Ask an Expert: Dr. Jennifer Locke Discusses Bladder Health for People with Parkinson’s
Dr. Jennifer Locke is a urologist with subspecialty training in reconstructive urology (female urology, male urology, neurogenic bladder, overactive bladder, urinary incontinence, and urethral stricture disease). Dr. Locke grew up in Tsawwassen, British Columbia and attended the University of British Columbia (UBC) for her undergraduate degree in chemistry. She then completed a PhD in experimental medicine at UBC, followed by her MD training at the University of Toronto (U of T). She completed her residency training in urology at UBC, followed by her fellowship training in reconstructive urology at the U of T. Her current clinical practice is based out of Kelowna, BC and consists of a mixture of general urology and reconstructive urology. Operating out of the Kelowna General Hospital, she serves the greater Okanagan region and beyond.
How does Parkinson’s disease (PD) affect the bladder, and what are the most common symptoms of bladder dysfunction in people with PD?
Parkinson’s disease can affect the bladder in many ways, with up to 75% of patients experiencing bladder issues. PD can cause the bladder to contract when someone is not ready to urinate, which may present as urgency (“I have to go really badly”), with or without leakage of urine. Leakage of urine is called urinary incontinence.
Parkinson’s disease can also cause a person to frequently urinate and only excrete small amounts at a time, which may be a sign of an overactive bladder. Overactive bladder occurs when the bladder sends repeated signals to the brain, telling it that it is full and needs to be emptied, even when this is not true. As a result, people with Parkinson’s may make many trips to the bathroom, both in the day and night, which can interrupt their sleep.
Lastly, it can cause patients to experience hesitancy, or an inability to start urinating. Hesitancy can be a result of an inability to relax the urethral sphincter muscles, and can result in urinary retention. When urine is retained in the bladder, bacteria can multiply in the urinary tract, which may cause urinary tract infections.
Are there any lifestyle changes people with Parkinson’s can employ to improve their bladder health?
Good bladder habits can improve symptoms and prevent a person from needing medications. One technique that is easy to integrate into your daily routine is timed voiding. This involves going to the bathroom on a schedule, usually every two hours, regardless of how much you feel the need to urinate. Timed voiding is helpful because it can prevent the bladder from becoming too full, as an overly full bladder may result in urinary urgency and incontinence.
For those who struggle to void completely, a technique called double voiding may be useful. Double voiding involves attempting to urinate more than once per bathroom trip. There are many techniques to encourage this – you could try sitting on the toilet for longer, rocking from side to side, standing up and sitting down again, or leaning forward slightly.
Are there any food or drinks that can help people with PD better manage their bladder health, and are there any food or drinks to avoid?
Water is the best fluid for your bladder health. It is non-irritating and helps to dilute the urine, as well as flush out potentially harmful bacteria. There are also many foods that may also promote bladder wellness, such as pears, bananas, squash, whole grains, oatmeal, and nuts. Eggs have been cited as one of the best foods for sensitive bladders, as they are high in protein and rarely lead to bladder irritation (Urology Care Foundation, 2018).
On the other hand, there are several foods and beverages that may be wise to avoid. Spicy foods can negatively affect the bladder by irritating the bladder lining and causing pain. Similarly, sugary foods and beverages can stimulate the bladder, which can result in urinary urgency and frequency. Caffeine is a well-known stimulant, which can irritate the bladder and cause it to contract inappropriately. Finally, alcohol is a powerful diuretic, which means it increases the production of urine, and can lead to both urinary frequency and urinary incontinence in people with bladder issues. Therefore, it is essential 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.
An elimination diet may help individuals figure out which foods and beverages are a trigger for their bladder symptoms. If a trigger food or beverage is removed, it is reasonable to expect an improvement in symptoms within 10 days. After 10 days, reintroduce the food or beverage; if symptoms flare up or return, the food or beverage is a likely culprit. To be sure you eliminate the right trigger, remove only one food or beverage at a time.
What medication options exist to treat bladder problems in PD?
In both men and women with urgency, with or without leakage, there are bladder relaxant medications that help reduce urgency symptoms (beta-3 agonists and anticholinergics, which work by relaxing the bladder muscles and increasing bladder capacity).
In men with hesitancy, there are medications that help relax the urethra and prostate, allowing them to empty their bladders more effectively (alpha blockers and 5-alpha reductase inhibitors, which block the action of 5-alpha reductase, an enzyme that plays a role in prostate growth).
Are there surgical options to help bladder dysfunction as a result of Parkinson’s?
For patients that have urinary urgency despite the use of oral medications, there is an option of injecting Botox into the bladder. One study found that Botox injections helped to reduce both daytime and nighttime urinary frequency, as well as urinary incontinence, which helped improve participants’ quality of life. Improvements lasted at least six months following the injections (Giannantoni, et al., 2011).
Sacral neuromodulation, a minimally-invasive surgery that implants a pacemaker into the back that stimulates the sacral nerve, has also been shown to help reduce common bladder problems in people with Parkinson’s, such as overactive bladder, urinary frequency, urinary incontinence, and urinary retention.
For male patients who can’t empty well, there are surgeries to open up the prostate (transurethral resection of the prostate and greenlight laser prostatectomy), as an enlarged prostate can slow down or block the flow of urine.
How might bladder health change as the disease progresses?
Unfortunately, as the disease progresses, bladder symptoms, such as urinary urgency, often get worse. However, it is important to note that worsening bladder symptoms are not always a direct result of Parkinson’s, but may be caused by other issues, such an enlarged prostate. The good news is that there are many modalities of treatments available to treat the symptoms, regardless of their cause.
How can someone with Parkinson’s tell if their bladder problems are caused by PD or by another unrelated condition?
There are two tests that can be done to help determine if the bladder problems are related to Parkinson’s disease: cystoscopy, a procedure that uses a thin camera to look inside the bladder, and urodynamics, a test that measures the performance and health of the bladder and urethra using electrodes and a catheter. Both of these tests are minimally invasive and can help pin down the diagnosis to help patients get the treatment they need.
What are some tips you have or resources you would suggest for people with PD while they wait to see a urologist?
Your family doctor can start you on any of the oral medications in advance of seeing a urologist. Furthermore, keeping a bladder diary may be useful, as it can give your future urologist a snapshot into your bladder health. The smartphone app Vesica is a convenient and easy-to-use bladder diary. For printed copies of a diary, visit Dr. Locke’s website at https://bit.ly/DrLockeBladderDiary.
Sources
Giannantoni, A., Conte, A., Proietti, S., Giovannozzi, S., Rossi, A., Fabbrini, G., Porena, M., & Berardelli, A. (2011). Botulinum toxin type A in patients with Parkinson's disease and refractory overactive bladder. The Journal of Urology, 186(3), 960-964. https://doi.org/10.1016/j.juro.2011.04.071
Urology Care Foundation (2018, September 17). 10 Foods Your Bladder Will Fall in Love With. https://urologyhealth.org/healthy-living/care-blog/10-foods-your-bladder-will-fall-in-love-with
This content was published in the Fall 2022 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.