Parkinson's disease affects more than your motor skills — though bowel and bladder issues become increasingly common with age anyway, Parkinson's patients are even more likely to have them. If you've noticed that going to the restroom isn't as easy as it once was, go with your "gut feeling" and talk to your doctor, who will have plenty of suggestions that could help.
What kinds of bladder issues might Parkinson's disease patients encounter?
The loss of nerve cells and dopamine means that Parkinson's disease, especially in its more advanced stages, can mess with the signals your bladder is getting from your brain. Among the trouble people with Parkinson's may encounter are:
- Urinary incontinence. Incontinence becomes more common with age, but Parkinson's patients are especially prone to it. That is because the bladder's sphincter can become dysfunctional, and your brain can send you messages that you need to pee urgently — like, right now, whether or not you're anywhere near a toilet — even when your bladder is nowhere near full.
- Trouble voiding. You may also find that you're unable to empty your bladder completely when you urinate, something that can happen if your sphincter is uncooperative or your bladder doesn't contract as it should. This, too, is a result of lowered dopamine levels. Another reason for trouble emptying the bladder is stool building up in your rectum and putting pressure on your urethra, interfering with the flow of your urine.
- Nocturia. This is an uncomfortable condition that will have you up multiple times a night to use the bathroom, caused by an overactive bladder. Some people don't wake up, causing them to void in the bed.
A multitude of factors can be responsible for giving you trouble with your bladder — Parkinson's isn't the only possible cause. When you take your problems to your doctor, they'll first investigate what's troubling you.
1. Have a chat with your doctor
Letting your doctor know what's going on is the first step on the road to improvement. Once they know you have trouble with your bladder, your physician will seek to determine the cause. Though medications can be prescribed for bladder problems, lifestyle changes — like changes to your diet, the timing of your water intake, and bladder training — and adjustments to the dosage of your Parkinson's drugs will likely be investigated as possible solutions first.
Adjusting the dose of your Parkinson's meds, or switching to a new medication, can sometimes help you overcome bladder problems. Medications can also be prescribed to help you relax your bladder, allowing more complete voiding. These include:
3. Could a catheter help you?
An intermittent catheter is a kind of catheter that is inserted to help you empty your bladder, after which it is removed. A nurse of other medical professional can help you with this, but many patients are able to do it themselves as well. If a catheter is only used to expel residual urine — "leftover pee" that you couldn't pass by yourself — it may only be used once a week.
4. Pelvic floor exercises (Kegels)
Kegel or pelvic floor exercises can strengthen the pelvic floor muscles in both men and women, which can both help prevent and alleviate stress incontinence. If you are suffering from incontinence because your pelvic floor has become weakened, due to age, a sedentary lifestyle, hormonal changes, and childbirth, Kegels can really help you out and put a stop to that leakage.
Kegels are easy to do:
- Sit on a chair, with a straight posture and your knees slightly apart.
- Tense the muscles you use when you're trying to hold in urine.
- Count to five.
- Relax your muscles.
- Repeat — as many times as you can.
5. Making adjustments to your restroom
Your incontinence may simply be caused by the fact that your declining motor function makes it difficult to reach the toilet in time or to use it effectively. Patients can use a small stool to lift their legs up a bit if the toilet is too high, which helps them attain a position that makes urination physiologically easier. If the toilet is too low, on the other hand, raised toilet seats can help out. You'll also benefit from clothes you can easily remove and a railing at the side of the toilet to grab onto to make it easier to lower yourself. Should you still have difficulties, you may find that a portable urinal is the answer for you.
Parkinson's patients may additionally benefit from:
- Drinking most of their fluids during the day while going easy on the water in the hours prior to bedtime to minimize nightly urination episodes.
- Cutting down on beverages that make you need to pee more, like anything that contains caffeine, sugary carbonated drinks, and alcohol.
- Incontinence pads can save you from small amounts of leakage.
- People who don't wake up when they need to pee during the night can try setting a "toilet alarm".
What kinds of bowel trouble might Parkinson's disease patients have?
People with Parkinson's may be more likely to experience problems with their bowels (the small and large intestines) than the general population. Symptoms of constipation include:
- Hard stools
- Less frequent bowel movements
- Straining and pain while trying to move your bowels
What can you do when you become constipated?
1. Let your doctor know
Your doctor should, again, be your first point of call, and one of the things they'll look at is whether your medications could be contributing to your constipation. Besides adjusting your meds, your physician may suggest you increase the amount of water you drink and propose dietary changes. Parkinson's patients dealing with more serious, persistent constipation that does not react to these kinds of changes can be offered medications such as laxatives, however. Should your doctor suspect something more serious may be going on — because you're also bleeding after bowel movements or suffering from unexplained rapid weight loss, for instance — they can refer you to a specialist.
Laxatives are generally only prescribed when lifestyle changes do not offer a solution. They should be used exactly as your doctor tells you to, and are only a temporary solution. Laxatives come in different kinds, with fiber-based laxatives making it easier to pass stool, and osmotic adding fluids to your bowels.
3. Dietary changes
A healthy and balanced diet is essential for easy bowel movements — to pass stool, you need both enough fiber and enough water. Parkinson's disease patients who suffer from constipation benefit from working with a dietitian to ensure that their diet is just right for them. In the meantime, you can take some steps to add dietary fiber to your routine and to reduce constipation in other ways:
- Take your levodopa on an empty stomach.
- Eat plenty of whole grains, vegetables, and fruits
- Make sure your fluid intake is adequate — a hot drink after you wake up is a good way to start the day
4. Exercise: Get things moving
Exercise has plenty of benefits for Parkinson's patients, including increased flexibility and reduced stiffness. It may help with constipation too, by giving your bowel muscles a boost, strengthening the pelvic floor, and making it easier to move your bowels.
5. What? A toilet routine?
Yes. We all know of people who keep a book or comic by the toilet to help them relax as they do their business, and you may even be one of them. This works for some because it's essential to relax as you move your bowels, but you can do that in other ways too. Just sit there, relax, and think about what you're going to be doing later — worrying about whether you can move your bowels is only going to make things worse. Let nature work for you; don't strain too much. Making your toilet comfortable is important, too. A small stool to raise your legs a bit can make your posture more conducive to bowel movements.