Up to 75% of people with Parkinson’s disease (PD) may experience bladder issues throughout the course of their illness. The most common problem is a hyperactive bladder, which can cause:

  • a sense of urgency or inability to hold in urine
  • frequent urination (over 7 times daily)
  • waking up one or more times every night to urinate (known as Nocturia)

Hyperactive bladder is related to numerous areas of degeneration in PD, including the nerve cells that control the bladder directly, the motor areas affected in PD, and sometimes, the higher-level control of urination in the brain.

Although uncommon, some people with PD may also experience a hypoactive bladder. Symptoms include:

  • difficulty starting urination
  • a sensation of not completely emptying your bladder
  • retention of urine, which can make someone more prone to urinary tract infections
  • leakage of urine

Not all bladder problems in people with PD are caused by the disease itself. Frequent urination can also appear in men with prostate problems; this is often accompanied by a slow or hesitant urine stream. If you are seeing a urologist for your bladder problem, make sure they are aware that you have Parkinson’s. Finding alternate explanations for your urinary problems is important for treatment, as bladder issues related to PD would not improve with surgical operations on the prostate.

 

Medical Treatment

There are several medication options that decrease the urgency and frequency to urinate. Sometimes, the medications for the motor symptoms of Parkinson’s can help the bladder problem. Your doctor may also suggest anticholinergic medications (Oxybutynin, Tolteridone) or trospium chloride (Trosec). If you have memory problems or hallucinations, anticholinergic medications should be avoided, as they can potentially worsen these symptoms.

Desmopressin, a nasal spray, is often recommended for nighttime urination. This drug reduces the formation of urine. A rare but dangerous side effect of this drug is low salt levels in the blood. If you start taking this drug, you will need routine blood tests.

For patients that have urinary urgency despite the use of oral medications, there is an option of injecting Botox into the bladder. Botox injections can reduce daytime and nighttime urinary frequency, as well as incontinence.

 

Lifestyle Treatment

If you are having trouble with hyperactive bladder, try to schedule bathroom trips at regular intervals, especially if you know a bathroom may not be nearby at some point during your day. A simple strategy to incorporate into your daily schedule is timed voiding, which means following a set bathroom routine at regular intervals, typically every two hours, regardless of your urge to urinate. Timed voiding is beneficial because it can prevent the bladder from becoming too full, preventing urinary urgency and incontinence.

If you encounter difficulties in fully emptying your bladder, a technique called double voiding can be helpful. Double voiding involves making an effort to urinate multiple times during a single visit to the bathroom. There are various techniques to encourage this practice, such as spending more time seated on the toilet, gently rocking from side to side, standing up and sitting back down, or leaning forward slightly.

The foods and beverages you consume can also make a difference. Water is the best fluid for your bladder health. On the other hand, caffeinated and alcoholic beverages, as well as spicy and sugary foods, can negatively affect the bladder by irritating its lining and causing pain, or increasing urinary urgency and frequency. Try to limit coffee, tea, juice, pop, alcohol, and spicy foods. This doesn’t mean you can’t have any in your diet – it just means to enjoy them in moderation.

 

Sources

Postuma, R., and Galatas, C. A Guide to the Non-Motor Symptoms of Parkinson’s Disease. (2012). Retrieved from this article.

 

Last updated: June 21, 2023