Urinary urgency

Urinary urgency is a very common problem in Parkinson’s.

Managing urinary urgency usually involves a mix of lifestyle changes, medications, and sometimes medical procedures.

What is urinary urgency?

Parkinson’s disease is mostly known for movement issues like tremors and stiffness, but it also causes many invisible symptoms. One of the most common and frustrating of these is urinary urgency, which is a sudden, intense need to urinate that is very hard to control.

Between 33% and 68% of people with Parkinson’s experience this intense urge to go. If the person cannot reach a bathroom in time, it leads to accidents, which is called urge incontinence.

Urinary urgency can be very dangerous for people with Parkinson’s because it greatly increases the risk of falling. When a sudden urge hits, a person naturally wants to rush to the toilet. However, Parkinson’s also causes balance problems, stiff muscles, and a condition where blood pressure drops quickly when standing up (orthostatic hypotension). Rushing to the bathroom, especially in the middle of the night, is a leading cause of bone fractures and head injuries in people with Parkinson’s. Beyond physical injuries, these bladder problems can also lead to social isolation, caregiver stress, and an increased chance of needing to move to a nursing home.

Causes of bladder issues in Parkinson’s

The neurological changes in Parkinson’s can disrupt the coordination of messages 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.

People with Parkinson’s often experience a sudden and overwhelming need to urinate, referred to as urgency, which can occur with little warning. This symptom, along with frequency (needing to pass urine often) and nocturia (waking up at night to urinate), is commonly seen in Parkinson’s.

Parkinson’s medications can influence urinary symptoms. As the effect of the medication fluctuates, particularly during “wearing off” periods, the bladder may respond with increased urgency. This optimisation of medication levels on bladder control helps manage these symptoms.

Additionally, stiffness and slowness of movement can make it challenging for you to reach the bathroom in time. Pelvic floor dysfunction, possibly worsened by reduced physical activity or age-related changes, can further contribute to urinary incontinence.

Management Strategies

Addressing these factors typically involves a holistic approach that may include lifestyle changes, medication adjustments, pelvic floor exercises, behavioural therapies, and managing coexisting conditions like urinary tract infections to improve bladder control.

Management may involve:

Lifestyle Changes: Doctors often recommend “timed voiding.” This means going to the bathroom on a set schedule (like every two hours) before the sudden urge strikes. Doing daily Kegel exercises (pelvic floor muscle training) can also give you more muscle strength to hold back leaks. It is also helpful to avoid drinks that irritate the bladder, like coffee, tea, and soda, and to stop drinking fluids a few hours before bedtime.
Medications: Doctors can prescribe pills to relax the bladder muscle. However, they must be very careful with older Parkinson’s patients. Common bladder drugs (called anticholinergics) block certain brain chemicals and can cause memory loss, confusion, or even dementia. Safer options include newer drugs like mirabegron (Myrbetriq) or vibegron, which relax the bladder without passing into the brain and causing mental side effects.
Medical Procedures: If pills and habit changes do not work, a urologist might suggest Botox injections into the bladder muscle to calm it down. Another simple procedure involves using mild electrical pulses on a nerve near the ankle (tibial nerve stimulation) to fix the communication between the bladder and the brain. Finally, Deep Brain Stimulation (DBS) surgery, which is often used to treat Parkinson’s tremors, has also been shown to greatly improve urinary urgency.

Continence Health Australia recommends that anyone experiencing urinary urgency discuss these symptoms with their care team.

Key Statistics

1. Urinary urgency affects between 33% and 68% of people with Parkinson’s disease. When looking at data combined from many different studies, researchers found that the average rate of urinary urgency among Parkinson’s patients is about 46%.
2. Urgency is directly caused by a lack of dopamine in the brain. In a healthy brain, dopamine is used to send “stop” signals that prevent the bladder from squeezing before it is completely full. As Parkinson’s disease destroys dopamine-producing cells, the brain loses its ability to inhibit the bladder. This causes the bladder muscle to become overactive and contract involuntarily, creating a sudden, intense emergency need to urinate.

3. Urgency creates a “perfect storm” for dangerous falls. When an intense urge hits, a person’s natural reaction is to rush to the toilet. Unfortunately, this urgency is often combined with other Parkinson’s symptoms like stiff muscles, balance issues, and drops in blood pressure when standing up (orthostatic hypotension). This combination makes patients extremely vulnerable to falls and bone fractures, especially when rushing to the bathroom in the middle of the night.

4. Behavioural therapy can reduce urgency symptoms by 50% to over 80%. Studies show that non-drug treatments, such as bladder training (urinating on a fixed schedule) and pelvic floor muscle exercises (Kegels), are highly effective at suppressing urgency and reducing leakage. If behavioural changes are not enough, doctors can successfully treat urgency with medications that do not cross into the brain (like beta-3 agonists), Botox injections into the bladder muscle, or Deep Brain Stimulation (DBS) surgery.

Sudden worsening of urgency, pain, or fever should be checked by a doctor, as it may indicate a UTI. It is important to differentiate PD from Multiple System Atrophy (MSA), which can also cause similar, more severe urinary symptoms.

How do I access supports?

It’s advisable to explore all available pathways to find the support that best suits your individual needs. Look to:

getting a GP referral to someone with Parkinson‘s experience
your state-based Parkinson’s organisation for advice
Ask Izzy https://askizzy.org.au/ to search for local services to access
private health to see what is covered in relation to consultations and expenses
DVA, NDIS or My Aged Care plan supports.

Disclaimer: Consult a healthcare professional for diagnosis and treatment of bladder issues.

Infosheet under review

References

Bladder & Bowel Community. (n.d.). Parkinson’s Disease and Incontinence.
Continence Health Australia.
Cutter, E. (2025). Balancing Efficacy and Cognitive Health In Bladder Assays. REPROCELL.
Davis Phinney Foundation. (2017). Tips for Alleviating Bowel & Urinary Dysfunction with Parkinson’s.
Gleeson, J. R. (2019). Parkinson’s Disease and Your Bladder. Michigan Medicine.
HARTMANN Direct. (n.d.). Parkinsons and Incontinence Managing Bladder and Bowel Problems.
Incontinence UK. (n.d.). Deep Brain Stimulation Improves Incontinence and Parkinson’s.
Luthra, S. (n.d.). Impact of Parkinson’s Disease on Urinary Function. TENA.
Parkinson’s Foundation. (2023). How to Manage Bladder and Common Urinary Issues in Parkinson’s.
Stephenson, R. (n.d.). Bladder Dysfunction in Parkinson’s Disease. Parkinson’s Foundation.
Unknown Author. (n.d.). Comprehensive Clinical Analysis of Pelvic Organ Dysfunction in Parkinson’s Disease: Pathophysiology, Neuro-Urological Management, and Integrated Care Strategies.
Unknown Author. (n.d.). Neuroanatomical Dysregulation and Clinical Management of Urinary Urgency in Parkinson’s Disease.
Neuro-Urological Integration in Parkinson’s Disease: Pathophysiology, Clinical Phenomenology, and Multimodal Therapeutic Frameworks.
Vaughan, C. P., et al. (2019). Behavioral therapy for urinary symptoms in Parkinson’s disease: A randomized clinical trial. Neurourology and Urodynamics, 38(6), 1737-1744