Parkinson's Disease and Incontinence - Incontinence Institute

Parkinson’s Disease is an incredibly complex disorder with an array of degenerative symptoms that can manifest a little differently in every person with the disease. This leads to questions and concerns related to the direction of your, or your loved one’s, health. When these concerns are sensitive in nature, such as the relationship between Parkinson’s and incontinence, the questions can become more difficult to ask.

But knowledge of both urinary and bowel incontinence is important to talk about because both problems can arise and addressing them is essential for informed, supportive, and effective care.

Does Parkinson’s Cause Incontinence?

Parkinson’s Disease can cause both bowel and urinary incontinence as part of its degenerative nature, though not always at the same time. These symptoms, when they appear, can be addressed in several ways as long as they remain a part of the dialogue between you and your caregivers, whether they be family, friends, or professionals.

What Kind of Incontinence Does Parkinson’s Disease Cause?

Incontinence is considered a non-motor symptom of Parkinson’s Disease, which is mainly considered to be a movement disorder. This means that much more research and emphasis have gone into the more noticeable motor issues that define the disease and not the prominent non-motor problems that accompany the disease.

This also means that the medication prescribed already to control a person’s motor functions doesn’t necessarily have any effect on non-motor-related symptoms, such as incontinence, which need to be addressed separately and discussed with your doctor. Identifying and treating incontinence issues aren’t just about increasing personal comfort. It’s about dignity. It’s about confidence. It’s about quality care.

Parkinson’s and Urinary Incontinence

Parkinson’s causes problems with automatic bodily functions, such as breathing, heart rate, and urinary function. Urinary incontinence is much different than fecal incontinence and usually doesn’t start to occur until the later stages of the disease. Urinary incontinence due to Parkinson’s is a two-fold problem. The bladder has trouble holding urine in, but, at the same time, it’s difficult to control the release of urine, leading to some serious discomfort and emergency bathroom visits.

Urinary incontinence problems can come in many forms:

A person with Parkinson’s may have to urinate very frequently, complicated by an increasingly difficult time with movement. Once they sit down, they may find it difficult to let go of the urine and void their bladder. While nearly 40% of Parkinson’s patients may experience some level of urinary incontinence, only 15% of patients should develop a serious urinary condition.

Parkinson’s and Fecal Incontinence

Did you know that 65% of Parkinson’s patients are affected by constipation, and, many times, the constipation is severe? The beginning stages of fecal incontinence start to occur immediately due to behavioral changes that can even preclude a diagnosis. For example, when someone starts to notice that their hand is shaking a little, they may be nervous about spilling something and reduce their intake of fluids. The trembling hand may be what causes you to call the doctor, but bowel problems have already begun.

Fecal incontinence also comes in several forms, including:

Parkinson’s Disease slows down our gastric motility function, which means that our ability to digest food and move waste through our system has slowed way down. When you mix this with all the medication that a person with Parkinson’s has to take and the fact that they aren’t always getting enough water or movement, constipation is an unfortunate side effect.

This means that a person with Parkinson’s can suffer from bowel impaction that needs to be removed or experience a loss of muscle control that can lead to accidents, and near-accidents, that can keep someone with the disease from living their best life. What can be done to treat incontinence in Parkinson’s patients?

What Can Be Done For Incontinence As A Result of Parkinson’s Disease?

When incontinence becomes a problem, there are several interventions that can be done, depending on the cause of the loss of function, whether it’s behavioral or medical.

Lifestyle Changes

Your diet will have a big impact on your ability to get back the control that you have lost. Certain foods can irritate your bowels, cause inflammatory reactions, and lead to incontinence problems. There may even be foods that bother you that may not bother another person in the same state. A great idea is to have a journal that documents what you have eaten, when you ate it, and how much you ate along with details from your bathroom visits to help your doctors identify problem foods not already on the list.

Along with a healthier diet, walking more, and generally moving around more, will help move waste along your bowels and help you know when it’s time to go.

Exercises

Did you know that there are physical therapy options for incontinence? Physical therapy has been pretty effective, especially for fecal incontinence, and can be used alongside a great diet and daily behavioral changes before any medication may be introduced. The goal is to strengthen your pelvic floor muscles, such as doing kegal exercises throughout your day.

Bowel training with a routine schedule can help you retain your bowel habits as well. Biofeedback is a way to retrain your bowel muscles by utilizing noninvasive sensors attached to the outside of your abdomen. It’s all about strengthening and retraining those muscles weakened by medication and disease.

Medications

Once your diet has been optimized for better digestive control, and incontinence is still a problem, medication may be helpful. But medication can be tricky and certain medications have been known to make problems worse or not mix well with other medications. If this is the next step in your plan, even OTC medications can have a harmful effect and you should report everything you take to your doctor. It’s essential to identify the source of your problems before treating them.

Sacral Nerve Stimulation

Your sacral nerve communicates important messages between your urinary tract, digestive tract, and your brain. These messages give you fair warning before you need to use the restroom and let you know when you are about to enter into a situation that could be messy and uncomfortable. There are a few non-invasive nerve stimulation options available to those who are interested. Options include:

InterStim Implants work for both bowel and urinary incontinence by using an internally implanted device that sends electric pulses to stimulate sacral nerves to increase your body and mind’s ability to communicate messages between your digestive tract and the brain. This should fully restore a person’s ability to use the restroom as intended, but is usually only an option when medication and behavioral modifications fail to help.
Axonics is another implant that works for both bowel and urinary incontinence and that also stimulates the sacral nerve, increasing the ability of your gut to communicate with your brain.

Both of these procedures are outpatient and usually only use a local anesthetic for implantation. You will be given a hand-held remote to control the devices and should be back on your feet soon. There are a few differences between these two particular options. While both implants are small and can’t be felt under the skin, Axonics is still a smaller device and requires charging once a month, for an hour. On the other hand, the InterStim II device doesn’t need charging but requires replacement every five years, unlike Axonics, which needs replacement every fifteen years.

The InterStim Micro needs to be charged once a week for 20 minutes, but also only needs to be replaced every fifteen years. You will need to discuss your options with your doctor and an incontinence specialist, who can help you determine which treatment is best for you and your life.

Don’t suffer in silence; we hear you and we see you.

Parkinson’s Disease and Incontinence