Bladder Issues & Incontinence

Man walking towards toilet holding toilet paper.

Bladder (or urinary) problems are common in Parkinson's disease (PD) and can affect quality of life. PD-related changes often cause these symptoms as well as other health issues common with aging or childbirth. With careful diagnosis and treatment — including adjusting daily habits, exercises, medications and sometimes procedures — many people can manage symptoms effectively with the help of their healthcare team.

How the Bladder Works

The bladder stores urine until it is full. Normally, this process happens automatically without much thought. When the time is right, the brain signals the bladder muscles to tighten and the sphincter muscles to relax, allowing urine to flow out. The sphincter muscles act like a valve to keep urine from slipping out at other times. When this system works well, people can control when they urinate.

How Parkinson's Affects the Bladder

Parkinson’s leads to the gradual loss of brain cells that produce dopamine — a chemical that helps control movement and automatic body functions, including bladder control. As Parkinson’s progresses, other chemical changes in the brain and nervous system — beyond dopamine — may also affect bladder function.

Common Bladder Problems in Parkinson's

Bladder issues in Parkinson's vary but often include urgency, frequency and difficulty emptying. The most common types are:

People may experience a sudden, strong urge to go to the bathroom or have to urinate often during the day — sometimes both. This happens because the bladder muscles contract too often or too strongly, even when the bladder isn’t full. Common triggers include running water, hearing the toilet flush or reaching for your keys to open the door. In some cases, urine may leak before getting to the bathroom.
Many people with PD wake up during the night. Sometimes, they wake up because of a strong urge to go to the bathroom. Other times, they wake for a different reason and then realize they need to urinate. Low daytime blood pressure can also increase nighttime urine production.

In some cases, people may not reach the bathroom in time — especially if their PD medications have worn off overnight. This can increase the risk of falls or accidents.
This happens when urine leaks during physical activities that put pressure on the bladder — like coughing, laughing, sneezing or lifting something heavy. It can happen if the pelvic floor muscles are weak or the sphincter doesn't fully close.

Although stress incontinence is not caused directly by Parkinson’s, it can still affect people with PD — especially women who’ve had children or people with weak pelvic floor muscles. Men may also experience it after prostate surgery.

How Bladder Problems Are Diagnosed

Diagnosing bladder issues in Parkinson’s can be tricky because symptoms may be caused by more than one issue — such as aging, medication effects, prostate problems or pelvic floor weakness. Also, people commonly feel overwhelmed or too embarrassed to bring up the topic to their doctor. However, it is important to find the cause, learn about treatment options and make choices based on what matters most to you.

Who Can Help with Bladder Problems

Your primary care doctor or neurologist is often the first stop when bladder symptoms appear. They can:

Rule out common medical issues.
Review medications that may affect the bladder.
Adjust PD medications if timing or "off" periods are contributing.
Refer a specialist.

Other professionals who may help include:

Urologist: Experts in urinary tract and bladder problems
Urogynecologist: Specialists in bladder and pelvic floor issues in women
Pelvic floor physical therapist: Help strengthen muscles to improve bladder control
Dietitian: Offer guidance on nutrition, fiber intake and hydration strategies to support bladder function and reduce constipation

Steps to Diagnose Bladder Problems

Your care team will work with you to understand what is causing your symptoms. Some steps are routine, while others may be used depending on your needs:

- Review of medical history and medications that may affect the bladder
- Discussion of symptoms
- Physical exam
- Screening for urinary tract infections
- Identify the type of bladder problem (urgency, frequency, stress incontinence, hesitancy, retention)
- Explore related factors such as:
  - Constipation, which can increase pressure on the bladder
  - Prostate enlargement or uterovaginal prolapse, which may block urine flow
  - Pelvic floor weakness
  - Hormonal changes in peri- and postmenopausal women
- Talk about personal goals, for example, fewer nighttime trips or fewer accidents
- Cough test to check for stress incontinence, which can happen during coughing, sneezing or exercise.
- Urodynamic testing (slowly filling the bladder through a small tube) to measure how well the bladder stores and empties urine

Urinary Tract Infections

People with PD are at higher risk for urinary tract infections (UTIs), especially if the bladder does not empty completely. While some UTI symptoms are easy to recognize, others may be more difficult to spot and can sometimes be mistaken for changes in PD. In older adults, confusion or hallucinations may be the only signs of infection.

- Burning or pain when urinating
- Frequent urge to urinate
- Cloudy or foul-smelling urine
- Lower belly or back pain
- Fever or chills
- Sudden confusion or changes in thinking, including hallucinations, especially in older adults
- Antibiotics
- Treating bladder problems to prevent future infections
- Vaginal estradiol may help reduce UTI risk in some women

If left untreated, UTIs can cause serious problems like kidney infections or severe confusion that sometimes require hospital care. If you or your loved one are hospitalized with Parkinson’s, use the Hospital Safety Guide to help advocate for the best possible care.

Treatment Options for Bladder Issues

Many approaches can help manage bladder problems in Parkinson's. Treatment will depend on your symptoms and goals.

- Limit caffeine, alcohol and fizzy drinks (these irritate the bladder).
- Manage constipation by eating enough fiber, drinking water and staying active.
- Schedule regular bathroom visits to avoid urgent situations.
- Elevate legs during the day to reduce nighttime urination.
- Stay hydrated during the day and reduce fluids after 6 p.m.
- Maintain a healthy weight.
- Bladder training: Gradually increasing the time between bathroom visits can help train the bladder to hold more urine and reduce urgency.
- Urge control techniques: Deep breathing, distraction or doing a pelvic floor contraction can help suppress the urge to urinate and prevent leaks.
- Pelvic floor exercises (Kegels): Strengthen the muscles that support the bladder. A pelvic floor physical therapist can teach effective ways to do Kegels and use biofeedback (sensors to monitor muscle engagement).
- Pessary device (for women): A small device placed in the vagina to support the bladder and help with prolapse or stress incontinence.
- Consider medication timing to address “off” periods affecting bladder function.
- Track symptoms like urgency and frequency to help adjust your treatment.
- Work with your PD doctor to look for patterns and adjust medications to improve bladder control.
- Anticholinergics (such as oxybutynin or tolterodine): Help calm an overactive bladder but can cause confusion, dry mouth or increase fall risk — especially in older adults.
- Beta-3 agonists (such as mirabegron or vibegron): A newer class of medications that helps relax the bladder muscle and has fewer cognitive (thinking) side effects. Common side effects can include headaches and palpitations (feeling like your heart is racing). Mirabegron is not recommended for people with high blood pressure that isn’t well controlled.
- Tamsulosin (Flomax): Often used in men to relax muscles in the prostate and bladder neck, improving urine flow when there’s prostate-related blockage.
- Botox injections: A procedure where small amounts of Botox are injected into the bladder muscle to reduce overactivity. This can improve urgency and leaking. In some people, it may cause difficulty fully emptying the bladder. Injections are typically repeated every 6 to 9 months.
- Neuromodulation: A treatment using a device to gently stimulate the nerves that control the bladder. It can improve communication between the brain and bladder. This is usually tried first with a temporary device before deciding on long-term use.
- Surgery for stress incontinence:
  - Bulking agents, which are injected near the urethra to help it stay closed.
  - Slings, which provide extra support for the bladder and urethra — commonly used in women.
If bladder leaks occur, these strategies can help you feel more comfortable and confident:
- Use absorbent pads or adult briefs.
- Keep a bedside commode or urinal nearby for nighttime use.
- Wear loose or easy-to-remove clothing.
- Make sure bathrooms are easy to reach and use.
- Limit liquids after 6 p.m. to help reduce nighttime bladder leaks and bathroom trips.

Bowel Incontinence in Parkinson’s

While less common than bladder issues, some people with PD also experience bowel incontinence: accidental leakage of stool.

What Causes It?

Muscle changes: Parkinson’s can weaken the muscles that control bowel movements.
Constipation: Hard, impacted stool may lead to leakage of softer stool around the blockage.
Brain-bowel signaling issues: PD can impair the brain’s ability to sense or control bowel movements.

What Can Help?

Manage constipation: Eat more fiber, drink plenty of water and stay active.
Pelvic Floor Therapy: A pelvic floor physical therapist can help improve muscle function and control.
Medications: Stool softeners or laxatives may help regulate bowel movements.
Incontinence products: Pads and garments designed for bowel leakage can help maintain comfort and confidence.

Talk with your care team if you’re experiencing bowel symptoms — support and treatment options are available.

Next Steps

Bladder symptoms may feel private, but you are not alone. Together, you and your healthcare team can find strategies that work for you. Managing bladder symptoms is possible, and many people improve their quality of life with the right support.

Page reviewed by Dr. Ankita Gupta, MD, MPH, FACOG, Associate Fellowship Director, Female Pelvic Medicine & Reconstructive Surgery at University of Louisville Health and Dr. Abhimanyu Mahajan, MD, MHS, Movement Disorders Neurologist at University of Cincinnati.