Urinary Dysfunction and Parkinson’s

Urinary Dysfunction and Parkinson's - Arun Mathur

We recently had the chance to talk to urologist Dr. Arun Mathur about urinary dysfunction, an issue many people with Parkinson’s experience. During this interview we talk about:

  • Urgency
  • Incontinence
  • Hypotonic bladder
  • Treatments
  • And more

Watch our interview below.

To download the audio, click here.

To download the transcript, click here.

Show notes

The Basics

  • Urinary Dysfunction is peeing too much or peeing too little.
  • Causes:
    • This can be caused by issues in the organs responsible for urination. For women, this would include an issue in the urethra or bladder. For men, this would include an issue in the urethra, prostate, or bladder.
    • This can also be caused by a disruption in the neurological signaling from the brain to these organs (as is the case in Parkinson’s).

Terminology

  • Urgency: The sudden need to urinate
  • Incontinence: Loss of bladder control. In other words, being unable to hold your urine long enough to get to the bathroom
  • Hypotonic bladder: When your bladder can’t push the urine out

Treatments

  • Treatments vary greatly based on the root cause of the urinary dysfunction
  • Manage Your Expectations
    • Drugs and non-pharmaceutical options will help to manage the symptoms but don’t expect them to all disappear
  • Non-Pharmacological
    • Cut out alcohol and caffeine, as they irritate the bladder. You’ll notice a difference in symptoms within a few days.
    • Adjust your fluid intake schedule. Drink a lot of liquids when you are able to get to the bathroom easily and cut back when traveling or before bed.
    • Do regular kegel exercises. Squeeze and let go 10 times every hour on the hour. Much like regular exercise, building up your pelvic floor muscles through exercise will take time, so don’t expect to see results for several weeks.
    • Self-catheterization – This involves using disposable or reusable self-catheters to give you more freedom and control over your symptoms.
  • Pharmacological
    • Anticholinergics
      • Shuts down the nerves that go down into the bladder that overfire during Parkinson’s. It’s very effective on urinary dysfunction but has higher side effects because the nerves that it affects also go to other parts of the body, including, the eyes, stomach, and salivary glands. Side effects can include blurred vision, dry mouth, stomach upset, and dry eyes.
    • Beta-3 agonists
      • Play with a different set of nerves, so they don’t affect those body parts, but they’re not as effective on urinary dysfunction.
      • These will often be prescribed first, to see if you can get results with fewer side effects.
    • Botox injections
      • Botox can be injected into the bladder every nine months or so to shut down parts of the bladder and reduce the amount of muscle that is contracted to release urine, thereby reducing urinary incontinence. The danger with botox is that it can shut down too many of the muscles, causing an inability to urinate.
  • Surgical Treatments
    • Pacemakers stimulate the nerves going to the bladder
    • Deep Brain Stimulation (DBS) can help with urinary dysfunction in select cases. However, it’s not usually a good treatment for urinary dysfunction because while DBS affects the upper motor neuron system, which does include bladder activity, the bladder actually has its own electrical mechanism at the base of the spinal cord which is unaffected by DBS.
  • Urinary Dysfunction has a huge impact on quality of life
    • Financial cost
    • Mapping out bathrooms
    • Self-conscious about smell
    • Clothing choices in case you leak
  • Seek treatment when it is substantially affecting your quality of life. This will vary from person to person.
  • Urinary Dysfunction is more common in older individuals with Parkinson’s because, in addition to a disruption in neurological signaling due to Parkinson’s, their organs themselves are beginning to lose function due to age.
  • In general, there are likely more people that struggle with urinary incontinence than is reported due to embarrassment or shame.
  • For men, prostate enlargement is a very likely cause of urinary dysfunction as they age, so if dealing with urinary dysfunction, it is important to determine if the symptoms are the result of prostate issues AND/OR Parkinson’s issues.

Additional Resources

Tips for Alleviating Bowel and Urinary Dysfunction in Parkinson’s

[Webnar Recording] Men and Parkinson’s

[Webinar Recording] YOPD Council: Non-Motor Symptoms

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