bacteria can grow and spread in the remaining urine, leading to UTIs.
Parkinson’s motor symptoms can also impact your ability to urinate as frequently. Slowness and stiffness can make it difficult to get to the bathroom. In addition, if you experience significant balance issues, you may not travel to the bathroom as often as you need to for fear of falling.
Parkinson’s can also cause constipation, which can cause UTIs by putting pressure on the urinary tract. Studies show that as many as 80% of people with Parkinson’s experience constipation, so if you frequently experience this symptom, be sure to talk with your care team and take action to manage it.
Cognitive changes can also increase your risk of UTIs. Maintaining continence—holding your bladder—is a complex mechanism that involves the micturition reflex (an autonomic reflex), a required response to the sensation of a full bladder, and the willful stopping of allowing the passage of urine. Cognitive decline can have a substantial impact on this complex process.
A recent study by scientists in the Department of Neurology at Cedars-Sinai Medical Center in Los Angeles, CA, found that UTIs are a leading cause of delirium, functional decline, falls, and hospitalization in people with Parkinson’s.
UTIs can cause confusion or hallucinations. Unexplained, sudden changes in cognition can signify a UTI, as can uncharacteristic irritation or social withdrawal. Studies have also shown a strong association between dementia and lower urinary tract symptoms. The exact reason for this association is still being investigated. Still, research has suggested that the immune system’s response to a UTI—specifically, the actions of a protein called interleukin 6 (IL-6)—may cause the delirium associated with these infections.
Multiple studies have shown that UTIs and respiratory tract infections are the leading cause of emergency room admission in people with Parkinson’s. Trips to the emergency room and hospital stays can increase several Parkinson’s symptoms, such as tremor, dyskinesia, and freezing. In addition, confusion and hallucinations can occur or worsen during hospital visits because of medical stress or as a result of medications you may be given during your stay, such as narcotics for pain or sedatives for sleep, anxiety, or agitation. Because hospital stays can have such an impact on your quality of life when you’re living with Parkinson’s, it’s important that you take action as you’re able to prevent conditions like UTIs that can lead to hospital visits.
If UTIs go untreated or undertreated, urosepsis (sepsis caused by a UTI) can occur. Sepsis is a life-threatening medical condition that emerges from the body’s extreme response to an infection. Sepsis, which can be caused by several different types of infections, is a leading cause of death in Parkinson’s, underscoring how essential it is to pay attention to signs of urinary complications and to get treatment right away if symptoms arise.
The first line of treatment for many people who develop UTIs is a course of antibiotics. Often, this is the only treatment needed. Several different antibiotics can treat UTIs, and your provider will use results from a urine sample to determine which is right for you.
If the UTI is considered complicated (caused by a narrowing of your ureters or urethra, or a blockage like a kidney stone or an enlarged prostate), your doctor might prescribe a higher dose of antibiotics. If the infection is severe or in your kidneys, your physician may refer you to the hospital for high-dose antibiotics administered through an IV.
Prevention is key to avoiding UTIs and the complications that may arise from them. Fortunately, there are several actions you can take right away to keep your urinary tract flowing correctly.
Although UTIs are common, and Parkinson’s increases your risks of these infections, the more you know about the causes, symptoms, and prevention strategies, the better prepared you will be to take action to reduce or eliminate them altogether.