What You Need to Know About Urinary Tract Infections (UTIs) and Parkinson’s

UTIs and Parkinson's - Davis Phinney Foundation

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. 

What is a UTI?

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. 

What causes UTIs, and are certain people more likely to develop them?

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. 

Some of the most common causes of UTIs in women include: 

  • Sexual activity. Sexually active women tend to have more UTIs than women who are not. A new sexual partner or sexual position can increase your risk of developing a UTI, as can specific types of birth control, such as diaphragms, unlubricated condoms, and spermicidal agents. Sexually transmitted diseases such as herpes, gonorrhea, chlamydia, and mycoplasma can also cause UTIs. 
  • Improper wiping techniques. After urination, women should wipe from front to back (from the perigenital area to the urethra) to reduce the spread of E. coli. 
  • Menopause. Menopause can increase the risk of UTIs because it leads to less circulating estrogen in a woman’s body, which in turn leads to changes in the urinary tract that make women more vulnerable to infection. 

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. 

What are the symptoms of a UTI?

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:  

  • Passing frequent, small amounts of urine 
  • Cloudy-looking urine 
  • Blood in your urine, or urine that is tinted red, pink, or brown  
  • Pain during sex 
  • Pelvic pain 
  • Fever 
  • Pressure in the lower pelvis 
  • Mental changes or confusion 

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.  

How does Parkinson’s impact the risk of getting UTIs?

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. 

How do UTIs impact or increase Parkinson’s symptoms?

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.  

What treatments are available for UTIs?

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. 

How can I prevent UTIs?

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. 

  1. Drink plenty of water. Drinking water dilutes your urine and makes you urinate more often. This keeps bacteria moving steadily through your urinary tract before they can multiply and cause infection. Suzette Sutherland, MD, director of female urology at the University of Washington School of Medicine, says that one of the top reasons people develop urinary tract infections is simply not drinking enough fluids and keeping their urinary tract flushed.  
  2. Track your symptoms. Use our bladder worksheet to track your urinary symptoms and help you plan a conversation with your physician about any urinary concerns. 
  3. Visit a physical therapist. A physical therapist can teach you pelvic floor exercises, such as Kegels, that can help you manage incontinence or other urinary challenges. Regular pelvic floor exercises can help strengthen and retrain the muscles associated with urination and defecation.  
  4. Take preventative measures regarding sexual activity. Sexually active women can minimize their risk of developing UTIs by urinating soon after intercourse and avoiding birth control methods like diaphragms, unlubricated condoms, and spermicidal agents. 
  5. Request a bladder scan. In this non-invasive procedure, a healthcare professional uses a handheld scanner to see whether there is any urine still in your bladder after you have urinated. This scan can identify voiding issues that you might not be aware of but are leading to frequent UTIs. 
  6. Discuss medication adjustments. Certain medications can lead to urinary retention, urgency, frequency, or incontinence. Diuretics for high blood pressure or vascular conditions, alpha-blockers for hypertension, antidepressants, pain medications, and sleeping pills can all play a role. If you are taking any of these medications and are experiencing urinary dysfunction and/or frequent UTIs, discuss medication options with your physician. 
  7. Visit a urologist. If UTIs become a frequent occurrence, you may need to visit a urologist, a medical doctor who specializes in conditions that affect the urinary tract, including bladder problems, UTIs, bladder and kidney cancer, kidney blockages and/or kidney stones, erectile dysfunction, and enlarged prostate glands. 
  8. Consider urodynamic testing. A urologist or other urinary specialist can use this diagnostic tool to assess how your bladder and urethra are functioning and identify the origin of your urinary symptoms. The results of your urodynamic test will help determine which medications will best alleviate your symptoms, which your physician can then prescribe. 
  9. Discuss non-pharmacological treatment options with your care team. Besides medication changes and rehab therapies, there are several treatment options you can discuss with your care team. One newer option is called Tibial Nerve Stimulation (TNS), a procedure in which tiny needles provide gentle electrical stimulation to a nerve and that has been found to decrease urinary urgency, frequency, and incontinence and cause UTIs. 
  10. Explore occupational therapy. An occupational therapist can help you create a safe environment to, from, and in your bathroom and teach you safety techniques to reduce falls so that balance and mobility concerns don’t keep you from urinating as often as you should.  

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.  

Learn More about Parkinson’s and Autonomic Symptoms

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