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Parkinson’s and continence

Expert: Victor McConvey RN, MACN

Victor McConvey is currently employed as the Clinical Nurse Consultant and Health Team Manager at Parkinson’s Victoria, the peak support and advocacy for people living with Parkinson’s. In this role he works across the state educating health care professionals about Parkinson's and working with consumers and groups on managing symptoms and improving self management. 

Current projects that Victor is involved in include: Developing the role and profile of the Parkinson’s Nurse Specialist in Australia, and participating in the working party reviewing clinical and consumer information generated by Parkinson’s Australia. Victor is the Key contact for the Australian College of Nursing’s Movement Disorder and Parkinson’s Nurses community of interest.  

Victor has been a Nurse for 25 years and has worked in the area of neurology for the past 18 years. Victor has worked in Clinical Management and service development positions in both Australia and the United Kingdom, including establishing the Parkinson’s Nurse Specialist position in Leeds (UK).

Watch the video

Parkinson’s Victoria and the Continence Foundation of Australia have collaborated to provide health professionals working with people living with Parkinson’s and their carers some much-needed information about how Parkinson’s can affect bladder and bowel control.

Presented by Victor McConvey, clinical nurse consultant, health information manager, Parkinson’s Victoria, this highly informative 12-minute video examines the following:

  • Correlation between continence issues and Parkinson’s
  • Most common bladder and bowel problems and when they occur
  • Treatment options
  • Lifestyle tips
  • How the bladder is affected and what can be done
  • Medication options
  • Help and advice

Q&A with Victor McConvey RN, MACN

Q: How is your bladder affected in Parkinson’s? And what medications are recommended?

In Parkinson’s there can be an alteration in the messages which are sent from the bladder to the part of the brain that interprets them (the Miturition centre). The brain will often only trigger one message which is the need to go NOW. This is called urgency, sometimes this message is fired off several times in a short period of time- this is called frequency, and it’s common for someone with Parkinson’s to experience them both. This symptom seems to improve when medications are working so may be more apparent when medication levels are low or possibly at night.

Some people also experience frequency of urination at night or nocturia. This relates to issues in the micturition centre and also in the normal function of getting rid of additional fluid that may have been retained during the day. Blood pressure fluctuations which are common in Parkinson’s will exacerbate this.

Some people may experience an inability to completely empty the bladder, known as retention.

Some medications that stabilise bladder muscles may assist, however as they occasionally worsen the symptoms of Parkinson’s or can create confusion, especially in older adults they are used sparingly and are closely monitored.

 

Q: What's the evidence for the use of Botox for overactive bladder in Parkinsons?

Botox injections into the bladder neck may be used in the instance of the person living with Parkinson’s not being able to empty their bladder effectively and retaining a residual volume.  In the instance of an over active bladder this symptom appears to be generated by an over active micturition centre in the brain. Getting Parkinson’s medications on time every time is the best way of minimising this symptom.

 

Q: In your opinion what  is the most debilitating aspect of bladder & or bowel dysfunction associated with Parkinson's disease?  

Constipation is the most common difficulty experienced in Parkinson’s. Some people will notice a tendency to become constipated 3-4 years before they are diagnosed with Parkinson’s. This symptom will persist throughout the course of the illness and is caused by a reduction in the peripheral dopamine produced in the gut causing it to slow down. Reduced physical activity associated with Parkinson’s will also worsen constipation. The Medications which replace Dopamine with in the Central Nervous system do not effect constipation which will need to be treated through dietary modification and carefully selected apperaints. Constipation is one of the most common causes of hospitalisation in Parkinson’s. 

 

Q: In response to a previous question you mentioned nocturia - how can this be managed?

Nocturia can be a problem and in Parkinson's may be more apparent at night when less medications are taken for Parkinson's so symptoms are often greater. 

The impact can be reduced by reducing fluid intake from early evening, and for people who retain some fluid (for example if they notice puffy ankles) through out the day a rest in the afternoon, with the feet elevated can be very helpful to reduce some of the fluid retained prior to going to bed. 

Many of the medications used to stabilise bladder control can worsen parkinsons symptoms or may interact with some of the medications so are used with caution.

People experiencing nocturia should also have other causes evaluated.