Autonomic functions
Another name for automatic functions is autonomic functions. They are controlled by the autonomic nervous system and include things like heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. In Parkinson’s, these functions can be disrupted, leading to a range of symptoms.
Bladder control challenges are common in Parkinson’s, ranging from urinary urgency, having little warning that you need to pass urine, urinary frequency, feeling like you have to pass urine often, usually only passing a small amount at a time, and urinary retention, not being able to completely empty the bladder, to nocturia, waking more than once overnight to pass urine. Manage these issues by staying hydrated and balancing fluid intake to avoid urgency without dehydration or UTIs. Pelvic floor exercises can also help strengthen pelvic muscles to improve control. Always consult a specialist to seek advice on medications or lifestyle adjustments.
Constipation, a prevalent issue affecting 80-90% of people with Parkinson's, is a result of the impact on the autonomic nervous system. This system, responsible for regulating smooth muscle activity in the gut, experiences disruption, leading to a slowdown in the movement of food through the GI (digestive) tract. Understanding this cause can help manage the symptoms of constipation in Parkinson’s, which include infrequent and difficult bowel movements, straining during bowel movements, hard or pellet-like stools, and a feeling of incomplete evacuation.
Drooling in Parkinson’s, also known as sialorrhea, occurs primarily due to difficulties with swallowing from muscle rigidity and bradykinesia (slowness of movement). Parkinson’s affects the muscles involved in swallowing, reducing the frequency and efficiency of this automatic action. As a result, saliva tends to pool in the mouth instead of being swallowed regularly. While the amount of saliva produced is typically normal, the lessened ability to manage it leads to excessive drooling. Consult with a speech pathologist or dental specialist for treatment options.
Dysarthria in Parkinson’s is a motor speech disorder caused by weakened muscles used for speaking. This condition affects nearly 90% of individuals with Parkinson’s. Symptoms include reduced vocal loudness, a monotonous tone, imprecise articulation of consonants and vowels, and a breathy or hoarse voice. These changes also lead to slower, softer, and sometimes slurred speech. Managing dysarthria often involves speech pathology to improve communication and maintain social interactions.
Dysautonomia in Parkinson’s refers to the autonomic nervous system dysfunction, which controls involuntary bodily functions. Heart rate, blood pressure, digestion, constipation, urinary incontinence, excessive sweating, sexual dysfunction and temperature regulation may occur years before motor symptoms. Managing dysautonomia often involves a combination of lifestyle changes, medications, and other treatments.
Fatigue is a prevalent and often debilitating symptom of Parkinson's, affecting up to half of those diagnosed. It is an overwhelming sense of tiredness that is not necessarily relieved by rest and can significantly impact daily activities. The exact cause of fatigue in Parkinson's involves neurodegenerative processes and the side effects of medications. Managing fatigue includes optimising medication regimens, incorporating regular physical activity, ensuring adequate sleep, and addressing any coexisting conditions such as depression or sleep disorders.
GI issues arise because the autonomic nervous system, which controls automatic bodily functions, is compromised in Parkinson's, disrupting digestive processes. The most common problem is constipation. Other symptoms include gastroparesis, or delayed gastric emptying, which results in bloating, nausea, and early satiety; dysphagia, or difficulty swallowing; and sialorrhea, or excessive saliva production. Additionally, you may experience bloating and abdominal discomfort due to the slowed movement of food through the digestive tract. Managing these symptoms involves dietary adjustments, medications, and the empowering role of lifestyle changes, along with professional guidance, to improve quality of life.
Parkinson’s can cause excessive sweating, a condition known as hyperhidrosis. People with Parkinson’s may experience sudden, profuse sweating, especially in the upper body and face. This can be pretty uncomfortable and may require frequent changes of clothing. Managing this symptom involves adjusting medications and using strategies to stay cool.
Low blood pressure (also known as orthostatic hypotension) can occur in Parkinson’s. Lightheadedness, dizziness, and fainting are common. You might experience weakness, blurred vision, or confusion. Shoulder or neck pain, trembling, and cold hands/feet can also occur. Management of hypotension should include drinking enough water to help regulate blood pressure. Prevent constipation, which can worsen symptoms. Avoid sudden movements; get up slowly from chairs and bed. Remember, your care team, including your GP, is here to help. They can recommend treatments to ease symptoms and provide the necessary support.
Loss of smell, known as anosmia or a reduced sense of smell (hyposmia), is a common and early symptom of Parkinson's. Profoundly affecting your ability to detect and recognise odours, it may impact nutritional habits, enjoyment of food, and changes in appetite. It also poses safety risks, as you may struggle to detect hazards such as spoiled food or gas leaks. Psychosocially, scent is linked to memories and emotional connections. Managing changes to your sense of smell requires adaptive strategies to enhance safety, maintain nutrition, and address emotional and social implications.
Types of pain associated with Parkinson’s include muscle pain, dystonia, radicular (shooting) pain and neuropathy. Unexplained pain is a common symptom in young onset, starting with the shoulder, elbow or hip. Musculoskeletal (muscle) pain is common and related to Parkinson’s rigidity and reduced joint movement. It often feels like an ache or in the neck and back but can affect any body part. Treatment options are limited, but minimising “off” periods, taking painkillers and doing gentle physical activity, along with medication adjustments, behaviour change techniques, pain education, relaxation methods, and complementary therapies like acupuncture, are also used to manage pain.
Peripheral neuropathy in Parkinson's refers to damage or dysfunction of the peripheral nerves. The changes to the nerves outside the brain and spinal cord can lead to various symptoms, including numbness, tingling, burning sensations, and weakness in the hands, feet, arms, or legs. In Parkinson's, peripheral neuropathy may relate to factors such as aging, diabetes (which is more prevalent in people with Parkinson's), or side effects of medications used to treat Parkinson's.
Seborrheic dermatitis, is a common chronic inflammatory skin condition affecting areas with lots of sebaceous glands. It can be effectively managed but currently has no cure. You may experience red, flaky skin on your scalp and face, especially around the nose, inner eyebrows, and eyelids, around and inside the ears, and less commonly on the chest, folds of skin, and groin. Topical treatments such as antifungal creams, corticosteroids, or medicated shampoos, lifestyle changes and regular skincare routines play a crucial role in managing this condition. Talk to a medical professional like your GP or pharmacist, or get a referral to a dermatologist.
Sexual dysfunction in Parkinson's encompasses a range of issues that can significantly impact intimate relationships and quality of life. For men, common problems include erectile dysfunction, difficulty achieving or maintaining an erection due to decreased blood flow or side effects of medications used to manage symptoms. Women may experience reduced libido, difficulty reaching orgasm, or discomfort during intercourse, often related to changes in hormone levels, medication effects, or physical symptoms such as muscle stiffness. Parkinson's may also impact intimacy and communication. Addressing sexual dysfunction in PD requires a collaborative approach involving healthcare providers who specialise in neurology, urology, gynecology, and sexual health.
Sleep disturbances are common and often significant, affecting up to 60-80% of people living with Parkinson’s. These disturbances can take various forms, including difficulty falling asleep, frequent awakenings during the night, restless legs syndrome (RLS), and rapid eye movement (REM) sleep behaviour disorder. REM sleep behaviour disorder (RBD) is particularly prevalent, characterised by acting out dreams physically, which can lead to injury for you or your bed partner. Sleep disturbances are thought to result from a combination of factors, including changes in the brain's neurotransmitter systems, medication effects, motor symptoms disrupting sleep patterns, and the presence of other coexisting conditions such as depression or anxiety. Proper management involves a comprehensive approach that may include adjusting medications, addressing motor symptoms that interfere with sleep, treating coexisting conditions, practising good sleep hygiene, and potentially using medications to improve sleep quality. Managing sleep disturbances effectively can significantly enhance the overall well-being and quality of life, so speak to your care team about your symptoms and management solutions.
Urinary incontinence in Parkinson's can arise from multiple factors related to both the condition itself and its treatments. The neurological changes can disrupt the coordination between the brain and the bladder. Medications commonly used to manage symptoms, such as anticholinergics or dopaminergic therapies, may also contribute to bladder control issues. Additionally, stiffness and slowness of movement, can make it challenging for you to reach the restroom in time. Pelvic floor dysfunction, possibly worsened by reduced physical activity or age-related changes, can further contribute to urinary incontinence. Addressing these factors typically involves a holistic approach that may include medication adjustments, pelvic floor exercises, behavioural therapies, and managing coexisting conditions like urinary tract infections to improve bladder control.
Urinary urgency refers to a compelling and sudden need to urinate that can be difficult to control. This symptom arises due to disruptions in the neurological pathways that regulate bladder function. Parkinson's affects the brain's ability to properly signal when the bladder is full or when it needs to be emptied, leading to an exaggerated sensation of urgency even when the bladder may not be completely full. Additionally, medications used to manage Parkinson's symptoms can sometimes exacerbate bladder symptoms, increasing urgency. Urinary urgency can significantly impact your daily life, causing discomfort, anxiety, and challenges in managing social situations. Managing urinary urgency involves strategies such as timed voiding schedules, pelvic floor exercises to improve bladder control, lifestyle modifications like fluid management, and occasionally medications to reduce bladder spasms or urgency sensations.
