Treatment of urinary and sexual dysfunction in Parkinson’s disease

Abstract

Treating urinary incontinence and sexual dysfunction in Parkinson’s disease (PD) involves a multicomponent approach. This incorporates patient goals for care and prioritizes lifestyle and behavioral therapy prior to the initiation of drug therapy in order to avoid adverse drug events. In addition to a targeted exam and careful medication review, assessment of mobility and cognitive function are important to develop patient-centered approaches to care. Pelvic floor muscle exercise-based behavioral therapy is a reasonable first approach to treat urinary symptoms. Drug therapy for urinary incontinence may involve bladder relaxants and/or treatments for concomitant bladder outlet obstruction in men. After evaluation of comorbid conditions and medications affecting sexual function, education regarding treatment options and specialist referral may be considered. Phosphodiesterase inhibitors should be used with caution in men with orthostatic hypotension, and limited evidence suggests efficacy for erectile dysfunction in PD.