Elsevier

Autonomic Neuroscience

Volume 92, Issues 1–2, 17 September 2001, Pages 76-85
Autonomic Neuroscience

Questionnaire-based assessment of pelvic organ dysfunction in Parkinson's disease

https://doi.org/10.1016/S1566-0702(01)00295-8Get rights and content

Abstract

Although patients with Parkinson's disease (PD) experience pelvic organ dysfunction of the urinary bladder, bowel and genital organs, an accurate incidence of the dysfunction and its characteristics have yet to be ascertained. We devised a detailed questionnaire on these three pelvic organ functions in PD patients and control subjects, in our search for a hallmark that would distinguish between the two groups. The PD group comprised 115 patients; 52 men and 63 women, age range 35–69 (average 59) years old, average duration of illness 6 years, median Hoehn and Yahr stage 3. All were taking levodopa with/without dopamine agonists. The control group comprised 391 local individuals who were undergoing an annual health survey; 271 men and 120 women, age range 30–69 (average 48) years old. The questionnaire had three parts: bladder (nine questions), bowel (four questions), and sexual (three questions for women, five for men) function. Each question was scored from 0 (none) to 3 (severe) with an additional quality of life (QOL) index scored from 0 (satisfied) to 3 (extremely dissatisfied). The completion rate was 100% for bladder and bowel functions, whereas for sexual function, it was 95% (control) and 88% (PD) for men and 82% (control) and 60% (PD) for women. As compared with the control group, the frequency of dysfunction in the PD group was significantly higher for urinary urgency (women 42%, men 54%), daytime frequency (28%, 16%), nighttime frequency (53%, 63%), urgency incontinence (25%, 28%), retardation (44% of men), prolongation/poor stream (men 70%), straining (women 28%); constipation (63%, 69%), difficulty in expulsion (men 57%), diarrhea (men 21%); decrease in libido (84%, 83%), decrease in sexual intercourse (55%, 88%), decrease in orgasm (men 87%), and in men, decreases in erection (79%) and ejaculation (79%). The QOL index for the PD patients was significantly higher for bladder (27%, 28%) and bowel (46%, 59%) but not for sexual dysfunction, despite the group's high prevalence of sexual dysfunction. In the PD patients, fecal incontinence was associated with urinary incontinence. Stress urinary incontinence and a decrease in libido were more common in women than in men. Bladder and bowel dysfunction, but not sexual dysfunction increased with the Hoehn and Yahr stage. Sexual dysfunction, but neither bladder nor bowel dysfunction, increased with age. Patients taking levodopa and bromocriptine more frequently had bladder (voiding phase) dysfunction than those taking levodopa only. The findings show that bladder, bowel and sexual dysfunction are all prominent in patients with PD. Amelioration of pelvic organ dysfunction, particularly bowel dysfunction which most affects the quality of life, therefore should be a primary target in the treatment of patients with PD.

Introduction

Various pelvic organ functions are controlled by extrinsic nervous pathways that involve neurons in the brain, spinal cord and peripheral ganglia (de Groat and Steers, 1988), of which the urinary bladder, bowel and genital organs are most commonly affected in neurological diseases. Symptoms commonly complained of by patients with idiopathic Parkinson's disease (PD) include urinary incontinence (37–70%), constipation (29–67%), and erectile dysfunction (40–60%) indicative that the central dopaminergic system is involved both in motor and autonomic pelvic functions Andersen, 1985, Berger et al., 1987, Edwards et al., 1991, Hattori et al., 1992, Gray et al., 1995, Martignoni et al., 1995, Stocchi et al., 1997, Stocchi et al., 2000. Most of these estimates are based on data from patients with PD who, because of their symptoms, visited a urology or gastroenterology clinic. In such cases, the patient samplings obviously were biased. Moreover, such symptoms are found in the general population although not much detailed information is available on each type of function Johannes and Avis, 1997, Malmsten et al., 1997, Holtedahl and Hunskaar, 1998, Laumann et al., 1999. We therefore devised a questionnaire on the three pelvic organ functions in PD patients seen at our neurology clinic and in control subjects, to establish a distinguishing hallmark between the two groups.

Section snippets

Materials and methods

We recruited 115 consecutive patients with PD seen at our neurology clinic. All met the clinical diagnostic criteria of idiopathic PD (Wenning et al., 2000) and responded well to levodopa with/without dopaminergic agonists (with bromocriptine mesilate, 32; with pergolide mesilate, 32; and levodopa/carbidopa alone, 51). All the patients underwent brain magnetic resonance imaging (MRI), which showed no abnormality indicative of degenerative parkinsonism including multiple system atrophy (Beck et

Results

The completion rate of the bladder and bowel parts of the questionnaire was 100% for both the PD patients and control subjects, men and women; whereas, in the sexual part, for men it was 95% (control subjects) and 88% (PD patients) and for women 82% (control subjects) and 60% (PD patients). There was no difference in age as to the completion rate of the sexual part of the questionnaire. We analyzed sexual function for an 84-patient (46 men, 38 women) and a 356-control subject (258 men, 98

Discussion

Although pelvic organ dysfunction is recognized in idiopathic Parkinson's disease (PD), it is difficult to determine to what extent PD contributes to it. Both PD patients and men aged 60 or older may have an obstructive component that contributes to their urinary symptoms and is brought about by benign prostate hyperplasia Araki and Kuno, 2000, Lemack et al., 2000. Women may suffer urinary incontinence owing to physical stress Sandvik et al., 1993, Holtedahl and Hunskaar, 1998. Similarly,

Conclusion

Dysfunction of the bladder and bowel and of sexual performance are all prominent in patients with PD. Amelioration of pelvic organ dysfunction, particularly bowel dysfunction which most affects the quality of life, therefore, should be a primary target in the treatment of patients with PD.

Acknowledgments

We thank Drs. Toshio Fukutake, Kimihito Arai, Masato Asahina and our other colleagues at the Neurology Outpatient Clinic in Chiba University Hospital who conducted the questionnaire. We also thank Ms. Junko Taniguchi for the creation of the database.

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