BPH TREATMENT: A WORD ON PARKINSON’S DISEASE AND URINARY TROUBLE
Together, BPH and Parkinson’s disease can add up to a diagnostic nightmare for a physician, because Parkinson’s disease can mimic the symptoms of BPH in three ways: One, it can produce a poorly sustained bladder contraction that leads to a drop in urinary flow rate and symptoms of urinary hesitancy. It also heightens the tone of the external urethral sphincter, which can lead to residual urine and obstructive symptoms. And, Parkinson’s disease can make the bladder muscle spastic or hyper-reflexive, which can cause irritative symptoms.
When BPH is suspected in a man with Parkinson’s disease, a doctor needs to be extremely conservative in treating the symptoms. The consequences of treating BPH symptoms in men with Parkinson’s disease are serious; in fact, one urologist believes, even persistent residual urine and recurrent urinary tract infections should not warrant a TUR in thisgroup of men. Still another complicating factor is that men with Parkinson’s disease are often taking several medications that can have significant side effects on the lower urinary tract.
So what to do? Probably the safest course of action is to start with an alpha-blocking drug, which works in two ways (a more thorough description appears earlier in this chapter): First, alpha blockers reduce resistance in the bladder outlet. They also decrease residual urine, and therefore the threshold for bladder instability and irritative symptoms. In Parkinson’s disease, the same factors that cause rigidity can affect the bladder’s ability to contract and the pelvic floor’s ability to relax when a man tries to urinate. One possibility, if this is happening to you, is to work with a physical therapist to learn techniques for relaxing your pelvic floor muscles, which might make urination easier.
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