Abstract
Bladder dysfunction (urinary urgency/frequency), bowel dysfunction (constipation), and sexual dysfunction (erectile dysfunction) (also called “pelvic organ” dysfunctions) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, pelvic organ autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, peripheral myenteric pathology causing slowed colonic transit (loss of rectal contractions) and central pathology causing weak strain and paradoxical anal sphincter contraction on defecation (PSD, also called as anismus) are responsible for the bowel dysfunction. In addition, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the pelvic organ dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Dietary fibers, laxatives, and “prokinetic” drugs such as serotonergic agonists are used to treat bowel dysfunction in PD. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life.
Highlights
Parkinson’s disease (PD) is a common movement disorder associated with the degeneration of dopaminergic neurons in the substantia nigra
In recent studies of PD patients who were diagnosed according to modern criteria [5, 51,52,53], the prevalence of LUT symptoms (LUTS) was found to be 27–63.9% using validated questionnaires [51,52,53], or 53% in men and 63% in women using a nonvalidated questionnaire that includes a urinary incontinence category [5], with all of these values being significantly higher than the incidence rates in healthy controls
In the differential diagnosis of PD and parkinsoniantype multiple system atrophy (MSA), large postvoid residuals, open bladder neck, and neurogenic change in sphincter motor unit potentials are all common in MSA [56, 63] whereas they are rarely seen in clinically typical PD
Summary
Parkinson’s disease (PD) is a common movement disorder associated with the degeneration of dopaminergic neurons in the substantia nigra. It is important to note that, unlike motor disorder, pelvic organ dysfunctions are often nonresponsive to levodopa, suggesting that they occur through a complex pathomechanism [6]. This is because pathology of PD is not confined to the degeneration of dopaminergic neurons in the substantia nigra, and involves other locations in the brain and other neurotransmitter systems than the dopaminergic system. For this reason, add-on therapy is required to maximize patients’ quality of life. This article reviews pelvic organ dysfunctions in PD, with particular reference to neural control of the bladder [2], bowel [2], and genital organs, symptoms, objective assessment, and treatment
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