Understanding UTIs in Parkinson’s: Why They Happen & How to Manage Them
Living with Parkinson’s means managing a wide range of changes in the body, but not all of these are related to your movement. While tremors and stiffness are well-known, hidden symptoms like bladder issues are incredibly common. One of the most frequent and potentially dangerous complications for people living with Parkinson’s is a Urinary Tract Infection (UTI).
Why are UTIs so common in Parkinson’s?
UTIs frequently affect people with Parkinson’s because of the loss of dopamine, a chemical messenger that helps control both voluntary movements and automatic bodily functions, including bladder control.
When the brain struggles to communicate properly with the bladder muscles, it can result in a condition known as neurogenic bladder. You might experience an overactive bladder that contracts too often, or your bladder muscles might fail to contract strongly enough. Because of this, the bladder may not empty completely when you go to the toilet. This leftover urine pools in the bladder, creating an ideal, warm environment for bacteria to multiply and cause an infection.
Additionally, the movement challenges of Parkinson’s, such as slowness (bradykinesia) and mobility issues, can make it difficult to reach the bathroom in time. Some people may require urinary catheters to help drain the bladder, which can also introduce bacteria directly into the urinary tract.
Worsening Parkinson’s or UTIs & Delirium
One of the most alarming things about a UTI in an older adult with Parkinson’s is that it can mimic a sudden, severe worsening of Parkinson’s symptoms.
When a UTI develops, it triggers an immune response. This releases inflammatory signals into the bloodstream, which can cross the blood-brain barrier and disrupt normal brain function. In a brain already vulnerable due to Parkinson’s, this inflammation can cause a medical emergency known as delirium.
Delirium is a sudden state of severe confusion and altered awareness. It can cause a rapid decline in a person’s cognitive and motor abilities. You might notice an abrupt increase in rigidity, a sudden inability to walk, more frequent falls, or the sudden onset of hallucinations.
How to tell the difference: The key difference between Parkinson’s progression and UTI-induced delirium is the timeline. Parkinson’s progresses very gradually over months and years, whereas delirium comes on abruptly over a few hours or days. If you see a sudden, drastic change in your loved one’s behaviour or movement, an underlying infection like a UTI is a primary suspect.
What to Look For
UTI symptoms in someone with Parkinson’s can be tricky to identify. They are typically divided into urinary and non-urinary signs.
Typical Urinary Symptoms:
- A burning sensation or pain when urinating.
- Sudden, often, strong urge to urinate.
- Passing frequent, small amounts of urine.
- Cloudy, dark, or foul-smelling urine. (n.b. if you are on Stalevo, an orange coloured urine is a side effect).
- Blood in urine.
- Pelvic discomfort.
- New or worsening urinary incontinence (leaking).
Non-Urinary Symptoms (Early Warning Signs):
- Sudden confusion, disorientation, or memory loss.
- Unexplained lethargy, fatigue, or general malaise.
- Agitation, restlessness, or unusual behaviour.
- New or worsening hallucinations and delusions.
- Pain in the lower abdomen, pelvis, or back.
- Fever and chills (Note: Many older adults do not develop a fever even with a severe infection).
The Connection Between Constipation & UTIs
Constipation is an incredibly common issue in Parkinson’s, sometimes appearing years before any motor symptoms. But did you know it is also linked to UTIs?
When the bowel is full of hard, impacted stool, it can mechanically press against the bladder and the bladder neck. This extra pressure restricts the flow of urine, making it even harder for the bladder to empty completely. Treating and managing constipation through diet, hydration, and getting proper medical advice can protect your bladder health.
What to Do (& Not Do) if You Suspect a UTI
- DO seek medical advice immediately. If you notice sudden confusion, increased falls, or urinary discomfort, contact a doctor right away. Early treatment prevents the infection from spreading to the kidneys or causing life-threatening sepsis. You can call 1800MEDICARE.
- DO drink plenty of water. Flushing the urinary system can help clear out bacteria.
- DO track the symptoms. Write down any sudden changes in mood, mobility, or toilet habits to share with your care team.
- DON’T assume Parkinson’s is just getting worse. Sudden declines are red flags for infections, not normal progression.
- DON’T demand antibiotics if there are no symptoms. Many people with Parkinson’s have bacteria living harmlessly in their bladder (known as asymptomatic bacteriuria). If there are no symptoms of illness or confusion, treating this with antibiotics is unnecessary and can cause harm, such as antibiotic resistance or severe gut issues.
- DON’T rely solely on cranberry juice. While once highly recommended, recent studies show cranberry juice is not a reliable cure or preventative measure for UTIs.
Lowering Your Risk of UTIs
Prevention is always the best approach. Here is how you can lower your risk:
- Stay Hydrated: Drink plenty of water throughout the day (aim for 6-8 glasses, unless your doctor advises otherwise due to heart or kidney issues).
- Practise Good Hygiene: Always wipe from front to back after using the toilet to stop bowel bacteria from reaching the urethra. Change incontinence pads frequently to keep the skin clean and dry.
- Manage Constipation: Eat a healthy diet, stay active, and speak to your GP or pharmacist about safe laxatives or stool softeners if required.
- Don’t Hold It: Encourage regular trips to the toilet. Holding urine allows bacteria more time to multiply.
- Bladder Training: Scheduled toilet visits (timed voiding) can help ensure the bladder is emptied regularly before it becomes overfull.
Seeking Advice & Treatment
If you suspect a UTI or are struggling with bladder control, your first point of contact should be your General Practitioner (GP) or your neurologist. They can rule out infections and adjust your Parkinson’s medications if needed. You may also be referred to a urologist (a doctor specialising in the urinary tract) or a pelvic floor physiotherapist who can teach you exercises to strengthen the muscles that control urination.
Treatments: If a UTI is confirmed via a urine test, it will typically be treated with a short course of antibiotics. YOU MUST TAKE THE WHOLE COURSE. Once the infection clears, symptoms like delirium and increased rigidity usually resolve.
For long-term management of an overactive bladder, doctors may prescribe specific medications to relax the bladder muscle. Today, drugs known as beta-3 agonists (such as mirabegron) are often preferred for people with Parkinson’s. Older bladder medications, known as anticholinergics (like oxybutynin), are generally avoided in older adults with Parkinson’s because they can cause severe side effects, including worsening confusion, dry mouth, and severe constipation.
If medications aren’t effective, specialists might suggest advanced therapies, such as Botox injections into the bladder muscle or gentle nerve stimulation (neuromodulation) to improve bladder control.
Reach out to Continence Health Australia on their helpline 1800 330 066 and watch our YouTube video with Neuro-urologist Ashani Couchman on bladder issues and solutions.
