It is important to discuss any bladder difficulties, included those listed below, with your doctor, even if this is embarrassing. Your doctor will make a proper assessment of any bladder problems.
- Inability or difficulty in emptying the bladder even when it feels full
- Significant uncontrolled leakage of urine at any time
- Unusually frequent urination (unless you already know you have a urinary infection)
- An urgent, immediate need to urinate, or urine leaking if you do not immediately do so
- Pain when urinating.
Writing notes to discuss with your doctor can help. These should include the nature of the difficulties experienced, their frequency, when the changes were first noticed and your normal eating and drinking habits.
Bladder problems can occur for a number of reasons, so the first approach will be to eliminate causes other than Parkinson’s, such as urinary infections (which can be common in older people) and prostate problems in men.
Treatment approaches for bladder problems may include:
General assessment and advice
Often a doctor will avoid medication initially, preferring to investigate whether diet, drinks, bowels, mobility, toilet environment and optimum control of Parkinson’s can affect – and improve - your bladder function.
Medication
The doctor may adjust your Parkinson’s medication as sometimes this can help. Medications may also be prescribed to:
- improve urgency and frequency problems by relaxing the bladder while it is filling and reducing unwanted bladder contractions
- overcome night-time problems by reducing urine production for approximately eight to ten hours after the medication is taken.
Exercise
Pelvic floor exercises are useful in preventing stress incontinence caused by weak pelvic floor muscles. These muscles, which stretch from the pubic bone at the front to the tail bone (coccyx) at the back of the body, are like a trampoline and work to support the bladder and bowel, as well as the uterus in women. They can become weak for many reasons, including childbirth, lack of exercise, hormonal changes and ageing, and this can cause urine to leak, particularly when coughing, sneezing, laughing or exercising.
Pelvic floor exercises can strengthen the muscles and so help control the bladder and prevent any leakage of urine. The following suggestions may help you to effectively do pelvic floor exercises on a daily basis, although it must be stressed that everyone is different and so each individual must find an exercise pattern to suit their own needs. A physiotherapist will be able to advise further.
Pelvic floor exercises:
- Sit comfortably in an upright chair with knees apart, making sure your weight is spread evenly on both buttocks.
- Imagine your pelvic floor is like a lift. Try to take the lift up and down to different floors, making sure you continue to breathe deeply down to the bottom of your rib cage throughout the exercise.
- Breathe in deeply, then all the way out, and take the lift to the first floor by tightening the lower abdominal muscles and back passage. As soon as you have tightened, resume normal breathing while you hold the muscles for a count of five.
- Slowly release the muscles completely.
- Next time, contract the muscles and take the lift to the second floor. Exhale as you contract, and resume breathing as you hold for a count of five, and then slowly release.
- Continue this again taking the lift finally to the third floor.
When performing the exercise, make sure you don’t tense your buttocks, bring your knees together, hold your breath, or lift your shoulders, eyebrows or toes upwards as you do them. If you do, your muscles will not be contracting correctly and the exercise won’t work.
Note: correct breathing and the ability to release the muscle to the basement floor after each hold is very important.
As you practice this each day, aim to squeeze harder to take the lift higher, and to hold the lift for longer at each floor. Increase the number of ‘lifts’ you do each time, but remember to rest between sets of squeezes. You may find it helpful to count and record how long you can hold for and how many squeezes you can do so that you can see your progress.
Try to build these exercises into your daily routine – ideally five times a day - and also use them whenever you think you may be about to leak urine, particularly if you are about to sneeze or cough.
Surgery
Surgical techniques may sometimes be used to treat stress incontinence and prostate problems.
Intermittent catheterisation
Intermittent catheterisation may be recommended if the problem is failure to empty the bladder resulting in much residual urine. It involves the insertion of hollow tubes into the urethra to drain urine away from the bladder and can be administered by the individual concerned, a carer or nurse.
