Treatment Strategies for the 4 Common Causes of Bladder Dysfunction in Parkinson's : by Dr. De Leon

As I mentioned previously there are 4 common causes that lead to Parkinson’s bladder problems. The most common being improper processing of dopamine message from brain to bladder causing a mixed up response with increase frequency and urgency. ( when is contracting or too active is called –detrusor hyperactivity).
Second, urgency and frequency can be caused by blockage or pressure on urethra from chronic constipation and thirdly increase sphincter pressure not allowing urine to flow and fourth bladder does not contract (detrusor hypoactivity) causing urine to stay trapped and giving a constant sense of needing to void.

However, before you decide that the urinary problems are caused by Parkinson’s Disease and not some other medical problem like diabetes make sure that all other causes are excluded. Several medications can cause bladder problems. The tricyclics (e.g amytriptaline, nortryptyline) can cause urine retention- these are commonly used for depression, sleep problems, & some other derivatives may be used at times for tremors. Diuretics commonly prescribed for blood pressure of course can increase your urgency and frequency.

In men, an enlarged prostate can cause problems with starting urine, may have decrease flow, hesitation, dribbling, urgency and frequency.
In women, having an enlarged uterus or the fact that they had multiple children can cause them to have weak pelvic muscles and cause stress incontinence (loss of urine with coughing or laughing) and can lead at times to increase urgency. Women are also more prone to urine infections especially after menopause which can lead to symptoms of urgency, frequency, incontinence.
If all medical causes are excluded or even before, a Parkinson’s patient may need to be referred to specialist like urologist to evaluate prostate or stress incontinence. If patient is a woman, she may need to go to a gynecologist to make sure her uterus is not enlarged and or pelvis not weak. The specialist will do a urine analysis to make sure no infection, might do ultrasound to look at uterus and bladder, prostate exam and blood work and also Urodynamic Tests.

‘Urodynamic tests evaluate how your urine is stored within the bladder, as well as how urine flows out of the bladder through the urethra. These types of tests can measure the speed and volume of urination (uroflowmetry), the amount of urine remaining in your bladder after urination (postvoid residual) or the pressure within the bladder (cystometry).”

If problem is not clear the neurologist or Movement disorder specialist may recommend an EMG test along with the Urodynamics to evaluate the status of the muscles of the bladder and pelvic floor. If either the gynecologist, or urologist in your area are unable to perform these tests an “EMG” specialist might be consulted…A urodynamic test is NOT a FUN TEST especially when you add needles into your bladder and pelvic muscles! They have to insert many small needles in your bladder then watch you go Void into a large container in front of several people while they measure everything! It is Not the most pleasant test in the world- not really painful- it is more embarrassing than anything else…but you will get through it -not much different than giving birth!

Often times, your neurologist will try some treatments before referring to a specialist if it seems like common ordinary urinary problem of mixed signaling. But, if symptoms are not resolving or getting worst, getting frequent infections or seriously interfering with your personal life in any shape or form (sleep, sex or hygiene) you MUST be seen by specialist ASAP. Usually for those that have hard to control bladder problems or mixed typed which CAN happen in a single Parkinson patient more frequent than you might think (I recommend keeping diary). For those that have multiple causes or not responding to treatment, the best treatment is a team approach.

Tips: to help with Nocturia (bladder urgency at night)

Avoid drinking fluids after 6 pm – especially if you have worsening symptoms at night
Have medications adjusted –especially Sinemet if wearing off in middle of night and causing you to have urgency or not being able to make to bathroom on time or disrobe fast enough. Dismiss meds that are causing bladder dysfunction. Similarly if getting to touilet is a problem get a bed side commode.
If bladder medication not lasting consider using patch that maybe longer lasting –Oxytrol 24hour patch for instance.
Get a bed wetting alarm. Prices range from $49 to $179.
If being awake causes you to go to bathroom more –talk to doctor about prescribing a sleep aid.
Foods to Avoid:

Chocolate
Tea
Caffeine
Alcohol
Spicy foods

Other treatments :
Topical estrogen
Biofeedback -which includes toilet retraining
Botox to bladder
Vaginal weights
Kegel exercises
Bladder surgery
Neuromodulation (2 types)
Interstim
PTNS

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***Do not make any changes to your medication prior to discussing with your physician or healthcare provider.
Dr. M. De Leon is a movement disorder specialist on sabbatical, PPAC member and research advocate for PDF (Parkinson’s Disease Foundation); Texas State Assistant Director for PAN (Parkinson’s Action Network). You can learn more about her work at http://www.facebook.com/defeatparkinsons101 you can also learn more about Parkinson’s disease at www.pdf.org or at www.wemove.org; http://www.aan.org, http://www.defeatparkinsons.blogspot.com

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