Bladder training and conservative advice may improve lower urinary tract symptoms (LUTS) in patients with Parkinson disease (PD) with and without incontinence, while the former may be superior, according to study results published in Neurology.
The quality of life of patients with PD may be significantly impaired in the presence of LUTS. While bladder training was shown to improve bladder control and continence in the general population without neurologic disease, limited data are available on the efficacy of bladder training for LUTS in patients with PD.
The single-center, randomized controlled trial included patients with PD and LUTS who were randomly assigned to a 12-week bladder training program or to conservative advice. At baseline, all participants completed a 3-day volume/frequency bladder diary; assessment of LUTS severity was made using the International Consultation on Incontinence Questionnaire–Overactive Bladder Module (ICIQ-OAB) and the International Consultation on Incontinence Questionnaire-Quality of Life Module (ICIQ-QOL).
The conservative advice included instructions to reduce alcohol and caffeine intake, along with advice regarding the management of constipation and containment products. The bladder training program included instruction on urge supersession and distraction techniques, coaching in pelvic floor exercises, a personalized voiding schedule, and a training video.
Of 82 patients invited to participate and given information, the study cohort included 38 patients, including 18 participants randomly assigned to conservative advice and 20 to bladder training program. Participants in the bladder training group were younger than those in the conservative advice group; however, groups were similar in terms of PD severity, disease duration, and levodopa equivalent dose. Bladder diary metrics and ICIQ scores were similar at baseline.
Both conservative advice and bladder training were associated with significant reductions in number of voids over the course of the study and a significant increase in volume voided. There was a trend toward a reduction in number of urgency episodes and incontinence episodes. At 20 weeks, there were significant reductions in ICIQ-OAB and -QOL scores.
At 12 weeks, patient perception of improvement was significantly better in the bladder training group. Furthermore, compared with conservative advice, bladder training was associated with significantly greater reductions in number of voids in 24 hours (mean decrease 2.3±0.8 voids vs 0.3±0.5; P <.05) and greater reductions in interference with daily life (2.1±0.8 point improvement vs 0.3±0.7 point deterioration; P <.05). Bladder training was not associated with change in urgency episodes.
At 20 weeks, changes in QOL remained consistently better for the bladder training group, compared with the conservative advice group; however, this was only significant for interference in daily life. Loss of significance in other measures may reflect loss of power from loss to follow-up. Similarly, volume voided per micturition increased and number of voids in 24 hours decreased at 20 weeks in the bladder training group compared with the conservative advice group, but this difference did not reach statistical significance.
The researchers noted several important limitations to the study, including the small sample size, inability to ascertain which of the bladder training elements resulted in improved outcomes, and age differences between groups.
“This study demonstrates that both [conservative advice] and [bladder training] may improve LUTS in PD. [Bladder training] was associated with a significantly greater patient perception of improvement than [conservative advice] alone,” concluded the researchers.
McDonald C, Rees J, Winge K, Newton JL, Burn DJ. Bladder training for urinary tract symptoms in PD: A randomized controlled trial [published online ahead of print, February 13, 2020]. Neurology. doi: 10.1212/WNL.0000000000008931