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Bladder and bowel problems

People with Parkinson's may be more likely to have problems with their bladder or bowels than people of a similar age without the condition.

However, not everyone with Parkinson's will experience these symptoms.

Who can be affected by bladder and bowel problems?

If you have Parkinson’s, you may be more likely to have problems with your bladder or bowels than people of a similar age without the condition.

Some of these problems are common in men and women of all ages, whether they have Parkinson’s or not.

Bowel problems are very common in the general public. But any change in bowel habit, particularly if you see blood in your bowel motions, should be reported to your GP.

Whatever the reason for your bladder and bowel problems, you can usually do something to help. It may be that the problem can be cured completely. But if that isn’t possible, there are many different ways of managing the symptoms so they don’t rule your life.

How does the bladder work?

The role of the bladder is to store urine and then empty it in the toilet. You normally become aware of the bladder filling when it’s about half full, and can wait to find the best time and place to urinate.

This acts as an ‘early warning system’. Someone with an ‘average’ bladder needs to use the toilet four to seven times a day and usually once or not at all at night.

The muscles around the bladder outlet (the urethra) and the supportive muscles of the pelvic floor help to maintain a watertight seal, even when the bladder is put under a lot of pressure, for example, when coughing or jumping. This helps you to ‘hold on’ if you need to go.

Your brain gives your bladder instructions, sending messages telling it when to hold on and when to empty. When you go to the toilet the muscles and bladder outlet relax, and the bladder contracts and pushes the urine out.

What type of bladder problems can I get if I have Parkinson’s?

Urge incontinence and nocturia are the most common bladder problems in Parkinson’s. These may happen because the messages from the brain giving the bladder instructions aren’t getting through properly.

Remember that not everyone with the condition will experience these problems and they may be caused by other things, so always talk to your GP if you are having problems.

Urge incontinence

If you have an overactive bladder, you may feel the need to urinate immediately, without warning. This means that you can’t ‘hold on’ as you might do normally if you don’t reach a toilet in time. This is called incontinence.

Nocturia

Nocturia is the need to urinate many times during the night because of an overactive bladder. As you get older, it is normal to need to get up once or twice in the night to urinate during the night. This may wake you up, or your bladder may empty while you are asleep.

Find out more about sleep problems and Parkinson's.

Problems related to childbirth

Childbirth can stretch the pelvic floor muscles and can damage the urethral sphincter (used to control the exit of urine in the urinary bladder through the urethra), which can cause incontinence. The pelvic floor muscles are the internal muscles around your bladder outlet.

Prostate problems

The prostate is a small gland which only men have. It is about the size of a walnut and surrounds the first part of the urethra (the tube that carries urine from the bladder to the penis).

As men get older, the prostate can gradually get bigger. Although this is normal, for some it causes problems by blocking the flow of urine. This makes it difficult to empty the bladder. You may experience the need to urinate more often, a difficulty in starting to urinate, a need to strain or an urgent need to go to the toilet.

Occasionally, the prostate can block the bladder completely and you might not be able to pass any urine at all. This is known as retention. If this happens to you for more than a few hours, or you are in great discomfort or pain, you should seek urgent medical help.

It can be difficult to tell the difference between an enlarged prostate gland and the problems emptying the bladder that Parkinson’s can cause. You can get tests done on the bladder, but even then, it might not be clear what the problem is.

The most important thing is to seek treatment, so make sure you share any concerns with your GP, specialist or Parkinson’s nurse.

Stress incontinence

This is when you let out urine because of physical stress, such as coughing, laughing, sneezing or exercise. This can happen to both men and women, but tends to be more common in women.

A smoker’s or heavy cough and being overweight can put an extra strain on the bladder outlet, causing stress incontinence.

Treating prostate problems

There are several different ways to treat an enlarged prostate gland. Medication and making changes to your lifestyle may help.

If your symptoms are severe, and medication hasn’t helped, then your doctor may suggest surgery. A procedure called a transurethral resection of the prostrate (or TURP) removes part or all of the prostate.

This is usually done using a small telescopic instrument inserted into the urethra, so it won’t cause scarring.

Some hospitals have introduced a procedure to shrink the prostate using lasers. As laser surgery is a relatively new technique, there isn’t research yet about how effective it is in the long term.

Before you start thinking about surgery, ask your GP, specialist or Parkinson’s nurse about a referral to a urologist. They will examine you and carry out any necessary tests.

Like all types of surgery, there may be some small risks. Make sure you discuss any potential problems with your specialist, so you can make an informed decision.

Products to help your bladder or bowel problem

There are many different products specially designed to keep you comfortable and prevent anyone else from knowing you have bladder or bowel problems. Talk to your healthcare professional about what option is best for you.

Hand-held urinals

There are a variety of hand-held urinals available for men and women.

These may be useful for someone who needs to urinate urgently, but who can’t get out of a bed or a chair in a hurry or when there is nobody available to help. If you have a tremor, you may find it’s slightly difficult to use these, so it’s worth trying different types.

For men, a bottle with a handle, a flat bottom and a non-spill adaptor might help avoid accidents or anxieties about getting to the toilet on time.

Some men find that when they use a bottle while sitting down the fly on their trousers is too short. Adapting trousers so that the opening is extended down to the crotch seam, as well as closing it with Velcro tabs rather than buttons or a zip, can make using a bottle much easier.

Pads and underwear

We don’t recommend ordinary sanitary towels as protection against leakage caused by bladder problems. There are many pads available that are specially designed for this purpose, ranging from small ones to cope with mild leakage, to much larger pads for those who need them.

Most pads are disposable and held in place inside your underwear. You can also get washable underwear with a built-in absorbent gusset. This is particularly useful if you feel safer with a pad in place ‘just in case’ because of an unpredictable bladder.

You may also be able to get larger disposable pads for free on the NHS or health service. Speak to your GP or district nurse about this. But in many areas, people with milder incontinence problems may have to buy their own pads or underwear.

Bed protection

You can buy various mattress covers, absorbent sheets, bedpads, and duvet and pillow covers if you need them. Washable absorbent sheets tend to be the most comfortable, but they can be heavy and difficult to handle when wet.

Appliances for men

Some men with urine incontinence may prefer to use a sheath or appliance rather than a pad. These fit over the penis and collect urine in a leg bag. They can be a bit difficult to put on, especially if you have a tremor, so you may need some help.

Appliances are available with a GP’s prescription. In England, the usual prescription charges will apply.

Odour control

This can be a common worry, but even if you have incontinence problems it is unlikely that anyone will notice a smell. Fresh urine should not smell unpleasant. It only starts to smell if it is left out in the air.

So, as long as you get changed as soon as you can and keep wet pads, clothing or bedding in an airtight container (such as a bucket with a lid) until it is washed, there shouldn’t be a problem.

Selecting a good pad or appliance is the best insurance against leakage of urine on to a mattress, chair or carpet, as these can often be difficult to clean effectively. Fresh air and use of an air freshener may also help if there is a slight smell.

If fresh urine does smell strongly, it could be due to a urine infection. If this is the case you should speak to your GP.

Skin care

If you are incontinent, you shouldn’t normally get sore skin, as long as you change frequently and take care to wash and dry your skin thoroughly.

Try to have a bath or shower daily if you can. It’s usually best to wash with ordinary unscented soap. Also, try to avoid using talcum powder or deodorants directly on your skin, as these can irritate.

If you find that your skin often gets sore, speak to your GP, specialist or Parkinson’s nurse. This is important because if the skin becomes broken this may cause an infection.

Your pharmacist may also be able to advise you on products for skin that gets sore.

Permanent catheters

A catheter is a thin flexible tube, which is inserted into the bladder. This can be done along the tube where you pass urine (known as urethral catheterisation) or through a hole in the abdomen (suprapubic catheterisation).

If you have severe difficulties emptying your bladder, you may not want to insert a catheter into your bladder several times a day (intermittent catheterisation). In this case, you may prefer to use a catheter that stays in all the time.

It can also help if you are incontinent and have not found any other way of managing the problem successfully, or if you’ve found it very difficult or impossible to get to the toilet.

For people with severe bladder problems, a catheter can be a positive choice and make life much easier.

If you decide to use a long-term catheter, you may prefer a suprapubic one. This is because they tend to be more comfortable and easier to manage, although they may not be suitable for everyone.

To help you make an informed decision about your treatment, make sure you discuss all options with your healthcare professional. You can then weigh up the advantages and disadvantages of which catheter may be suitable for you.

How does the bowel work?

The bowel processes the food that we eat and extracts the nutrients that the body needs.

Food passes from the stomach into the small bowel. Eating, drinking or physical movement will help the movement of food through the large bowel to the rectum.

The large bowel receives liquid waste from the small bowel and takes out some of the water to leave soft bowel motions (called faeces or stools). A person will pass these when they feel the need to go to the toilet. If the time and place are not convenient, a person should be able to wait.

When a person is ready to empty their bowel, the rectum contracts to push out the faeces. Then, the anal sphincter muscle relaxes and opens, and the stool is passed. This may be done with a little extra help from abdominal muscles bearing and pushing down and possibly a little straining.

Like the bladder, storing then emptying the bowel seems like a simple process, but the bowel is controlled by complex nerves and muscles.

What type of bowel problems can I get if I have Parkinson’s?

Constipation

Constipation is when your stools are hard and difficult to pass, or when you have bowel movements much less frequently than you’ve had before.

Some people have a daily bowel movement, but many people go only once every two or three days and are not constipated. As long as the stool is soft and easy to pass without too much straining, there is nothing to worry about.

Constipation can be a common bowel problem for people with Parkinson’s. This can be because of the following:

  • Parkinson’s symptoms, such as slowness of movement and rigid muscles, affect the muscles in the bowel wall. This can make it harder to push stools out of the body.
  • If you find it difficult to move around or exercise much, this can also mean your bowel isn’t stimulated to work properly.
  • You may find it difficult to chew and swallow food. This means it’s harder to have a diet with plenty of fibre, which helps to keep stools soft and easy to pass.
  • If you don’t drink enough fluid, this can cause stools to be harder and more difficult to pass. This can get worse during hot weather.
  • Medication can make constipation worse. It may be your Parkinson’s drugs or other types of medication, such as antidepressants.
  • It may become difficult to contract your abdominal muscles and the anal sphincter may not relax at the right time to allow you to pass the stool easily. Sometimes, the sphincter may tighten when it should relax, which can make emptying the bowels difficult.

If your constipation is very bad, it may make you feel unwell, tired and nauseous. It can also cause abdominal pain. If you need to strain a lot, you may get haemorrhoids (more commonly known as piles).

Sometimes if you get constipated, the bowel can become loaded with hard stools and you might find it difficult to pass anything. This is called ‘impaction’. In this case your bowel may overflow, and there can be accidental leakage.

This may either be lumps of stool or a brownish mucus that looks like diarrhoea. If this happens, you will need urgent medical attention and should contact your health professional, minor injuries clinic or go to A&E.

Constipation can mean your body isn’t able to absorb your Parkinson’s medication properly, which can lead to your symptoms getting worse. But things can be done to try to treat the problem, so speak to your GP, specialist or Parkinson’s nurse if you are having difficulties.

Diarrhoea

People with Parkinson’s can get diarrhoea for the same reasons as people who don’t have the condition. For example, because of an infection or food poisoning.

If you have Parkinson’s, you might find it difficult to get to the toilet in time. You may also find it hard to squeeze the sphincter muscles in your bottom. This can cause leakage before you can reach the toilet.

Weak sphincter

Childbirth and minor operations in the area (such as for piles) can cause your sphincter to become weak. This can cause difficulties in holding on to stools if you feel a need to empty your bowels. If you can’t get to a toilet quickly, this can result in incontinence.

Problems caused by poor mobility

Some people with Parkinson’s might soil their underwear because mobility problems can make it difficult to wipe effectively after using the toilet.

If this is the case, it might help to use moist toilet tissue, a bidet, or a specially adapted bottom wiper. An occupational therapist or the Disabled Living Foundation will be able to offer further advice.

What can I do to prevent bowel problems?

Some problems are difficult to avoid, but there are some things you can do to make them less likely to happen.

Exercising

As with Parkinson’s in general, it helps to maintain a healthy lifestyle and stay as active as you can. Exercise will stimulate your bowels, which can help prevent constipation and contribute to stronger pelvic floor muscles.

Exercise can also lift your mood and help you to keep a positive outlook. A physiotherapist can provide more advice on exercising when you have Parkinson’s. Ask your GP, specialist or Parkinson’s nurse about a referral.

Increasing your fibre intake

Eating more fibre-rich foods and drinking more fluids can help if you have constipation.

Ways to get more fibre in your diet:

  • Choose a breakfast cereal containing wheat, wheat bran or oats, such as Weetabix, porridge or bran flakes.
  • Eat more vegetables, especially peas, beans and lentils.
  • Eat more fruit – fresh, stewed, tinned or dried. Good ones include prunes or oranges.
  • If you find it difficult chewing high-fibre food, you can get some types which dissolve in water. You can also get drinks which are high in fibre.
  • Drink plenty of fluids throughout the day to avoid dehydration. Any fluid is suitable, including water, fruit juice, milk, tea, coffee and squashes.

Try to increase how much fibre you get gradually, to avoid bloating or flatulence (wind). A dietitian can give you more information and advice. You can usually get a referral through your GP, specialist or Parkinson’s nurse.

Addressing practical aspects of eating and drinking

Some people with Parkinson’s may have problems chewing and swallowing. This can make it difficult to eat a diet with plenty of fibre. A speech and language therapist can give advice about this.

If it takes you a long time to eat and your meal goes cold, eat smaller portions and go back for seconds that have been kept warm. You can get special plates that will help keep your meals warm – the Disabled Living Foundation has more information.

An occupational therapist will also be able to give you some practical advice.

Having a routine

Keeping to a routine can help, especially if you’re away from home and your usual environment, so try to empty your bowels at the same time of day if you can.

You might want to consider the best time of day for you to empty your bowels. This may be after breakfast, after a hot drink or when your medication is working best.

Many of us try to rush these things, but it is important to allow yourself enough time and to try to relax. Try to push from your waist, and try not to hold your breath and strain.

Respond as soon as you can when you feel the urge to open your bowels – putting it off can lead to hard stools and more difficulty.

Using laxatives

You may find that you need to use a laxative regularly to avoid constipation. You may need to use a laxative for long periods of time.

The medication available for constipation may not suit everyone, so it is important that you discuss possible treatments with your GP, specialist or Parkinson’s nurse.

Remember, it is not crucial to empty your bowels on a daily basis, so don’t worry if you’re unable to do this. However, it is important to keep an eye on things and not let your bowel become impacted (when the bowel becomes loaded with hard stools).

Who can I talk to about bladder and bowel problems?

While self-help is very useful, it is important not to struggle alone with bladder and bowel problems. Plenty of professional help is available.

A lot of people find it embarrassing to talk about these subjects, but don’t let this stop you from getting help if you need it. The professional you see will have heard about similar problems before and will be able to help you find a solution.

Your GP will usually be your first port of call. You may find it useful to keep a short diary of your bladder and bowel habits before your GP appointment. This may help you explain the difficulties you are experiencing.

Your GP can carry out some treatments, or they may refer you to one of the following specialists:

  • A urologist, who specialises in the urinary system.
  • A gynaecologist, who treats conditions and diseases in women.
  • A gastroenterologist, who specialises in the intestines and bowels.
  • A coloproctologist, who specialises in disorders of the lower bowel.
  • A neurologist, who specialises in diseases of the brain and nervous system.
  • A geriatrician, who specialises in conditions and diseases of older people.

You might also be referred to one of the following healthcare professionals:

  • A district nurse may visit you at home and help you with general advice, bladder training or pelvic floor muscle exercises. They may also be able to arrange a free supply of continence pads if you need them.
  • A continence adviser is a specialist nurse who assesses and manages incontinence and who may visit you at home or see you in a clinic.
  • A physiotherapist can help you improve your general mobility and teach you pelvic floor muscle exercises.
  • An occupational therapist can advise on physical aids, clothing adaptations and equipment to help with everyday activities such as going to the toilet and bathing. You can often see your occupational therapist without being referred by a GP – ask your local social services or social work department.
  • A dietitian can give advice on increasing your fibre intake, and on food that is easier to chew and swallow. Your GP can advise you on finding a dietitian.
  • You can also speak in confidence about any bladder and bowel problem to a Parkinson’s nurse.

What examinations may I need to have?

Your GP or specialist will probably ask a series of questions to find out what the problem is. These may include:

  • When did the trouble start?
  • How often does it happen?
  • Can you feel when your bladder or bowel is full?
  • Are you having difficulty emptying your bladder or bowel?
  • How often are you using the toilet?

Parkinson’s symptoms, such as slowness of movement and rigid muscles, affect the muscles in the bowel wall. This can make it harder to push stools out of the body. You may be asked to keep a chart for several days of how often you use the toilet and how much you drink.

You may also be asked for a urine sample to test for infection and they will normally carry out a physical examination.

Bladder or bowel problems can be complex in Parkinson’s, so sometimes specialist tests or X-rays may be needed. All of these can usually be done in an outpatient department or clinic.

Toilet adaptations

Sometimes practical issues can make bladder and bowel problems worse. For example, if you have trouble moving, you may find it difficult to get to the toilet in time.

Some people also find it hard to move themselves into the right position to use the toilet, or may have difficulty undoing clothes or fastenings, such as zips or buttons.

These problems can be frustrating, but there are things you can do to make using the toilet as easy as possible for you.

Toilet seat

If the toilet is too low it can be very difficult to get down on to it and get up again afterwards, especially if you have stiff hips. A raised toilet seat can help, but it’s important to get a seat that has adjustable clips to fix it securely to the toilet bowl.

Footstool

If your feet do not reach the floor when you’re sitting on the toilet, a footstool may help you to get in a better position to empty your bowels.

Rails

There are a wide variety of grab rails and toilet frames available that can help you use the toilet independently.

Clothing

If you have difficulty with movement and co-ordination, some items of clothing (such as those with buttons) may take a while to undo. This may put you under unnecessary pressure.

Sometimes, a very simple adaptation, such as adding a tab to a zip, may help. If you have poor grip, adding thumb loops to pants and choosing styles that are not too tight (such as boxer shorts for men) can make it quicker and easier to pull them up and down.

You can also get special braces to help lower your trousers without the risk of them falling down. Trousers with an elasticated waist, such as tracksuit bottoms, may also help.

For women, skirts can be tucked into the waistband, so that both hands are free to use grab rails. This prevents clothes dangling into the toilet bowl and getting wet.

An occupational therapist will be able to offer more advice on clothing adaptations.

A new toilet or an alternative

If you have real difficulties getting to the toilet, it may be possible to get a grant to build a new one, perhaps downstairs. An occupational therapist can advise you on this.

Not all homes are suitable for building new toilets, so a commode might be needed. A commode is a moveable toilet that doesn’t use running water. It looks like a chair, with a container underneath that can be removed and cleaned after someone has used it. They can be very discreet.

National Key Scheme

The National Key Scheme offers disabled people independent access to thousands of locked public toilets around the country. Toilets can be found in shopping centres, pubs, cafés, bus and train stations and many other locations in most parts of the country.

For a small donation Disability Rights UK can give you details of where toilets are located and can supply a radar key.

More information about bladder and bowels

Disabled Living Foundation

A charity giving impartial advice and information on daily living aids, including mobility equipment. It has a helpline, factsheets and an equipment demonstration centre where you can try items for free.

Disability Rights UK

A charity that offers a radar key, allowing you access to thousands of accessible toilets in the UK.

Bladder and Bowel UK (formerly PromoCon)

This organisation provides a national service in England, working as part of Disabled Living, Manchester, to improve life for all people with bladder or bowel problems. It offers product information, advice and practical solutions to both professionals and the general public.

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Looking after your bladder and bowels when you have Parkinson's (PDF, 4MB)

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