Parkinson's disease is one of the most common movement disorders. Its essence is dopamine deficiency and its primary symptoms are motor slowing, muscle rigidity, resting tremor, gait and postural abnormalities.
Table of contents:
- Autonomic disorders
- Bladder dysfunction
- Differential diagnosis based on bladder dysfunction
- Sexual dysfunction in Parkinson's disease
- Medication used and sexual dysfunction
In addition to motor deficits, problems with sleep, the mental sphere and sensory symptoms and autonomic dysfunction are often present.
Autonomic dysfunction
Autonomic dis orders in Parkinson's disease include excessive salivation, swallowing problems, constipation, delayed gastric emptying, orthostatic hypotension and genitourinary disorders.
Standard drug treatment not only has no effect on autonomic dysfunction, but in many cases can exacerbate such symptoms.
Bladder dysfunction
Among Parkinson's patients, lower urinary tract symptoms are reported in 38-71% of patients, significantly more often in men than in women. In the majority, bladder dysfunction appeared after the onset of motor dysfunction. They mainly include difficulty holding urine, urinary urgency, daytime and nighttime urinary frequency.
Parkinson's disease, photo: panthermedia
Urodynamic abnormalities include reduced bladder capacity and excessive activity of the detrusor muscle. The problem lies in the phasic and involuntary contraction of the detrusor and the unrestrained relaxation of the sphincter.
The overactivity of the detrusor is due to the involvement of inhibitory and excitatory brain areas. Patients also have high resting urethral pressure, which is associated with the use of the drug levodopa.
Differential diagnosis based on bladder dysfunction
Excessive voiding activity occurs in various forms of parkinsonism due to degenerative or vascular changes.
In Parkinson's disease, in contrast to multiple system atrophy and dementia with Lewy bodies, there is no urinary retention after micturition and no open bladder neck.
The use of standard drugs for motor symptoms in Parkinson's disease may further contribute to overactive bladder. If problems arise, cholinergic or serotonergic drugs are used.
Sexual dysfunction in Parkinson's disease
37-65% of Parkinson's disease patients suffer from sexual dysfunction. Most commonly, patients complain of decreased libido, reduced frequency of intercourse, erectile dysfunction, orgasm and ejaculation.
In most patients, problems of the sexual sphere appeared after the onset of motor deficits. This makes it possible to differentiate Parkinson's disease with multiple system atrophy, in which sexual dysfunction occurs before the motor deficits.
Parkinson's disease, photo: panthermedia
Among men with Parkinson's disease, depression, movement disorders and pain inevitably lead to problems with sexual activity, mainly with erection in women, while weakened libido and lack of orgasm predominate.
Medication used and sexual dysfunction
In the case of depression, which often accompanies Parkinson's disease, appropriate antidepressants are usually used, which are risk factors for erectile dysfunction. In addition, the reduction in sexual functioning in these individuals is due to a deterioration in self-esteem, mood and quality of life.
The dopaminergic drugs used in parkinsonism also have a partially beneficial effect on sexual functioning, if their effect is insufficient the drugs of first choice for Parkinson's patients become drugs that inhibit the breakdown of nitric oxide, they facilitate the relaxation of the smooth muscle of the cavernous tissue.
