Urinary problems are common as we age, but those with Parkinson’s Disease are at higher risk of developing multiple urinary issues. It is important in Parkinson’s disease to stay very hydrated, but this oftentimes may worsen bothersome symptoms. Thus, it is important to pinpoint what urinary problems one is having and to find strategies (both non-medication and medication) to help improve symptoms.
Urinary symptoms include the following:
- Urinary frequency: Refers to the need to go to the bathroom frequently throughout the day. This is not usually an issue unless someone also has “urinary urgency.” Medications are not usually recommended for urinary frequency, but strategies that are helpful include “timed voiding” in which people preemptively use the restroom before they feel the need to urinate. There are medications that can be helpful (Myrbetriq, Gemtesa, and Sanctura).
- Urinary urgency: Refers to the lack of warning that one may have before needing to use the bathroom. Non-medication strategies include “timed voiding” (preemptively using the bathroom). For example, if one regularly needs to urinate after 3 hours, he or she may instead proactively use the bathroom 30 to 60 minutes earlier when the urge to urinate has not yet happened. There are medications that can be helpful (Myrbetriq, Gemtesa, and Sanctura).
- Nocturia: Refers to the need to use the bathroom overnight. This is the most common urinary complaint and those with Parkinson’s Disease (>60%). Non-medication strategies include limiting your water intake after 8 PM and sleeping with the head of the bed at least 20 degrees elevated (either with a bed wedge or adjustable mattress). Having a bedside commode can be helpful in preventing falls if someone has to regularly get out of bed to use the bathroom. There are medications that can be helpful (Myrbetriq, Gemtesa, and Sanctura).
There are other urinary symptoms that people may experience that are a bit more complicated to explain. Your Neurologist will work with you to determine if you have a urinary issue separate from the ones mentioned above. This may require evaluation from a Urologist, post-void residual ultrasound (checking your bladder before and after urination with an ultrasound to see if there is urine still in the bladder), and or urodynamic studies (tests that measure how well the bladder functions).
There are a few medications that I consider for safe for patients with Parkinson’s Disease.
Safe medications:
• Myrbetriq (mirabegron)
• Gemtesa (vibegron)
• Sanctura (trospium)
Unsafe medications: may cause memory impairment
• Ditropan (oxybutynin)
• Vesicare (solifenacin)
• Detrol (tolterodine)
• Toviaz (fesoterodine)
Unsafe medications: may cause low blood pressure
• Flomax (tamsulosin)
• Cardura (doxazosin)
• Uroxatral (alfuzosin)
• Rаpaflо (silodosin)
What is Timed Voiding?
Timed voiding is a bladder training technique where you urinate on a fixed schedule rather than waiting for the urge to go. This helps retrain your bladder to improve control and reduce urinary symptoms. Timed voiding is shown to improve bladder control and reduce accidents.
How to Start Timed Voiding:
- Track Your Urination:
For a few days, write down when you urinate and any accidents. This helps understand your current pattern. - Set Initial Intervals:
Based on your diary, choose intervals that are shorter than the time you usually go without urinating. For example, if you usually go every 2 hours, start with every 1.5 hours. - Follow the Schedule:
Go to the bathroom at the set times, even if you don’t feel the urge to urinate. - Adjust Gradually:
Once you are comfortable with the initial interval and can avoid accidents, increase the time between bathroom visits by 15-30 minutes each week. - Stay Consistent:
Stick to the new intervals throughout the day. If an accident occurs, shorten the interval slightly and try again.
Tips for Success
• Stay Consistent: Stick to your schedule, even if you don’t feel the urge.
• Plan Ahead: Make sure you have access to a bathroom when needed.
• Stay Hydrated: Drink plenty of fluids but avoid caffeine and alcohol, which can irritate the bladder.
• Be Patient: It may take a few weeks to see improvements.
Author Mick Reedy, MD, is a Movement Disorders Specialist with
Inova Parkinson’s and Movement Disorders Center (IPMDC)