Understanding the Link Between Incomplete Bladder Emptying and Chronic UTIs in Parkinson's Disease

When most people think about Parkinson’s disease, they think about tremors, rigidity, slowness, or falling. Those are the visible symptoms which is why they are “noticed”.  Very few people talk about the bladder. Even fewer understand how the bladder can quietly drive a chronic state of inflammation, infection, and endotoxin release that worsens symptoms far beyond urinary discomfort.

I didn’t understand this fully for a long time though I had hints of understanding from my cofounder, Suzanne’s journey with her Mom’s Alzheimer’s. Her mother’s  dementia was much worse each time she had a UTI.  Doctors would “treat” the infection with antibiotics and there would be an immediate improvement in cognition.  

I did know that John often had urinary urgency but I didn’t understand that he also likely had incomplete voiding. What incomplete voiding means is that not all of the urine is released and a portion remains in the bladder.  This can be the cause over time of a visible protrusion or pooch in the belly and a contributor to low grade urinary tract infections.  Once I realized that this was an issue, I started noticing it more in conversations with people with Parkinson’s. 

One of our good friends with Parkinson’s, who helped me plan John’s memorial service, mentioned she had a chronic UTI last year.  I told her that endotoxin from persistent bladder infections could be a major driver of worsening Parkinson’s symptoms. At the time, I was just beginning to understand more deeply about the lining of the gut, the brain, the bladder and other organs and our blood vessels.  This lining is called the glycocalyx endothelial surface layer and endotoxin can be a significant cause of damage to this important lining. 

I saw her again recently and asked if she still had the infection. She looked at me with a mix of frustration and discouragement and said, “I can’t get my doctor to take me seriously.” The UTI was still there. She was still symptomatic. And no one was connecting the dots to how this was driving inflammation, likely brain inflammation, a hallmark of Parkinson’s. 

The bladder is controlled by the autonomic nervous system.  Because the bladder is considered an area of other specialty not in the expertise of neurologists, if you mention these issues in an appointment you would typically be referred to a urologist.   Neurologists do not typically connect urinary retention, chronic infection, or endotoxin release to tremor, fatigue, anxiety, or brain fog. They do not recognize how dangerous incomplete bladder emptying is for people with Parkinson’s.

Last week, after giving a presentation to our local Parkinson’s support group, another woman came up to me. I had spoken about endotoxins and referenced UTI's in the talk. She told me she has had chronic UTIs for a long time and her symptoms are worse each time the infection comes back. She has been on so many antibiotic courses that she is now resistant to many of them. No one has talked to her about bladder mechanics, pelvic floor coordination, hydration strategies, probiotics, or irritation or damage to the lining of the bladder. The issue of autonomic dysfunction and incomplete voiding has only been peripherally addressed with daily catheterization.  But catheterization can also contribute to increased risk of infection.  She understands that the increasing use of antibiotics is not solving the problem. She was seeking help.

Generally speaking in medical training there is a lack of understanding of how damaging repeated courses of antibiotics are to the protective glycocalyx endothelial surface layer and how critical this barrier is to everything in the body. Most medical education also doesn't address the microbiome which makes many of the things we need to stay healthy and fight off infections or how damaging antibiotics are to this critical factor of vitamins, hormones and neurotransmitters.

So what is endotoxin?  

Endotoxin, also called LPS, is a toxic molecule found on the outer membrane of Gram-negative bacteria, especially E. coli, the most common cause of urinary tract infections. Endotoxin is a lipid (fat) molecule that can incorporate into our protective membranes and change the structures in ways that make it more difficult for our immune system to work properly.  

When bacteria like E.coli grow in stagnant urine or die during antibiotic treatment, they release large amounts of endotoxin into the bloodstream. This triggers inflammation throughout the body and directly impacts the gut–brain axis. E. coli is also relevant for Parkinson’s because it produces a protein called curli, an amyloid fiber that can accelerate misfolding of alpha-synuclein, the hallmark protein involved in Parkinson’s. For readers who want a deeper explanation of endotoxin and how it affects the body, I’ve written a separate post on LPS and its role in chronic inflammation that you can find here: [https://www.marthasquest.com/post/rethinking-parkinson-s-disease-1].

I share these stories because this pattern is not rare and it is profoundly under-recognized and important to the pathology and worsens over time.

Why Bladder Problems Matter in Parkinson’s

Parkinson’s affects far more than motor function. The autonomic nervous system, the part that controls digestion, blood pressure, heart rate, sweating, and bladder function, often becomes impaired early.

For the bladder, autonomic changes can cause difficulty starting urination, weak bladder contractions, poor coordination between bladder and sphincter, and urine that never fully empties.

Even 50 to 100 milliliters left behind — just a couple of tablespoons — becomes a warm, stagnant, nutrient-rich reservoir ideal for bacterial growth, biofilms, and ongoing endotoxin release.

Many people with Parkinson’s have silent UTIs. No burning, no urgency, no classic symptoms. Yet the infection is there, and each flare sends a wave of endotoxin into circulation. Or they have urgency and think is is "just Parkinson's" but don't realize the UTI connection.

An Under Recognized Vicious Cycle

Here is the typical pattern but I think it is more often identified in females and goes undetected in many males:

1. Autonomic dysfunction leads to incomplete bladder emptying.

2. Residual urine becomes a breeding ground for bacteria, endotoxin rises

3. Recurrent UTIs lead to repeated antibiotics, die off releases more endotoxin

4. Antibiotics disrupt the microbiome and weaken the glycocalyx/mucosal barriers.

5. Gut dysbiosis increases systemic inflammation and endotoxin load.

6. A weakened bladder lining (also glycococalyx) makes infections more likely.

7. The cycle repeats, often with bacteria becoming “resistant.”

Over time this leads to chronic infection, embedded biofilms, rising antibiotic resistance, and worsening neurological symptoms. While working on this article,I remembered a version of this in my mother as well, many years before Parkinson’s ever entered my life, in her MS, she also experienced chronic UTIs.

Why Antibiotics Often Make Things Worse

Antibiotics kill bacteria, but they also release large pulses of endotoxin when bacteria die. This die off can often make Parkinson’s symptoms worse during the process.  There are binders that can be used to help reduce the impact and help gently remove the cellular debris from this die off.  Antibiotics also eliminate the Lactobacillus species that protect the urinary tract, create a higher pH that allows pathogens to grow, and disrupt the gut bacteria that support immune function.

Breaking the Cycle

This is a systems problem. The solutions must address the body at multiple levels. This is not meant as medical advice, rather as a systems based guide to what’s happening and some actions to consider that may help the situation. Always consult your physician if you have a UTI. You may want to share some of this information to get additional feedback from your doc.

1. Improve bladder emptying.This is the most important and most overlooked step. People with Parkinson’s often benefit from Kegel and relaxation exercises, timed voiding every two to three hours, double voiding, and morning hydration with filtered water plus a pinch, of unrefined mineral salt, which supports autonomic signaling. Pelvic floor therapy, vagus nerve  or visceral manipulation by a trained therapist can be very helpful.

2. Restore the urinary and vaginal microbiome. This is especially important for women. Lactobacillus crispatus supports a low pH environment and inhibits E. coli adhesion. D-mannose helps prevent bacteria from attaching to the bladder wall. Cranberry PACs (not sugary juice) disrupt bacterial biofilms.

3. Reduce endotoxin during and after antibiotics. Gentle binders such as activated charcoal (at night) or Organic Gut Solution, partially hydrolyzed guar gum or pectin (during the day), and support for bile flow (like taurine or TUDCA) can help neutralize endotoxin released during bacterial die-off.

4. Support the gut–bladder axis. Short-chain fatty acid producers like Faecalibacterium, Roseburia, and Bifidobacteria strengthen mucosal immunity. Our Sugar Shift clinical trial demonstrated increases in these beneficial species and a significant reduction in endotoxin, which is why I often include it in protocols for people with chronic UTIs, not as a sales pitch, but because the data show it supports the terrain and specifically reduces serum endotoxin.

5. Gently weaken biofilms. N-acetylcysteine, pomegranate extract, and ursolic acid can weaken biofilms without damaging the bladder lining. This is an NAC product that a researcher friend of mine has tested for quality and efficacy. Any time you are taking supplements it is important to work with a practitioner who can help you navigate how much and when to take it.

Why This is Important

People with Parkinson’s are already carrying a heavy burden of autonomic dysfunction, gut dysbiosis, and inflammation. Adding chronic UTIs and endotoxin load to that picture creates a downward spiral that can accelerate symptoms and erode quality of life.

This pattern is reversible. When bladder emptying improves, when the urinary microbiome is restored, and when endotoxin is managed thoughtfully, infection frequency drops and symptoms often improve.

If you or someone you love has Parkinson’s and recurrent UTIs, you are not alone. More importantly, the problem is not “just aging,” and it is not something you have to accept. With awareness, small daily practices, and the right support, this cycle can be broken.

I want to leave you with something practical: the exercises and techniques that help the bladder empty more completely. These are simple but powerful tools that many neurologists and primary care physicians never mention.

Exercises and Techniques to Improve Bladder Emptying

1. Kegel and relaxation practice (5 to 7 minutes daily). There are also pelvic floor physiotherapists and you could ask your doctor for a referral to one of these so that insurance would cover the cost.  Begin with three slow breaths to relax the pelvic floor.Do five gentle contractions, holding for three seconds and releasing for five seconds.Do five longer holds, five seconds on and ten seconds off.Finish with thirty seconds of full relaxation, letting the pelvic floor drop.Immediately try to urinate afterward. This improves coordination and bladder emptying.

2. Timed voiding.Go to the bathroom every two to three hours, whether or not you feel the urge.This prevents urine from stagnating.

3. Double voiding. After you finish urinating, stand up or shift your position. For men, sitting down can help to improve this voiding. Sit back down and try to urinate again.This often releases the last bit of urine that would otherwise remain in the bladder.

4. Morning hydration.Drink filtered water with a small pinch of unrefined mineral salt (not Morton’s, something like Redmond’s Real Salt).This supports blood volume, autonomic signaling, and bladder contraction strength.

5. Avoiding dehydration.Many people with Parkinson’s drink less to avoid urgency or accidents.Unfortunately, this concentrates urine and makes infections more likely.Sip water consistently in the first half of the day. 

These simple practices can dramatically reduce residual urine, disrupt biofilms, lower endotoxin load, and help prevent the cycle of chronic infection and repeated antibiotics.