Bladder problems in Parkinson’s: ask the expert
Bladder problems are a common non-motor symptom in Parkinson’s. This blog explores current research into this area and what is being done to improve treatments.
When we asked people affected by Parkinson’s what their research priorities were for improving everyday life, ‘reducing urinary problems’ emerged in the top ten.
Bladder problems can have a significant impact on people’s quality of life.
Let’s hear Paul’s story…
I was diagnosed with Parkinson’s about two years ago, but I can now look back and see that I’ve had symptoms for five years or so, and this includes problems with the waterworks. My problem is not an inability to go, but if I need to go, I need to go now.
It really affects me, my first thought when planning a trip is when am I going to be able to go to the toilet. My life is controlled by where my nearest toilet is. It’s a very embarrassing situation to be in. My doctor has given me pills for an overactive bladder, which help a bit. But they don’t make the problem go away. Although my other Parkinson’s symptoms can be frustrating at times, if I could control my bladder problems it would be life changing for me.
It has taken me some time to accept that my condition is a disability and as such I can access disabled facilities. The Radar Key Scheme allows me to access over 10,000 disabled facilities across the UK and you don’t need to have a blue badge to use one. The scheme has given me much more confidence. If like me you are struggling with bladder incontinence then you should consider getting yourself a Radar Key, it can be a lifesaver!
Paul, Patient and Public Involvement Volunteer
We’re joined by Dr Jalesh Panicker, an expert in neurological disorders and bladder problems, who answers some of the key questions on this topic.
What are the different types of bladder problems people with Parkinson’s might experience?
In studies that have looked into non-motor symptoms of Parkinson’s, bladder problems are one of the most common reported. It should be noted however that not everyone with Parkinson’s will experience bladder problems. Moreover bladder symptoms can arise from different causes separate from Parkinson’s and therefore tests may need to be carried out before concluding that symptoms are Parkinson’s related.
There are two problems with the bladder that people experience-
- Problems with holding urine — inability to hold urine in the bladder causing increased frequency to urinate. This may result in rushing to the toilet (urgency) and can sometimes lead to incontinence. The most common symptom is what is known as nocturia, getting up at night to pass urine. There can be different reasons why people with Parkinson’s report nocturia.
- Problems with urinating — difficulty emptying the bladder causing hesitancy, a weak urine stream, an interrupted flow and retention of urine. People may find it much harder to notice these symptoms. It is therefore quite important to measure what is left behind in the bladder after passing urine. If a significant quantity of urine is left behind in the bladder, there is an increased risk for urinary tract infections.
What is the connection between Parkinson’s and bladder problems?
The bladder is responsible for holding and then expelling urine from the body. Signals from the brain are responsible for controlling these functions, and in Parkinson’s these signals can get interrupted.
Dopamine plays an important role in controlling the reflex responsible for bladder control, essentially it has an inhibitory effect on this reflex. When dopamine levels decrease in Parkinson’s, this can lead to a loss of control of this reflex and the bladder is no longer inhibited; it gets a life of its own and begins to misbehave.
Like dopamine, other chemicals in the brain are altered in Parkinson’s and it is likely that changes in their levels can also contribute to bladder problems in Parkinson’s.
What should people do if they start experiencing bladder problems?
In the first instance, speak to your GP. The bladder problems may or may not be related to Parkinson’s. The GP should, therefore try to exclude other reasons that may be contributing to bladder problems. A bladder scan may be done as part of these investigations.
How can people manage bladder problems?
The Radar Key helps people to access public toilets, as mentioned by Paul.
Pelvic floor exercises are advised to help strengthen muscles that can help with bladder control.
What are the current treatment options?
Medication, known as antimuscarinic agents, can help to calm the bladder, helping with urgency, frequency and incontinence. They relax the bladder and allow more urine to be held. But we use this with caution as there can be side effects including constipation and maybe even memory loss. Mirabegron is another drug that is available and is being prescribed more and more.
Another treatment that people may be advised to have is Botox injections. Most of us will be more familiar with Botox as an anti-wrinkle agent — it works by blocking signals from our brain to muscles, so they can no longer contract. Injecting Botox into the bladder wall (into a muscle called the detrusor) has been shown to relax this muscle and thereby help with problems of holding urine (known as detrusor overactivity).
Although Botox has not been trialled or licensed for Parkinson’s for the relief of bladder symptoms, it has been shown as an effective treatment for overactive bladders in neurological conditions in general. But, this treatment has limitations as there is a risk that it will result in urine not being completely removed from the bladder. In addition, the effects wear off and the treatment needs to be continually repeated.
Are there any new treatments being developed?
There is a need for better treatments in this area and tibial nerve stimulation is a recent development. This treatment involves electrical stimulation of the nerve behind the ankle that sends signals to the nerves controlling the bladder.
I am working on a Parkinson’s UK/ Dunhill Medical Trust funded research project led by Professor Doreen McClurg exploring whether home based, non-invasive tibial nerve stimulation may be effective in controlling bladder symptoms. To do this small patches are attached to the surface of the skin near the ankle using a machine called a TENS machine. We hope to assess if this is an effective way to control overactive bladder symptoms in people with Parkinson’s.
What are the remaining research questions?
We still need to understand more about the risk factors that contribute to the development of bladder problems in Parkinson’s. As I have mentioned, better treatments are needed for bladder symptoms, preferably non-surgical and non-invasive. Alongside this, there are new and existing drugs that need to be fully investigated, to see if they can benefit people with Parkinson’s who have bladder symptoms. With support from Parkinson’s UK, we have recently researched a drug called melatonin to see whether this might be helpful in managing the symptom of nocturia in individuals with Parkinson’s, and the final results should be out very soon.
Dr Richard Axell, Principal Clinical Scientist at the University College London Hospital and Honorary Senior Lecturer in Jalesh’s Uro-Neurology Group at the Queen Square Institute of Neurology, UCL, has applied for a National Institute of Healthcare Research Grant to investigate why people with Parkinson’s may develop problems emptying their bladders. They are interested in developing a model to predict if people with Parkinson’s are at risk of developing an under-active, poorly contracting bladder. People affected by Parkinson’s helped to assist in the design of this study.
Richard tells us more —
“We developed our proposal in collaboration with Parkinson’s UK after I was awarded a Research Involvement Award. The award was funded by Parkinson’s UK to facilitate a collaboration with people with Parkinson’s who are trained and willing to be involved in research projects. This group helped to ensure that our abstract had a clear and understandable message, and the study was relevant and planned in an appropriate and feasible manner. We plan to meet as a group every six months to help evaluate impact, monitor progress, and maximise the dissemination potential of the study.”
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This blog is not meant as health advice. You should always consult a qualified health professional or specialist before making any changes to treatment or lifestyle.
Huge thanks to Dr Jalesh Panicker, Consultant Neurologist and Clinical Lead in Uro-Neurology at The National Hospital for Neurology and Neurosurgery, and Reader at the UCL Queen Square Institute of Neurology, London.