Urinary Dysfunction in Parkinson’s Disease: Overactive Bladder, Incontinence & Treatment

Urinary dysfunction is a prevalent non-motor symptom of Parkinson’s Disease (PD), affecting the bladder's ability to store and empty urine. The most common issue is an overactive bladder(OAB), leading to urgency (a sudden, strong need to pee) and frequency (going often, especially at night). Less commonly, patients may have difficulty emptying the bladder. These problems are caused by the disruption of nerve signals between the brain and the bladder.

The Bladder-Brain Disconnect

In a healthy system, the brain tells the bladder to relax and store urine until it is full, and then signals it to contract when it is appropriate to go. In Parkinson's, these signals get scrambled. The autonomic nervous system, which controls these automatic functions, is compromised.

Common Urinary Symptoms

1. Urgency and Frequency (OAB)

The bladder muscle (detrusor) becomes hyperactive. It signals that it is full even when it contains a small amount of urine.

• Urge Incontinence: The need to go is so sudden that the person cannot make it to the bathroom in time.

• Nocturia: Waking up multiple times at night to urinate. This disrupts sleep and increases fatigue.

2. Difficulty Emptying (Hesitancy)

Less common in PD but possible. The bladder muscle is too weak to push the urine out, or the sphincter muscle won't relax.

• Symptoms: Trouble starting the stream, a weak stream, or a feeling of incomplete emptying.

Impact on Quality of Life

• Social Isolation: Fear of accidents can make patients reluctant to leave the house.

• Sleep Deprivation: Nocturia fragments sleep, worsening other PD symptoms.

• Falls Risk: Rushing to the bathroom, especially at night in the dark, is a major cause of falls.

Diagnosis and Treatment

A urologist can perform urodynamic testing to see exactly how the bladder is functioning.

1. Behavioral Techniques

• Bladder Retraining: Scheduled voiding (going every 2 hours) to prevent urgency.

• Fluid Management: Limiting fluids in the evening (but staying hydrated during the day).

• Double Voiding: Urinating, waiting a minute, and trying again to ensure the bladder is empty.

2. Medications

• Anticholinergics: These relax the bladder muscle (e.g., Oxybutynin). Caution: They can cause confusion and memory issues in older adults, so they are used carefully in PD.

• Mirabegron: A newer drug that relaxes the bladder without the cognitive side effects of anticholinergics.

3. Practical Aids

• Bedside Commode: Reduces the distance to travel at night.

• Absorbent Pads: For peace of mind during outings.

• Easy-access Clothing: Pants with elastic waists instead of buttons/zippers.

Key Takeaways

• It's treatable: You don't have to live with incontinence.

• Check for infection: Sudden worsening of bladder symptoms is often a sign of a Urinary Tract Infection (UTI), not just PD progression.

• Review meds: Some high blood pressure meds (diuretics) can worsen frequency.

• Safety first: Use nightlights and remove rugs to prevent falls during night trips to the bathroom.

FAQ

Q: Is urinary incontinence a sign of late-stage Parkinson's?
A: Not necessarily. It can happen at any stage, though it tends to get more bothersome as the disease progresses.

Q: Can Botox help with bladder issues?
A: Yes, Botox injections into the bladder muscle can relax it and reduce urgency/incontinence. It is an option if oral medications don't work.

Q: Why do I have to pee so much at night?
A: Besides bladder overactivity, PD patients often have fluid accumulation in their legs during the day (edema). When they lie down, this fluid goes back into the bloodstream and is processed by the kidneys as urine.