Even though the exact mechanism is not known in detail, there are treatments that can be effective in treating urinary urgency in Parkinson disease. The mainstay of treatment for motor symptoms in Parkinson disease, carbidopa/levodopa (brand name Sinemet®), may have an effect on urinary symptoms. At first, it may actually worsen symptoms, but over the long-run, there may be an improvement. Deep brain stimulation (specifically, STN DBS) in some cases has also been found to improve urinary symptoms, although this is not always the case and should never be a reason to seek this surgery.
Urinary Urgency
Medicines are grouped by those that reduce contraction of the bladder wall muscle called the detrusor. These medicines are the most effective treatment for urinary urgency in PD is a class of medications known as anti-muscarinic agents, sometimes more generically called anti-cholinergic agents. These include oxybutynin (brand name Ditropan®) and tolterodine (brand name Detrol®).
Side effects sometimes make them hard to use and include:
- Cognitive problems
- Dry mouth
- Drowsiness
- Heart palpitations or anxiety.
Stress incontinence and mixed incontinence
- Physical therapy- pelvic floor exercises (Kegel) , biofeedback
- Surger
Urine retention
Blockage of urine outflow is often associated with prostate problems or other causes of damage to the bladder neck or urethra. Alpha blockers are a group of medicines that relax muscle in the area of the bladder that narrows to block outflow. Other treatments including laser therapy and surgery are helpful in individual cases.
A Urologist specializes in bladder problems and can do more extensive testing. Of course, medical providers can only treat a problem if they know about it, so if you or your loved one with Parkinson disease has urinary symptoms, don’t hesitate to mention it to your doctor and ask for a referral.
[See accompanying article on bladder health]
Nocturia- multiple trips to bathroom at night
Frequent trips to the bathroom disrupt sleep and are often the source of falls. Some people drink less due to this problem further worsening low blood pressure or dehydration.
- Don’t skimp on drinking. Drink more in the beginning of the day and limit fluids after dinner.
- See an occupational therapist for tips on keeping you safe. Bedside commode, urinal, low lighting in hallways to bathroom are some simple recommendations
Author: Daniel J. Burdick, MD,Movement Disorders Fellow, University of Washington, VA Puget Sound Health Care System
References:
Benarroch E. Neural control of the bladder: recent advances and neurologic implications. Neurol 2010; 75: 1839-1846.
Winge K and Fowler C. Bladder dysfunction in parkinsonism: mechanisms, prevalence, symptoms, and management. Mov Dis 2006; 21(6): 737-745.