Bladder Problems

[Chicory]

I have been having a problem with my bladder. About 6 weeks ago I ended up going to the ER at 4 am because my bladder was full and I couldn't urinate. Since that time I have been having to self-cath. I went to a urologist and he did tests and found I have a bladder stone. I have to have surgery and he will break it up with a laser. The urologist said the stone is caused by not emptying my bladder and that not being able to empty my bladder is caused by the Parkinson's. Well, I talked to my neuro this week and he said Parkinson's doesn't cause that. My sister found on the internet that urine retention is a rare side effect of Mirapex. The neuro had not seen it before, but found that it is listed a possible side effect. Has anyone else had this problem? My neuro is taking me off Mirapex and putting me on Stalevo. Hopefully that will sove my problem and I won't have to self-cath anymore.

[pegleg]

Hi Chicory

Isn't it strange how one doctor says one thing that totally contradicts another? Was it your neuro who said that urinary retention was not caused by PD? If so, here are a few things you can tell/show him or her.

I was diagnosed with interstitial cystitis years ago until I went to a urologist who specialized in neurogenic problems. I had urinary retention in a bad way. IIt would take forever to "get started," and when I did I could not empty my bladder, causing me to go every hour or two and all through the night. Then at other times I had incontinence - I couldn't make it in time. After a full battery of tests and a "urinary work-up," I was told I had a neurogenic bladder due to the Parkinson's. The work--up included a cystoscopy, ultrasound, and cystometry. I have included info below you can show your doctor, or just go see another one. This is pretty common with advancing Parkinson's.
Peggy


PARKINSON'S NEUROGENIC BLADDER:
Definition

Neurogenic bladder is a dysfunction that results from interference with the normal nerve pathways associated with urination.

Description

Normal bladder function is dependent on the nerves that sense the fullness of the bladder (sensory nerves) and on those that trigger the muscle movements that either empty it or retain urine (motor nerves). The reflex to urinate is triggered when the bladder fills to 300-500 ml. The bladder is then emptied when the contraction of the bladder wall muscles forces urine out through the urethra. The bladder, internal sphincters, and external sphincters may all be affected by nerve disorders that create abnormalities in bladder function.

There are two categories of neurogenic bladder dysfunction: overactive (spastic or hyper-reflexive) and underactive (flaccid or hypotonic). An overactive neurogenic bladder is characterized by uncontrolled, frequent expulsion of urine from the bladder. There is reduced bladder capacity and incomplete emptying of urine. An underactive neurogenic bladder has a capacity that is extremely large (up to 2000 ml). Due to a loss of the sensation of bladder filling, the bladder does not contract forcefully, and small amounts of urine dribble from the urethra as the bladder pressure reaches a breakthrough point.

Causes and symptoms

There are numerous causes for neurogenic bladder dysfunction and symptoms vary depending on the cause. An overactive bladder is caused by interruptions in the nerve pathways to the bladder occurring above the sacrum (five fused spinal vertebrae located just above the tailbone or coccyx). This nerve damage results in a loss of sensation and motor control and is often seen in stroke, Parkinson's disease, and most forms of spinal-cord injuries. An underactive bladder is the result of interrupted bladder stimulation at the level of the sacral nerves. This may result from certain types of surgery on the spinal cord, sacral spinal tumors, or congenital defects. It also may be a complication of various diseases, such as syphilis, diabetes mellitus, or polio.

Diagnosis

Neurogenic bladder is diagnosed by carefully recording fluid intake and urinary output and by measuring the quantity of urine remaining in the bladder after voiding (residual urine volume). This measurement is done by draining the bladder with a small rubber tube (catheter) after the person has urinated. Kidney function also is evaluated by regular laboratory testing of the blood and urine. Cystometry may be used to estimate the capacity of the bladder and the pressure changes within it. These measurements can help determine changes in bladder compliance in order to assess the effectiveness of treatment. Doctors may use a cystoscope to look inside the bladder and tubes that lead to it from the kidneys (ureters). Cystoscopy may be used to assess the loss of muscle fibers and elastic tissues and, in some cases, for removing small pieces of tissue for biopsy.
Source: http://www.healthatoz.com/healthatoz/Atoz/ency/neurogenic_bladder.jsp

NEUROGENIC BLADDER
What is neurogenic bladder?

Neurogenic bladder is the loss of normal bladder function caused by damage to part of the nervous system. The damage can cause the bladder to be underactive, in which it is unable to contract and unable to empty completely, or it can be overactive, in which it contracts too quickly or frequently.

What are the symptoms of neurogenic bladder?

Inability to control urination, also known as urinary incontinence, is perhaps the most common symptom associated with the neurogenic bladder. This may be caused by abnormalities in bladder capacity or malfunction of control mechanisms such as the bladder neck and/or external urethral sphincter muscle that are important for the bladder's storage function.

Symptoms including a dribbling urinary stream, straining during urination or inability to urinate may also be associated with neurogenic bladder. Urinary retention may result either from loss of bladder muscle contracting performance or loss of appropriate coordination between the bladder muscle and the external urethral sphincter muscle.

Irritating symptoms, such as urinary frequency and urgency, may be evidence of bladder hyperactivity. Other irritating symptoms may include painful urination (dysuria), which may be a result of a urinary tract infection (UTI) caused by urine being held too long in the bladder. UTI with fever is a sign of potential severe kidney infection (pyelonephritis) and is a more worrisome situation as it may result in permanent damage of the kidney(s).

Stones may also form in the urinary tract of individuals with a neurogenic bladder caused by the stoppage of urine flow and/or infection.

Abnormal backup of urine from the bladder to the kidney(s), also known as vesicoureteral reflux (VUR), may develop as a means of releasing high pressure within the bladder. A UTI is of particular concern as VUR may place the patient at significant risk for a severe kidney infection by transporting infected bladder urine directly to the kidney(s).

How is neurogenic bladder diagnosed?

When neurogenic bladder is suspected, both the nervous system (including the brain) and the bladder itself are tested. In addition to complete medical history and physical examination, diagnostic procedures may include:

X-rays of the skull and spine

an electroencephalogram (EEG) to identify brain dysfunction
imaging tests of the bladder and ureters
function tests that involve filling the bladder to see how much it can hold and if it empties completely

How is neurogenic bladder treated?

Medication for treatment of overactive bladder may improve or relieve irritating symptoms and/or incontinence. Antibiotics are important for treatment and prevention of urinary tract infections (UTIs), especially in patients with vesicoureteral reflux. Other medications may improve bladder control by increasing outlet resistance at the bladder neck.

Clean intermittent catheterization (CIC) was developed by Dr. Jack Lapides in the early 1970s as a means of emptying the bladder in the case of a bladder muscle that is unable to contract or in patients with loss of appropriate coordination between the bladder muscle and the external urethral sphincter muscle.

Surgical cutting of the external urethral sphincter with the use of an endoscope passed through the urethra may allow free flow of urine into an appropriate receptacle and eliminate the need for CIC in order to empty the bladder. Also, endoscopic injection of paralytic agents directly into the external urethral sphincter muscle is another technique that provides temporary relief.

Permanent stents can also be used in the bladder neck for effective urinary transportation.

At times, however, damage to bladder anatomy and function is so severe that capacity needs to be improved with bladder augmentation (increasing bladder size with various tissues), vesicoureteral reflux needs to be corrected and/or an alternate tube for emptying the bladder may need to be surgically constructed.

What can be expected after treatment for neurogenic bladder?

A person can expect extensive follow-up evaluation of bladder and kidney function. This may involve repeated X-rays, ultrasound, blood tests and bladder function tests.

Although some characteristics of the neurogenic bladder may improve or resolve, most issues typically require constant attention and reevaluation.

Proactive management of patients with a neurogenic bladder may decrease the risk of damage to the bladder and kidney(s) and, therefore, potentially limit the need for future intervention. This has been shown in management of neurogenic bladder patients with spina bifida..
Source: http://www.urologyhealth.org/adult/index.cfm?cat=03&topic=109
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Other sources:
http://www.emedicine.com/med/topic3176.htm

[Chicory]

Pegleg- thank you for all the info.

In the info. you cited it says an overactive bladder is common in Parkinson's and mentions problems with the spinal cord for an underactive bladder. My neuro said the same thing about the spinal cord. Also, my Parkinson's is not advanced. However, it sounds like your bladder problems are similar to mine and I was diagnosed with interstitial cystitis also. Now I self-cath when I wake up at 3 am to go to the bathroom, and then I don't have to keep getting up to go a little bit each time. I am glad to know someone else has had the same problem.

I can't get a new neuro. It took me a long time to find this one who has helped me. I will take your info. to my next visit.

I have had the urology tests done 3x now. The first 2 times everything was normal (at least on the day of the tests.)

Urine retention is listed as a rare side effect of Mirapex, so maybe things will get better now that I am stopping the Mirapex and taking Stalevo.

[pegleg]

Quote by Chicory: maybe things will get better now that I am stopping the Mirapex and taking Stalevo

Let's hope so!

Peg

[Connie]

A couple of years ago my husband kept getting Urinary Tract infections. The urinologist would treat him with medication, but in a couple of months it would come back again.

I started giving him ProBiotic Acidophilus with the advise of a lady at the health store. Her father kept getting bladder infections and this product helped him. Maybe it's a coincidence, but my husband has not had another UTI infections since taking this. Actually, he dosent' get up as much durning the night anymore. Some nights not at all.

[Chicory]

I found some answers to my questions by watching a talk from the Young Onset Parkinson Network Conference. According to Dr. Ronald Pfeiffer, obstructive urinary symptoms are less common in parkinson's, but they do occur. They include hesitancy in initiating urination, weak urinary stream, and "overflow" incontinence.

Here is the link:
http://event.netbriefings.com/event/npf/Archives/conference/

Chicory

[proudest_mama]

Chicory, thanks for the link. I'll look it up.

I, too, have horrible vision and at night I am a danger to society if I try to drive. My daytime vision isn't affected nearly as much. I was concerned enough that I went to a specialist too.

Quite by accident, I assure you, I had to wear a different pair of glasses (my old ones) and, voila', I can see ten times better. It truly is interesting and I have no logical explanation. The only thing that I can pinpoint it to is that my current glasses are progessive line bi-focals and my old pair are not bifocals at all.

I now keep that other pair of glasses in my van and switch them when I need to. I'd surely like it if someone else tries this and it works.

But I'm a little confused now because you state that my poor vision is due to having PD, but I always thought (and swear that a doctor told me) that it was due to one of my meds . I was given the impression that when I get off that, particular, med (it's either Artane or Mirapex, I can't remember), that my vision would get better.

If anyone has "proof" either way, we'd love to hear from you!

Terri