Hypothesis / aims of study
Parkinson's disease (PD) is the second most common degenerative disease, affecting around six million people worldwide. It’s characterized as a subcortical affection initially with predominantly motor manifestations. However, sexual dysfunctions and voiding are present, due to multiple factors such as: severity of disease, motor symptoms, depression, functional dependence, vesicle-urethral dysfunction due to the neurological alteration, cognitive changes that result in loss of perception of micturition events, main and side effects of anti-Parkinson drugs. The aim of this study was to evaluate the bladder behavior, sexual function and pelvic floor muscle function in patients with Parkinson's disease.
Study design, materials and methods
A cross-sectional observational study of a quantitative character developed with patients with PD, realized in a countryside city of the Brazil. The research was approved by the Ethics Committee. In this study were included patients over 18 years with Parkinson's disease history, who scored higher than 19/20 without a school history and 23/24 without a history in the Mental State Examination (MMSE), and who did not present a lower urinary tract infection. Ten patients were evaluated, including 5 males and 5 females; there were no exclusions in this study. In order to evaluate the voiding function, questions were asked about urinary frequency, involuntary loss of urine and / or exertion, characteristic of urine loss, onset of symptoms of urine loss, use of a protector, type and frequency of their Exchange. The functional evaluation of the pelvic floor muscle (PFM) was performed in 07 and they accepted to perform this procedure, the PERFECT scheme that evaluates the degree of strength by the Modified Oxford Scale was applied. For the evaluation of sexual function, the following questions were addressed: perception of pleasure and frequency of orgasm. As well, validated instruments were applied: International Erectile Function Index (IEFI) and Female Sexual Questionnaire (FSM) for sexual function in men and women, respectively. The data were analyzed in the software Statistical Package for Social Sciences for Personal Computer (SPSS-PC), version 20.0. the data were presented by descriptive statistics.
Results
The mean age of the study population was 65.1 (± 13.3), 50% of the participants were female, 80% were Caucasian, 80% were married, 20% practiced regular physical activity. About urinary loss, 70% of the participants reported loss of urine after the diagnosis of Parkinson's disease, of which 50% had urgency urinary incontinence. 60% had sexual activity, 40% reported having no sexual desire or that sexual desire had decreased. As to the perception of the pelvic floor, 40% had PFM perception and contraction symmetrically.
Regarding UI, the mean age of participants who reported having loss of urine was 64.43 (± 15.25) years, had been diagnosed with PD for approximately 7 years. The majority of participants who presented this condition were female (57.1%), did not practice physical activity (85.7%), there was no report of alcohol or tobacco products.
Regarding sexual function, it was observed that a considerable proportion (42.9%) individuals with urinary incontinence reported having decreased or absent sexual desire. 42.9% reported having orgasm during sexual intercourse, and presented International Erectile Function Index (IIFE) and Female Sexual Questionnaire (QS-F) for sexual function in men and women, respectively, 718,57 and 17.
The PERFECT was performed in 7 participants (3 volunteers did not accept). Of these, 57.1% showed the perception of the PFM with muscular strength lower than 3 on the Oxford scale, 85.7% used abdominal accessory muscles, 57.1 % recruited the adductor musculature and 71.4% the gluteal musculature.
Interpretation of results
In the present study, it was observed that the majority of individuals with PD had urinary incontinence, and that a considerable proportion had reduced libido and PFM perception, as well as low scores regarding sexual function. These results corroborate a study that reported that bladder dysfunction and sexual dysfunction are prominent in PD patients. Urinary manifestations are usually present in PD, causing a significant impact on quality of life.
In PD, characteristic dysautonomic phenomena occur, among these manifestations, it can mention neuromotor disorders, such as the presence of resting tremor, muscular rigidity, bradykinesias, difficulty initiating voluntary movements, postural instability due to loss of posture reflexes, orthostatic hypotension, post hypotension dyspnea, sialorrhea, constipation, bladder dysfunction and sexual dysfunction.
It is believed that the involvement of the autonomic nervous system (ANS) may be due to the disease itself, the medication being used, or a combination of these factors. Bladder dysfunctions may be a consequence of PD itself and the course of the disease.
Sexual dysfunctions are common in patients with PD and represent one of the disabling aspects of the disease. This is due to the evolution of the disease itself, or factors related to age, comorbidities, personal relationships, sleep disorders, depression and medication, which may justify our findings.
The literature also points out that erectile dysfunction and protracted ejaculation are present in most men with PD, whereas in women there are reports of loss or decrease of libido.
Referring to pelvic floor muscle weakness can be justified by the motor alterations that the disease causes, and may contribute to bladder dysfunction and sexual dysfunction.
Concluding message
It was observed that the majority of patients with PD presented urinary incontinence, sexual dysfunctions and the musculature of the MAPs. Regarding quality of life, it was observed that patients with PD without UI had better scores in the physical domain. These findings call attention to a therapeutic intervention with an intergral view of the individual.The improvement of pelvic organ dysfunction, particularly bladder and sexual dysfunction, most affects quality of life, should be a primary target in the treatment of PD patients.