Tuesday, October 4, 2022

Urinary Problems Parkinson’s Disease

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Parkinson’s Disease And The Bladder

Urinary Dysfunction and Parkinson’s with Arun Mathur

In this 30-minute video lecture Dr. Donna Deng explains the cause of bladder dysfunction and quality of life consequences. Treatment options include behavioral modification, pharmacologic, nerve stimulation , Implantable Impulse Generator, and Botox injections. Last line of treatment for older men with Parkinsons should be prostate surgical procedures.

Why Talk About It

Because of stigma, embarrassment, and the misconception that urinary problems are just part of getting old, urinary dysfunction is underreported by people with Parkinsons as well as the general population.2

One type of urinary problem is overactive bladder, or the sudden, uncontrolled need or urge to urinate. Some people will experience the need to pass urine multiple times a day and night, while some will leak urine when they feel the urge to urinate.3

Urinary dysfunction, at a minimum, negatively affects quality of life and can lead to difficult to treat urinary tract infections, sepsis, and death.4

Quality of life effects include higher risk for falls due to having to urinate at night and increased isolation due to embarrassment and social stigmas. About 50 percent of nursing home admissions list urinary dysfunction as a major factor in admissions.5

Mirabegron In Patients With Parkinson Disease And Overactive Bladder Symptoms: A Retrospective Cohort

This is the first series reporting the use of mirabegron in Parkinsonâs disease patients.

50% of Parkinsonâs disease patients had improved overactive bladder symptoms after 6 weeks of mirabegron.

Mirabegron appeared safe with only two mild adverse events .

The persistence rate with mirabegron was high .

Amit Batla and Natalie Tayim each declare no potential conflicts of interest.

Mahreen Pakzad has been a speaker for Astellas.

Jalesh N. Panicker has received royalties from Cambridge University Press, has been involved in trials supported by FirstKind Ltd, Allergan and Ipsen and has received speaker honoraria from Wellspect, Astellas and Allergan.

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How Does Parkinsons Impact The Risk Of Getting Utis

In Parkinsons, the brains control of the urinary sphincter can become disrupted, leading to difficulty holding urine. As a result, people with Parkinsons may experience storage symptoms, which can increase the frequency and/or urgency of urination and lead to nocturia when you wake up multiple times at night to go to the bathroom. Another set of urinary symptoms, called voiding symptoms, can cause urination hesitancy, straining, interrupted stream, and double voiding . You may experience symptoms in both sets, which puts you at a higher risk of developing a UTI.

Voiding symptoms often go unnoticed for longer than storage symptoms do, and they can play a significant role in the development of UTIs. For example, if they keep you from fully emptying your bladder each time you urinate or keep you from urinating as often as you should, bacteria can grow and spread in the remaining urine, leading to UTIs.

Parkinsons motor symptoms can also impact your ability to urinate as frequently. Slowness and stiffness can make it difficult to get to the bathroom. In addition, if you experience significant balance issues, you may not travel to the bathroom as often as you need to for fear of falling.

Typical Dosing For Myrbetriq

Figure 5 from Bladder, Bowel, and Sexual Dysfunction in Parkinson

Overactive bladder:

  • Myrbetriq is usually started at 25 mg by mouth once a day. It can be taken alone or together with 5 mg of solifenacin.
  • If needed, your healthcare provider may increase your Myrbetriq dose to 50 mg once a day after 4 to 8 weeks.

Neurogenic detrusor overactivity:

  • Children weighing less than 77 pounds should take Myrbetriq Granules. The dose will depend on the childâs weight. It usually ranges from 3 mL to 8 mL once daily.
  • Children weighing 77 pounds or more can take either Myrbetriq tablets or Myrbetriq Granules. If taking Myrbetriq tablets, the dose usually starts at 25 mg once a day and may be increased to 50 mg once a day after 4 to 8 weeks. If taking Myrbetriq Granules, the dose usually starts at 6 mL once a day and is increased to 10 mL once a day after 4 to 8 weeks.

Your dose may differ if you have kidney or liver problems.

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Medical Comorbidities And Nocturia

Concomitant urological pathologies may also contribute to reduced nocturnal bladder capacity. Patients with PD may develop storage dysfunction as a result of benign prostate enlargement, which is common in the age group prevalent for PD and may cause nocturia and nocturnal polyuria. Often urodynamic studies are required to evaluate the relative contribution of bladder outlet obstruction. Other urological pathologies include malignancy of the bladder, bladder stones, interstitial cystitis, and pelvic organ prolapse or from stress incontinence. Urinary tract infection can lead to urinary frequency and may exacerbate nocturia.

The treatments used to manage PD may, in themselves, influence LUT symptoms. The effects of levodopa on LUT symptoms are inconsistent, however, and worsening of symptoms have been reported in some studies whereas improvement has been reported in others., , It has been suggested that during acute administration, l-dopa may cause worsening of symptoms, but is known to ameliorate the first sensation of bladder filling on long-term administration. Dopamine receptor agonists have been reported to promote storage in a study using bromocriptine. In another study, a change from bromocriptine to pergolide lessened nocturia. Apomorphine was reported to increase bladder capacity. DBS may have variable effects on LUT dysfunction, though an improvement in nocturia has generally been noted.-

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Bladder And Bowel Problems

Bladder and bowel problems are common in men and women of all ages, but people with Parkinsons are more likely to have these problems than people who dont have the condition.

If you have Parkinsons, you may be more likely to have problems with your bladder or bowels than people of a similar age without the condition.

Some of these problems are common in men and women of all ages, whether they have Parkinsons or not.

Bowel problems are very common in the general public. But any change in bowel habit, particularly if you see blood in your bowel motions, should be reported to your GP.

Whatever the reason for your bladder and bowel problems, you can usually do something to help. It may be that the problem can be cured completely. But if that isnt possible, there are many different ways of managing the symptoms so they dont rule your life.

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Recommended Dosage For Adult Patients With Oab

How does Parkinson’s disease affect the urinary system?

MYRBETRIQ Monotherapy

The recommended starting dosage of MYRBETRIQ is 25 mg orally once daily. If needed, increase to the maximum dosage of MYRBETRIQ 50 mg orally once daily after 4 to 8 weeks. For administration instructions,see Dosage and Administration .

MYRBETRIQ Combination Therapy with Solifenacin Succinate

The recommended starting dosage for combination treatment is MYRBETRIQ 25 mg orally once daily and solifenacin succinate 5 mg orally once daily. If needed, increase to the maximum dosage of MYRBETRIQ 50 mg orally once daily after 4 to 8 weeks. Refer to the Prescribing Information for solifenacin succinate for additional information. For administration instructions,see Dosage and Administration .

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What To Do About It

Be honest with your doctor and report any urinary tract issues ASAP. Your next step will most likely be with a urologist. Your urologist will perform tests and examinations to rule out other problems. My doctor looked for benign prostatic hyperplasia and prostate cancer.

There are medications and surgery methods to treat these conditions. I have had surgery for benign prostatic hyperplasia. Barring any of these conditions, your symptoms related to Parkinsons may be treated by medications. Your doctor may also recommend exercises such as kegels.1

For those with leakage issues, absorbent pads are available for both bedding and clothing. I take medications and episodically used pads. I encourage you to stay socially active, even it it means wearing pads.

Prevalence Of Nocturia In Pd

Questionnaire based studies generally report a high prevalence of nocturia, with figures ranging between 76% and 86%,, though one study reported a prevalence of only 34.6%. In a study of 115 PD patients using a questionnaire on pelvic organ functions, Sakakibara et al. reported nocturia in 53% of men and 63% of women with PD.

Nocturia has been reported in 34.6% of PD patients using a semistructured interview in 1,072 consecutive patients with PD in the large, multicentric PRIAMO study.

This apparent variability in prevalence between studies could be put down to several factors, including differences in the demographic features of the cohort of patients being studied, and the occurrence of medical comorbidities. LUT symptoms are more prevalent with advancing disease and were most frequent in patients at H & Y stage 4 to 5 with a reported prevalence of around 90%. Moreover, the term nocturia has been applied differently in studies and the prevalence varies according to the definition being used. The International Continence Society made an attempt to standardize the definition of nocturia in 2002 and, based on a consensual approach, put forward the complaint that the individual has to wake at night one or more times to void.

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Recommended Dosage For Pediatric Patients Aged 3 Years And Older With Ndo

For pediatric patients 3 years of age and older, select the appropriate product based on the patients weight.

Pediatric Patients weighing less than 35 kg: Use MYRBETRIQ Granules

The recommended starting and maximum doses of MYRBETRIQ Granules, administered as extended-release oral suspension once daily , are shown in Table 1. The recommended dosages are determined based on patient weight. Evaluate patients periodically for potential dosage adjustment. For administration instructions, see Dosage and Administration .

Table 1: MYRBETRIQ Granules Recommended Dosage for Pediatric Patients Aged 3 Years and Older Weighing Less Than 35 kg as an Extended-Release Oral Suspension

Body Weight Range

Characteristics Of Eligible Studies

Figure 5 from Bladder, Bowel, and Sexual Dysfunction in Parkinson

After applying the inclusion/exclusion criteria, a total of 286 articles were identified from the databases. First, we screened the titles and abstracts this led to the removal of 249 articles. When considering the remaining 19 articles, we excluded 14 articles because useful data were missing. One article was eliminated due to duplication. Finally, our analyses involved four high-quality RCTs . Figure 1 shows a flowchart that presents the selection process. Study features and patient characteristics are given in Table 2.

FIGURE 1. Flowchart of the study selection process. RCT, randomized controlled trials NLUTD, neurogenic lower urinary tract dysfunction.

TABLE 2. Study and patient characteristics.

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Nasal Spray Provides Relief For Nocturia

One published study examined the effectiveness of AV002, a recently approved emulsified vasopressin nasal spray, in treating elderly patients with nocturia due to nocturnal polyuria. Benjamin M. Brucker, MD, associate professor in the Departments of Urology and Obstetrics and Gynecology, director of female pelvic medicine and reconstructive surgery and neurourology, and director of the female pelvic medicine fellowship program, reported results during a late-breaking session of the 2018 meeting of the American Urological Association and as part of a team at the International Continence Society 2018 annual meeting in Philadelphia.

Men and women with nocturia awaken multiple times during the night to urinate, interfering with sleep patterns and often triggering associated problems, such as cognitive decline, depression, and a weakened immune system. Although anticholinergics are currently the standard treatment, previous research by Dr. Brucker and his colleagues demonstrated that AV002 acts faster and is more effective.

The treatment paradigm were currently following isnt very effective as a medical community, we could be doing a better job with the management of these patientsand now we have the needed insight to effectively and safely get them the deep, restorative sleep they need.Benjamin M. Brucker, MD

Bladder Problems In Parkinsons

The primary function of the bladder is twofold to store urine as it is made and then to empty the urine. With Parkinsons, problems can emerge in both areas.

Recent studies suggest that 30-40% of people with Parkinsons have urinary difficulties. Despite the frequency of urinary dysfunction, actual urinary incontinence is relatively uncommon. Troublesome incontinence develops in only about 15% of people with Parkinsons.

The most common urinary symptoms experienced by people with Parkinsons are:

  • The need to urinate frequently
  • Trouble delaying urination once the need is perceived, creating a sense of urinary urgency

These symptoms usually mean you have an irritable or overactive bladder. Your bladder is signaling the brain that it is full and needs to empty when, in fact, it is not. This can happen at any time, so you might have to get up multiple times during the night to go to the bathroom.

Impairment of bladder emptying is a less frequent but still troublesome feature of urinary dysfunction in Parkinsons. This may be caused by delay or difficulty in relaxation of the urethral sphincter muscles. These muscles must relax for the bladder to empty. This can result in hesitancy in initiating urination, difficulty in generating a stream and incomplete emptying of the bladder. Dystonia involuntary muscle contractions of the urethral sphincter has also been described.

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How Can I Prevent Utis

Prevention is key to avoiding UTIs and the complications that may arise from them. Fortunately, there are several actions you can take right away to keep your urinary tract flowing correctly.

  • Drink plenty of water. Drinking water dilutes your urine and makes you urinate more often. This keeps bacteria moving steadily through your urinary tract before they can multiply and cause infection.Suzette Sutherland, MD, director of female urology at the University of Washington School of Medicine, says that one of the top reasons people develop urinary tract infections is simply not drinking enough fluids and keeping their urinary tract flushed.
  • Track your symptoms. Use our bladder worksheet to track your urinary symptoms and help you plan a conversation with your physician about any urinary concerns.
  • Visit a physical therapist. A physical therapist can teach you pelvic floor exercises, such as Kegels, that can help you manage incontinence or other urinary challenges. Regular pelvic floor exercises can help strengthen and retrain the muscles associated with urination and defecation.
  • Take preventative measures regarding sexual activity. Sexually active women can minimize their risk of developing UTIs by urinating soon after intercourse and avoiding birth control methods like diaphragms, unlubricated condoms, and spermicidal agents.
  • Management Of Reduced Functional Bladder Capacity

    wHolistic! – Urinary Dysfunction in Parkinson’s – Dr. Jalesh Panicker

    Antimuscarinic Agents

    Antimuscarinic medications are the first-line treatment for bladder storage symptoms and detrusor overactivity. Oxybutynin, tolterodine, solifenacin, and trospium chloride have beneficial effects on nocturia. If prescribed, a low dose is initially recommended with a progressive increasing dosage. Furthermore, the strict respect of the scheduled taking is important in order to reduce nonurinary anticholinergic effects.

    However, their side-effect profile, which corresponds to an increasing anticholinergic burden, limits their use. The risk of urinary retention has not been specifically assessed in PD. Consequently, a repeated PVR measurement is recommended. In addition, constipation was reported not to be increased in parkinsonian patients using antimuscarinics. Of particular concern is the impact on cognitive functions in patients with PD, especially in the elderly. Anticholinergic medications can add to the anticholinergic burden of antiparkinsonian therapy and thus to the cognitive dysfunction . Drugs such as trospium chloride or tolterodine, which do not cross the bloodbrain barrier, have may be preferred. However, evidence supporting these considerations in clinical practice is limited, and caution is advised when using an antimuscarinic agent in PD.

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    Increasing Your Fibre Intake

    Eating the right amount of fibre and drinking enough fluids can help if you have constipation.

    To get more fibre in your diet:

    • choose a breakfast cereal containing wheat, wheat bran or oats, such as Weetabix, porridge or bran flakes.
    • eat more vegetables, especially peas, beans and lentils.
    • eat more fruit fresh, stewed, tinned or dried. High fibre fruits include prunes or oranges.
    • drink plenty of fluids throughout the day to avoid dehydration. Lots of fluids are suitable, including water, fruit juice,
    • milk, tea and squashes. Cut out caffeine to avoid overstimulation of your bladder.

    If you find it difficult chewing high-fibre food, you can get some types which dissolve in water. You can also get drinks which are high in fibre.

    Try to increase how much fibre you get gradually to avoid bloating or flatulence .

    A dietitian can give you further advice. Ask your GP, specialist or Parkinsons nurse for a referral.

    Parkinsons Disease And Your Bladder

    Many diagnosed with Parkinsons disease experience urinary tract issues. A Michigan Medicine urologist discusses treatment options for patients to consider.

    Anne Pelletier-Cameron, M.D., often jokes to her patients that shes a female plumber of the lower urinary tract. On a more professional note, however, shes a urologist in the Michigan Medicine Department of Urology.

    In this role, Pelletier-Cameron treats patients with a variety of lower urinary tract symptoms. Some of her patients have been diagnosed with Parkinsons disease, a progressive nervous system disorder that impacts movement. But the breakdown of nerve cells that characterize Parkinsons disease can also cause non-movement symptoms, including bladder issues.

    Half of all women and 17% of men will experience urinary incontinence, or the inability to hold urine, she says, noting that for Parkinsons disease patients, those numbers escalate.

    Many of my PD patients end up having other bladder problems, including issues with urgency and frequency, says Pelletier-Cameron. Nocturia, or the need to urinate many times during the night, is also common, along with difficulty in emptying the bladder.

    Pelletier-Cameron says the impact of bladder symptoms cant be ignored.

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