For many, it is embarrassing to bring up taboo topics with your doctor ― from sexual dysfunction to incontinence. However, when it comes to living with Parkinson’s disease (PD), sometimes these topics can be connected to the disease itself or side effects to PD medications.
No topic should be considered off limits to discuss with your healthcare team. The more we normalize and bring awareness to these issues, the less taboo they become. Scroll down to view some of these topics and their connection to Parkinson's, or click to jump straight to a specific topic.
People with Parkinson’s may experience bladder problems. Common difficulties include:
- urinary urgency: a frequent and urgent need to urinate even when the bladder is not full
- nocturia: frequently waking up at night to urinate
If these problems or other urinary change occurs, talk to your doctor to determine that the problem is not related to PD ― such as a bladder or urinary tract infection (UTI), an enlarged prostate or other medical issue. Lifestyle changes, pelvic floor exercises, bladder training and a myriad of products exist to help minimize and address this common issue in adults.
- Learn more: Urinary Incontinence, Bathing and Grooming, Getting Dressed, Caring for You (the Caregiver)
Sexual dysfunction is common in men and women with PD. The issue often goes unaddressed as patients, spouses and healthcare providers may not be comfortable discussing sex. Parkinson’s itself may cause sexual dysfunction due to the loss of dopamine. Medications, such as anti-depressants, can also contribute to sexual dysfunction. To note, most PD drugs are not associated with impotency or loss of libido.
Hypersexuality can also be linked to certain dopamine agonists. There are many ways to address PD-related sexual dysfunction, and it all starts with speaking to your doctor. Try writing your symptoms down before your next appointment and telling your doctor you have a sensitive issue you want to discuss. Read our “Sex Therapy, Couples Therapy And Behavioral Therapy Tips” article.
- Learn more: Sexual Health and Parkinson’s, Intimacy Issues and Parkinson’s Disease 101, Navigating Sexuality and Intimacy with PD
Impulse Control Disorders
Dopamine medications have improved life for millions of people, but researchers believe that some people with PD on dopamine agonists or monoamine oxidase (MAO) inhibitors can develop impulse control disorders: unhealthy levels of gambling, shopping, eating or sexual activity.
If you believe that you or a loved one has an impulse control disorder, try to identify a trend in unhealthy behaviors and discuss it with your doctor. These disorders usually respond to medication changes. Your doctor can often work with you to reduce your dosage or switch to another medication.
When asked, up to 30% of people with Parkinson’s have thought about suicide. Experiencing a sense of helplessness can occur at any stage of the disease. If you are feeling stuck and your feelings have evolved into thoughts about suicide, there are places to turn to for support.
Depression and pain are PD symptoms that can lead to suicidal thoughts. While often going undiagnosed or undertreated in people with Parkinson’s, depression is treatable. However, keep in mind that not all people at risk for suicide are depressed. People with Parkinson's benefit from a team-based healthcare approach that includes a social worker, therapist, psychologist or counselor. With a team in place, should depression or suicidal thoughts occur, you have an established relationship with a professional you trust. It is never too late to add a mental health professional to your care team.
There are 24-hour suicide prevention hotlines that can help, such as the National Suicide Prevention Lifeline at 1-800-273-8255 and The Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-4357.
For many, stress can be a part of life when caring for someone with a chronic illness such as PD. However, some care partners may have a tough time coping with the fact that they need help. Care partners and their loved ones should address caregiver burnout as soon as you notice warning signs: feelings of anxiety, anger followed by guilt, bitterness towards family members and depression.
In general, 40 to 70 percent of caregivers are significantly stressed, and about half of these meet the criteria for clinical depression. While a challenge in itself, learn your limits as a care partner and find a support network that works for you. Many times, you can work with your loved one’s care team or a social worker to find additional help and resources that work best for you.
- Learn more: Balancing Life and Caregiving, Caregiver Stress, What to Expect Emotionally and Your Health Needs
For many, the term palliative care is associated with fear. Think of palliative care as supportive care, defined as helping people with Parkinson’s and care partners plan for the future, address non-motor symptoms and provide an extra level of support. Palliative care can help people with PD and their families at any stage.
Palliative care is not the same as hospice care. It does include hospice, which is end-of-life palliative care, but also provides support for patients and families from the time of diagnosis.
- Learn more: Launching A Modern Supportive Care Program Across U.S. Centers of Excellence, Advanced PD and Palliative Care in the 21st Century and Palliative and Hospice Care
End of Life Planning
Many adults avoid the subject altogether. However, all adults, even if their health is excellent, should document their wishes and preferences should a health emergency occur. If you have a spouse, partner, children or others you care about, as your disease progresses estate planning can help you ensure that they are provided for and cared for, if necessary.
Get organized. Consider creating a binder with the following main document categories: Medical, Family, Insurance/Property and Finance. Make sure that a close family member or friend knows where to find them in case they are needed. Taking the time to make advance preparations for this inevitability is practical and necessary. Honest conversations about end-of-life planning and care may not be comfortable or easy, but they are important so you can ensure that your wishes are honored.
- Learn more: Planning Ahead: Estate Planning, End of Life, The Role of Hospice, Getting Organized, Caregiving: Preparing for Changes, Planned Giving
Addressing Uncomfortable Topics with Your Doctor
Doctors usually wait until the end of an appointment to ask, “anything else?” How do you transition into your potentially uncomfortable topic?
- Remember that your doctor has heard it all. She/he wants to help you increase your quality of life.
- Give yourself a quick pep talk. Your symptom or issue has been impeding on your quality of life. The conversation will only last a few minutes and may have a simple solution.
- Write it down. Give yourself a natural transition in the conversation to bring up your topic. Try something like, “I wrote down some symptoms and/or issues I want to discuss, and they are sensitive in nature.”
- Add details. Try to remember when the issue began, how long it has been a problem, when it occurs and all your symptoms.
Your doctor will work with you to address the issue and can often provide guidance or a recommendation.
For more information on non-motor Parkinson’s symptoms visit our non-movement symptoms articles. You can also discuss any topic with our Helpline at 1-800-4PD-INFO (473-4636).
For more insights on this topic, listen to our podcast episode “Clinical Issues Behind Impulse Control Disorders” and “How to Talk about Impulse Control Disorders.”