Changes in urination can be — but aren’t always — part of Parkinson’s disease (PD). If they do happen, they’re more common in people who’ve lived with PD for many years. They’re also more common in older people, both with and without PD.

In Parkinson’s, urinary changes happen because the disease impacts nerves that control the bladder, which holds and empties urine. When signals to the bladder don’t work properly, urinary changes can occur.

If the bladder has trouble holding urine, you might:
 

• Go more often (urinary frequency),
• Have to go as soon as you feel the urge (urinary urgency), 
• Not make it on time or accidentally lose urine (urinary incontinence), or
• Wake up at night to use the restroom (nocturia).
  In older men, with or without PD, an enlarged prostate might cause or worsen nocturia.

Treatment options may include:

• Medication adjustment. 

  “Water pills” or diuretics, which flush out extra fluid to treat blood pressure or leg swelling, can increase urine symptoms. Other blood pressure medications and some antidepressants also may impact urination. Review your medications and any need to adjust with your doctor.

• Limitation of fluids and caffeine, especially near bedtime.
  But make sure to drink enough water to support general health and, if you experience it, low blood pressure.
• Scheduled bathroom breaks throughout the day.
  Using the restroom every two to four hours (or other timeframe directed by your doctor), even when you don’t feel the need to go, can help limit frequency, urgency and incontinence.
• For incontinence, bladder muscle strengthening.
  A physical therapist who specializes in this area can teach you exercises. You also can consider incontinence products, such as absorbent pads or protective garments. Try to keep your or your loved one’s skin clean and dry as much as possible to avoid irritation or infection.
• For nocturia, a clear, well-lit path to the bathroom.
  Remove rugs, cords and any other items that could trip you. Plug in motion-sensor nightlights that turn on when you walk by. Consider a bedside urinal or commode so you don’t have to go far.
• Therapies to relax the bladder.
  Medications may include oxybutynin (Ditropan), tolterodine (Detrol), solifenacin (Vesicare) or darifenacin (Enablex). These drugs have many potential side effects, such as constipation and confusion, which can limit benefits for people who are older or have memory and thinking changes. A newer medication, mirabegron (Mybetriq), does not have these potential side effects, but can cause high blood pressure. For men with prostate enlargement, doctors may prescribe medications (or a minor surgical procedure) to shrink or relax the prostate and ease urine symptoms. If these or other treatments aren’t helpful, your doctor may suggest botulinum toxin (Botox) injections into the bladder or non-invasive electrical stimulation of nerves to relax the bladder.

If the bladder has trouble emptying, you might have difficulty starting urination or notice a weak stream or dribble. In older men, with or without PD, an enlarged prostate could cause or worsen bladder emptying problems. In some people, significant constipation could contribute, too. Treatments may include:
 

• Reviewing your current medications to see if any impact the bladder
  Certain antidepressants, pain medications and even Parkinson’s medications (trihexyphenidyl) can cause trouble urinating. Talk with your doctor about which medications might be causing symptoms and how you might adjust or discontinue them.
• Taking medication to help the bladder empty
  Bethanechol (Urecholine) encourages the bladder to drain. Like all medications, it has potential side effects, including dizziness, sleepiness, nausea, vomiting, diarrhea and others. For men with an enlarged prostate, doctors may recommend medication (or a minor surgical procedure) to target the prostate and ease urine symptoms.
• Using a tube (catheter) to drain urine at regular intervals
  A health care professional will teach you how and when to properly use the tube at home.

It’s important to treat bladder emptying problems because they could lead to infection. A urinary tract infection (UTI) can cause pain or burning when urinating, changes in urine color, or the need to go more often or more urgently. Sometimes, especially in advancing Parkinson’s, a UTI might not cause urine symptoms, or a person might not notice them. Instead, they might experience more stiffness, slowness or other difficulty moving. Those who have significant memory or thinking changes might experience behavior changes or new or worsening confusion or hallucinations (seeing things that aren’t there). To check for an infection, your doctor collects a urine sample for lab testing. To treat an infection, they prescribe antibiotics. If you have frequent or hard-to-treat UTIs, your doctor may suggest you visit a urine/bladder specialist (urologist) and/or an infectious disease specialist.

To learn more about this topic, watch a webinar.