Bladder Problems

The bladder has two main roles: to store urine as the kidneys produce it, and to expel urine from the body. The bladder expands like a balloon as urine fills it. The average bladder can hold about half a litre of urine at a time. On average, a healthy person urinates four to six times a day.

When the bladder is about half-full of urine, sensors send a signal to the brain, warning that the bladder will need to be emptied. Most people are able to delay emptying and can choose when to go to the toilet.

As the bladder continues to fill, more urgent signals are sent to the brain announcing the need to urinate. The sphincter muscles around the urethra (bladder outlet) and the pelvic floor muscles maintain a watertight seal.

When you are ready to urinate, your brain sends a signal to the bladder, telling it to contract. At the same time you relax the sphincter muscles, allowing urine to pass from the body. 

Bladder function is very complicated and sometimes, for a variety of reasons, bladder (or urinary) problems occur. These are common in the general population at all ages and may include:

increased frequency of going to the toilet. Generally associated with age-related reduced bladder capacity (as we get older, our bladder capacity decreases), but may also be due to other causes, such as urinary infections including cystitis. Increased urination frequency during the night is known as nocturia

difficulty in passing urine. The stream becomes poor and it takes longer to empty the bladder. This tends to happen in men with large prostates or in women who had gynaecological surgery resulting in a tight sphincter

urinary incontinence. An unintentional passing of urine.

Urinary incontinence can be further classified as:

urge incontinence. Urine leaks out before the person gets to the toilet when they have an urgent need to go. They simply cannot voluntarily stop the detrusor muscle in the bladder from starting to contract, or prevent the sphincter muscles from relaxing when the bladder pressure rises

stress incontinence. Laughing, coughing and other actions that cause the pressure inside the abdominal cavity to rise can result in a leakage of urine. As the bladder is inside the abdominal cavity, any rise in pressure means bladder pressure also increases. The sphincter should contract and prevent any leaks, but if it is weak some urine may escape. Women who have had a number of babies could have weakened their sphincter and pelvic floor muscles and are therefore particularly susceptible to stress incontinence. Female hormone levels also affect the health of the sphincter, and older women may suffer with stress incontinence after the menopause. Men who have undergone prostate surgery could have some damage to their sphincter resulting in stress incontinence

mixed incontinence. Urge and stress incontinence can occur together and is particularly distressing. A person with urge problems can cough and cause bladder pressure to rise. But as they have difficulty suppressing bladder contractions and as their sphincter is weak, the urine will start to flow without control

dribbling or overflow incontinence. If the bladder is unable to empty properly, the residual urine can build up and eventually overflow, continuously and uncontrollably, in small amounts.

These difficulties can be very embarrassing and have an enormous impact on a person’s quality of life. 

http://www.epda.eu.com/en/pd-info/symptoms/bladder-problems/?Opentab=c0,2 

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Urinary incontinence (involuntary loss of urine) is a common symptom in Parkinson's disease (PD).

Why do problems occur in PD?

The bladder is a muscle which gradually expands as urine collects. At the opening, there is a muscle called the sphincter. This muscle is usually closed except when urinating. Both muscles are controlled by the brain. When 1-2 cups of urine have collected in the bladder, the bladder may begin to have small contractions that signal the brain that the bladder is filling up. The brain can suppress the contractions until it is convenient for the person to go to the bathroom. When ready, the brain allows the bladder to contract while the sphincter relaxes. This allows the urine to leave the bladder.

Difficulty holding urine is the most common problem.

In PD, the brain’s control of the sphincter is disturbed. The bladder becomes overactive and wants to empty even when there is just a small amount of urine present. This results in following symptoms

urgency

frequency

incontinence

repeated nighttime urination.

Drugs are available (e.g. Ditropan®, Detrol®, Vesicare®, Hytrin®, Probanthine®) to help. These medications relax the bladder muscle.

Difficulty eliminating urine is another common problem.

It can be caused by a sphincter that wants to close when the bladder is ready to empty or by a bladder muscle that is too weak to expel urine. This is a concern because incomplete bladder emptying can cause accumulation of urine and the growth of bacteria. The latter can result in an infection. The symptoms of difficulty eliminating urine include:

weak urinary stream

dribbling or leaking

feeling that the bladder has not completely emptied

These problems should be carefully evaluated by your urologist to determine their cause. If the symptoms are PD-related, the most successful management is intermittent catheterization. 

Document:

The following signs of bladder problems should be reported to your health care provider:

1. Leakage of urine significant to cause embarrassment.
2. Inability to urinate when bladder is full - requires immediate attention.
3. Unusually frequent urination without a proven bladder infection.
4. Needing to rush to the bathroom or losing urine if you do not "arrive in time."
5. Pain related to urination.
6. Progressive weakness of the urinary stream which may be accompanied by a
   feeling that the bladder is not emptying completely.

Also, note how often you urinate in 24 hours, how often you are incontinent, how many times you urinate at night, and over what period of time these changes have occurred.

Management may include

• Medication for urinary urgency and frequency
• Urological evaluation
• Intermittent self-catheterization for urinary retention
• Incontinence aids: Although urinary incontinence can often be treated, there are
  times when incontinence aids are needed. Knowing which aids work best for you and where to get them can restore your freedom and confidence. Incontinence aids are primarily chosen by the degree of absorbency required and the ease of use. During the night, high absorbency pads are usually required. Briefs with elastic around the legs and sticky tabs on the side are the most absorbent. Gel briefs are more absorbent than cellulose and can hold 2-3 voidings. For daytime use, "undergarments" which button at the hip or underwear shields may be sufficient and are easy to pull up and down.
  
  
  The National Association for Continence or N.A.F.C. is an organization which provides a resource guide for a nominal fee as well as other self-help information: phone: 1-800-BLADDER (252-3337) or www.nafc.org. 
  
  
  http://www.parkinson.org/sites/default/files/Urinary%20Problems%20in%20Parkinson's%20Disease.pdf