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There’s a disconnect between YouTube videos about bladder issues put out by various Parkinson’s organizations (see example below) and documents you can find by Googling “Parkinson’s disease” + “urinary tract infections.” Basically, the leading Parkinson’s organizations present urinary tract infections and related bladder problems as treatable and bothersome, but not life-threatening. The video below mentions these problems:
- Overactive bladder
- Bladder urgency
- Needing to wake up often at night to pee (nocturia)
- Incontinence
- Inability to pee and/or weak urine stream
- Constipation (which can impact bladder performance)
Dr. Aron Mather (the doctor in the video) notes that non-Parkies experience many of these problems as they age, but Parkinson’s patients experience them at a higher level. However, the symptoms are treatable with medications and non-pharmacological techniques. The biggest issue seems to be how the symptoms impact you personally. “Urinary problems may not be life-threatening,” he says, “but they are massive when it comes to quality-of-life issues.” Thus, Parkies may choose to wear only black, to hide the fact that they didn’t make it to the bathroom in time. Or they become hyper-sensitive to how they smell when they wear pads that absorb small amounts of urine that emerge whenever they sneeze or cough. “We really do need to spend more time on some of these non-motor symptoms, particularly the incontinence side, which kind of get brushed under the table,” he says. “It’s not a hot topic.” He barely glosses over the term “urinary tract infection.”
Contrast this with the following abstract from an article from the NIH (National Institute of Health)’s website:
Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson’s disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.
That’s quite a scary difference of opinion, isn’t it? And how should I proceed going forward?
At the moment, I’m following the advice of Dr. Mather, when he discusses non-pharmacological fixes to urinary problems (Note: I don’t have any urinary problems right now):
- Cut back on caffeine
- Avoid alcohol
- Cut back on food and drink in the evening
- Tighten up my pelvic floor by doing Kegel exercises
Dr. Mather also discusses surgically inserting pacemakers next to the bladder and learning how to perform self-catheterization, but I’m not sold on these ideas now, nor do I want to add another drug to my already very full drug regimen.
So I’m left with the question: how much do I have to fear?
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And for a little levity, a brief clip from the Broadway show, “Urinetown.” Complete with Japanese subtitles.
To see the entire show, click here.
