Parkinson's

• Parkinson’s primarily affects older people
• Slow onset (0-30 years)
• Most common neurological condition
• 1% of people over 60 have it
• 2% over 80 have it
• 100,000 live with Parkinson’s in Australia¹
• Around 10,000 are affected²

• Impaired gait- shuffling, ataxia
• Rigidity
• Bradykinesia (slowness of movement)
• Tremor to hand/arm
• Impaired balance
• Altered swallow- Dysphagia
• Altered speech- Dysphasia
• Dyspraxia
• Decreased dexterity
• GIT disturbances
• Sleep problems
• Mood changes
• Dementia symptoms (Cognitive changes- worsen slowly as disease progresses)¹

• Bladder re-training can assist in some cases. This involves attempting to hold on for a bit longer each time the urge is felt to urinate. This should be supervised by a professional.
• Screen for urinary tract infections which can create frequency and urgency.
• Educate about the best way to sit on the toilet to promote the most effective emptying of bladder and bowel⁷ and allow time for this.
• Advise on appropriate absorbent pads if there is any urinary or faecal leakage and to improve social continence, confidence and quality of life.

• Reduce fluid intake late in the evening
• Avoid Diuretic medication in afternoon or evening
• Avoid alcoholic or caffeinated drinks that can cause urgency
• Bladder re-training might also help avoid nocturia in some cases

Nocturia can lead to daytime fatigue, mood swings, decreased concentration, and decreased quality of life, falls have also been associated with nocturia, so it is important to manage this.

Treatment for retention is often aimed at preventing kidney damage. It may include medicine, urinary catheters, antibiotics to reduce the chance of infection, and, in severe cases, surgery.

Provide a safe environment to reduce the risk of falls and to promote independence.

• Ensure furniture is not in the way of the path to the toilet (or commode)
• Place a clear sign on the toilet door (if memory an issue)
• Provide clothing free of buttons and zips – velcro works well
• Use a raised toilet seat to provide better stability
• Install handrails in the bathroom, provide urinal bottles or commode chairs
• Discuss the use of continence products. Pull up pants in the early stages of Parkinson’s can promote independence and confidence and reduce anxiety

Individuals may need some physical assistance with toileting, adjustment of clothing, perineal hygiene and placement/removal of pant or pad.

Providing a safe environment is also necessary to reduce a risk of falls and to promote as much independence as possible. Raised toilet seats, urinal bottles, commode chairs and handrails in the bathroom could be options.

There are a number of products that can help individuals stay dry and comfortable. These include pads, liners, pull-up pants.

• Advise the individual to allow time for proper emptying of the bladder to avoid residual urine.
• Promote and educate about the best way to sit on the toilet to promote the most effective emptying of bladder and bowel. Refer to “best toilet position” information at: https://www.bladderandbowel.org/help-information/resources/toilet-positions/
• Monitor for signs of urinary retention or a possible UTI.
• If the individual is experiencing chronic constipation or faecal impaction discuss ways to add fibre into their diet and the need for good hydration. Provide education about aperients or enemas if required.
• Promote wearing an incontinence pad if there is any urinary or faecal leakage and to improve social continence and quality of life. Faecal smearing can be assisted with the use of TENA Duo.

References:

1. www.parkinsons.org.au
2. https://www.nzbri.org/Labs/parkinsons/Epidemiology/#:~:text=12%2C300prevalence%20and%20incidence,0.2%25%20of%20the%20total%20population
3. https://www.medscape.com/answers/453539-45905/what-is-the-role-of-the-brainstem-in-the-neuroanatomy-of-neurogenic-bladder
4. www.bladderandbowel.org