Bladder control

Living with Parkinson’s can be challenging, and bladder issues can add an extra layer of frustration.

But there is hope! With the right support and strategies, you can manage and alleviate bladder issues and improve your quality of life.

Common bladder control causes & symptoms

Bladder issues are common in Parkinson’s, affecting up to 40% of people with the condition. The symptoms can range from urinary urgency and frequency to retention and nocturia (waking up multiple times a night to use the bathroom). These issues can be caused by a combination of factors, including nerve damage, medication side effects, and underlying medical conditions.

Why do you need to go more urgently & more often?

Parkinson’s affects the brain’s ability to control the bladder, leading to issues with both storage and emptying. The changes in dopamine levels that occur in Parkinson’s can impact the bladder muscle’s function, causing it to contract or relax abnormally.

Parkinson’s and other underlying problems can affect the bladder, including:

nerve pathways from the bladder to the brain
bladder muscles‘ parkinsonian stiffness and rigidity
medication side effects
enlarged prostate
weak pelvic floor
constipation.

Common bladder control issues

Parkinson’s can significantly impact bladder control, leading to various issues that can disrupt daily life.

The most common ways Parkinson’s affects bladder control are:

Urinary urgency, a sudden, intense need to urinate with little warning, making it difficult to delay urination until reaching the toilet.
Urinary frequency, a frequent need to urinate, but only passing small amounts each time.
Urinary retention, an incomplete emptying of the bladder, often unnoticed, which can be detected by ultrasound after urination. Certain medications for urgency can also cause retention.
Post-urination drip, also known as after-dribble in men, this is a form of retention where urine continues to flow after finishing urination.
Nocturia, or frequent nighttime urination disrupting sleep, can be caused by fluid retention during the day and reabsorption when lying down.
Stress incontinence, or accidental leaking during exercise, coughing, sneezing, or laughing due to weak pelvic floor muscles or an enlarged prostate.

Understanding these common bladder control issues and solutions for their effective management can improve your quality of life.

Manage bladder issues

Managing bladder issues

The first step in managing bladder issues is to seek support from your healthcare team. Your GP, Parkinson‘s Nurse or continence specialist can help you identify the underlying causes of your symptoms and develop a personalised plan to address them.

In addition to seeking support from your healthcare team, there are several strategies you can try to manage and alleviate bladder issues:

Bladder training by gradually increasing the time between trips to the bathroom can help your bladder learn to hold more urine.
Pelvic floor exercises will strengthen your pelvic floor muscles to improve bladder control and reduce leakage. Speak to a physiotherapist or continence nurse who can help develop pelvic floor exercises for you. There are also free videos online.
Males can manage post-urination drip by sitting down to empty the bladder and applying gentle pressure behind their scrotum to encourage urine flow. Repeat this motion twice to ensure complete emptying.
Manage nocturia by resting with your feet up in the afternoon to reabsorb excess fluid. Avoid reducing fluid intake after 5 pm and prioritise drinking enough water throughout the day. Avoid caffeine and alcohol, and consider using a commode or bottle in your bedroom if needed.
Lifestyle changes like drinking plenty of water, avoiding caffeine and alcohol, and preventing constipation.
Manage Parkinson’s symptoms and bladder issues with medication prescribed by your GP.
Use devices such as commodes or bedpans to make it easier to use the bathroom at night.

Management aids

Many products can help manage urinary incontinence. Some people find it reassuring to wear an incontinence product when away from home.

Funding may be available to help reduce the cost of incontinence aids and specialist nurses. The Federal and State Governments offer a range of subsidy schemes to help offset the cost of continence products including:

Continence Aids Payment Scheme (CAPS): An Australian Government scheme that provides a payment to assist eligible people who have permanent and severe incontinence to meet some of the cost of their continence products.
DVA Rehabilitation Appliances Program (RAP): The DVA provides a range of continence products to eligible members of the veteran community through the Rehabilitation Appliances Program (RAP).
National Disability Insurance Scheme (NDIS) Continence Supports: The NDIS supports people under 65 with a permanent disability that prevents them from taking part in everyday activities.
State and Territory Schemes: Australian States and Territories operate a range of funding schemes for continence products and disability equipment.
Public toilet access: There are also public toilet maps on websites or map apps that can help you find your nearest while you are out. Master Locksmiths Access Key (MLAK) and Invisible Disabilities lanyard toilet access card are also available to help access toilets while out and about.

Key Statistics

Nocturia is the most common urinary symptom occurring in more than 60% of people living with Parkinson’s. (1)
Botulinum toxin (aka Botox) injections can be used to treat intractable urinary incontinence in Parkinson’s. (2)

Bladder control infosheet pdf
learn more

Information kindly reviewed by the Continence Foundation Australia.

To get help with continence issues contact the National Continence Helpline at 1800 33 00 66. It provides free information and can connect you with services near you. Or go to their website at continence.org.au

References:

(1) Yeo, L., Singh, R., Gundeti, M., Barua, J. M., & Masood, J. (2012). Urinary tract dysfunction in Parkinson’s disease: a review. International urology and nephrology, 44(2), 415–424. https://doi.org/10.1007/s11255-011-9969-y

(2) Sakakibara, R., Panicker, J., Finazzi‐Agro, E., Iacovelli, V., Bruschini, H., & Parkinson’s Disease Subcomittee, The Neurourology Promotion Committee in The International Continence Society. (2016). A guideline for the management of bladder dysfunction in Parkinson’s disease and other gait disorders. Neurourology and Urodynamics, 35(5), 551-563.

(3) Vaughan, C. P., Burgio, K. L., Goode, P. S., Juncos, J. L., McGwin, G., Muirhead, L., Markland, A. D., & Johnson, T. M., 2nd (2019). Behavioral therapy for urinary symptoms in Parkinson’s disease: A randomized clinical trial. Neurourology and urodynamics, 38(6), 1737–1744. https://doi.org/10.1002/nau.24052