Sensation of a need to empty the bladder often or intensely, even when the bladder is not full. These are common and related problems in Parkinson’s disease, as well as in aging, and sometimes are called overactive bladder. Either can result in urinary incontinence, an involuntary leaking of urine that occurs with or without stress (such as coughing or sneezing). Urinary frequency and urgency account for most noc-turia, the need to get up at night to go to the bathroom. As with many secondary symptoms, it is important to make sure there are no underlying causes of these problems.
Urinary tract infections cause both frequency and urgency, as well as burning, and are far more common in women than in men. Generally when there is an infection, the urine has a foul smell and may be cloudy or discolored; however, catechol-o-methyltransferase INHIBITOR (COMT) medications such as entacapone (Comtan) also turn urine dark orange. Another condition that causes similar symptoms is interstitial cystitis, also significantly more common in women. In men the prostate gland enlarges with age and can interfere with the flow of urine. Sometimes a consultation with a urologist (physician who specializes in disorders of the urinary tract) is necessary to determine whether these conditions exist.
The disease process of Parkinson’s is itself largely responsible for these symptoms, as it affects the function of smooth muscle tissue such as composes the bladder and other structures of the urinary tract. anti-parkinson’s medications, especially anticholinergic medications, further contribute by blocking the action of acetylcholine, to reduce smooth muscle motility. Sometimes adjusting the choice or dosage of medication can eliminate or reduce frequency and urgency.
Following a frequent voiding schedule, in which the person urinates at planned intervals of two to four hours whether or not there is a need to empty the bladder, sometimes helps relieve the sensations of urgency. It also can relieve the anxiety that many people have about finding a bathroom when the urge strikes. Some people attempt to stave off the sensations of urgency and frequency by limiting the amount of water and other liquids that they drink during the day. This is generally not a good idea, as dehydration can result. As well, adequate hydration helps to fend off another common problem in Parkinson’s disease, constipation.
Various medications also can relieve symptoms. Among those commonly prescribed are oxybu-tynin (Ditropan), tolterodine (Detrol), propanthe-line (Pro-Banthine), dicyclomine (Bentyl), and flavoxate (Urispas), which are anticholinergics. For men with prostate enlargement doctors sometimes prescribe prazosin (Minipress), a medication also used to treat high blood pressure and that has a clear risk of potentiating orthostatic hypotension in people with Parkinson’s. All of these medications can cause drowsiness and have various other side effects, although they generally do not interact with anti-parkinson’s medications.