Urinary Incontinence and Parkinson's

Genitourinary dysfunctions are those related to the sex organs or urinary system. Many people with Parkinson’s disease (PD) have genitourinary dysfunctions, such as:

• Urinary incontinence – the inability to hold urine
• Bladder dysfunction – urgency to urinate or frequent urination
• Sexual dysfunction – including decreased sex drive, inability to orgasm, erectile dysfunction in men, decreased lubrication in women, or pain with intercourse in women

Genitourinary dysfunctions can greatly impact the quality of life of people living with PD, and urinary dysfunctions are associated with higher levels of being placed in nursing care.¹

Urinary incontinence in Parkinson’s disease

The most common urinary difficulty experienced by people with PD is a frequent and urgent need to urinate. This may occur even when the bladder is not full. Recent research studies estimate approximately 27-39% of people with PD experience urinary difficulties, although urinary incontinence only develops in about 15% of those with PD. Bladder issues are more common in the later stages of PD.²

Sexual dysfunction in Parkinson’s disease

People with PD may experience sexual dysfunction, including loss of desire, inability to orgasm, erectile dysfunction in men, decreased lubrication in women, or pain with intercourse in women. Some studies have found that sexual dysfunction may occur in 60-80% of men and women with PD. Older patients with PD have more sexual dysfunction than younger patients, although sexual dysfunction is also greater in older adults who do not have PD. In addition to age, conditions such as diabetes, hypertension, and depression can factor into sexual dysfunction.^3,4

There are several factors that can lead to sexual dysfunction in people with PD. In addition to the motor symptoms of PD, which may create practical barriers to engaging in sexual activity, non-motor symptoms like depression, anxiety, or sleep disturbances can also impact a person’s sex drive. Many people with PD express dissatisfaction with their sexual life.^3,5

Some people with PD who are treated with dopamine agonists develop impulse control disorders, like hypersexuality. Hypersexuality can lead to unusual or increased sexual behavior, which may have devastating effects on relationships. Changing medications or reducing the dose of medication can help, and people who experience any side effects such as impulse control disorders should bring it to the attention of their doctor.³

Treatment for genitourinary dysfunctions

Unlike the motor symptoms of PD, genitourinary dysfunctions do not respond to levodopa therapy, and other treatments must be used. There are several medications that can help manage urinary difficulties, including Detrol® (tolterodine), Ditropan® (oxybutynin), Enablex® (darifenacin), and Vesicare® (solifenacin). These medications work to block or reduce overactivity in the bladder. Treatments for sexual dysfunction include counseling or talk therapy, treating erectile dysfunction with Viagra® (sildenafil) or Cialis® (tadalafil), and the use of lubricants in women.^1,3-5