PARKINSON’S DISEASE

Parkinson’s disease (PD) is a degenerative disorder of the central nervous system. While it is a brain disorder that progresses slowly, those with PD do experience a multitude of physical limitations including incontinence. As the disease attacks the brain, it focuses on dopamine-producing cells. These cells are vital to brain health, as they deal with signals controlling muscle movement. Early in the course of the disease, the most obvious symptoms are movement-related; including shaking, rigidity, slowness of movement, and difficulty with walking and gait.

As the disease advances, thinking and behavioral problems may arise, with dementia commonly occurring in the later stages. Depression as well as sensory, sleep, and emotional problems are universally cited.

CAUSES

Common in patients with Parkinson’s disease, the bladder becomes overactive and develops unwanted contractions which are difficult or impossible to stop. These often happen at a low volume of filling, creating a high frequency and urgency. When the bladder contraction causing the sensation of urgency is too strong—the “I can’t hold it” moment—leakage may occur.

Along with the frequency/urgency issue, patients with PD and their caregivers note nighttime frequency as a chief complaint. In fact, getting up often at night has recently been shown to be the most common, non-motor symptom affecting patients with Parkinson’s disease. Trips to the restroom at night also increase the risk of falls and serious injuries.  Due to muscle limitation as well as perception issues, nighttime urgency is something to be managed.

The most widely recognized gastrointestinal problem in Parkinson’s disease is impairment of bowel function. This can be one of two kinds. The better known is decreased frequency of bowel movements, or constipation. Decreased bowel movement frequency is due to sluggish travel of material through the colon, and as many as 80% of people with Parkinson’s disease may experience this slow rate of colon transit. If you are having three or less bowel movements a week, your doctor should be notified.

TREATMENT OPTIONS

Treatment of slow-transit constipation in PD involves measures designed to increase colonic motility. It makes sense that one of the easiest to implement changes involves diet.

BEHAVIORAL MODIFICATIONS

• Increase both fluid and fiber intake – Current recommendations suggest that daily fiber intake should be in the range of 20–35 grams, but the average American only consumes around 14 grams.

• Add a stool softener – Your doctor may suggest initiation of an agent that draws fluid into the colon, such as lactulose.

• Colon-cleansing agent – MiraLAX® or others may be employed to encourage colonic movement. .

• Enemas – Also employed to keep material moving through the colons to avoid constipation.

PHARMACEUTICAL TREATMENT

There have been some suggestions that apomorphine injections just prior to attempting a bowel movement may be helpful, but formal studies of this approach have not been undertaken.

• Botulinum toxin injections into the sphincter muscles have also been successfully employed in small numbers of patients.

• Desmopressin – By mimicking ADH or vasopressin, the kidney produces less urine.

• Darifenacin – This medication relieves bladder spasms and treats overactive bladder.

• Oxybutynin – Relaxes the detrusor muscle of the bladder.

• Tolterodine – This medication is an antimuscarinic and functions much like oxybutynin.

• Solifenacin – This is a recently introduced anticholinergic that is a more selective antimuscarinic agent with fewer anticholinergic side-effects.