Quick answer. Parkinson’s affects far more than movement. Non-motor symptoms – including constipation and bladder problems, low blood pressure on standing, sleep problems, fatigue, pain and loss of smell – are common and can affect quality of life as much as, or more than, the motor symptoms. Some, like loss of smell and constipation, can appear years before diagnosis. The important message is that many of these are treatable or manageable, and because they are easy to overlook, it is worth raising them proactively with your Parkinson’s nurse or specialist rather than assuming nothing can be done.
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The hidden side of Parkinson’s
Movement symptoms get most of the attention, but non-motor symptoms are present at all stages and can dominate later on. The Parkinson’s Foundation’s research has found that mood, depression and anxiety have the greatest impact on wellbeing – more than many common motor symptoms. Because these symptoms are less visible and easy to attribute to ageing or something else, they often go unreported. Yet recognising them as part of Parkinson’s is the first step to getting help, and many respond well to treatment or practical management. This guide covers the physical non-motor symptoms; a separate guide looks at mental health and mood.
Constipation and bladder problems
Bowel and bladder changes are common in Parkinson’s. Constipation is one of the earliest and most frequent non-motor features and can precede diagnosis by years; it is helped by eating more fibre, drinking enough fluids and staying active, with laxatives used only on medical advice. On the bladder side, the most common problem is an overactive bladder – a sudden urgent need to pass urine, going frequently, and getting up at night. These symptoms can be embarrassing to raise, but they are manageable, and your care team can suggest practical measures and treatments, so it is worth mentioning them.
Low blood pressure on standing
Many people with Parkinson’s experience a drop in blood pressure when they stand up, called orthostatic hypotension. The NHS describes this as dizziness, blurred vision or even fainting when moving from sitting or lying to standing, and it is an important cause of falls. Practical, general measures such as standing up slowly, in stages, and staying well hydrated can help, and your care team may review your medications or suggest other measures. Because this symptom directly increases fall risk, it is worth flagging to your doctor rather than putting up with the dizziness or assuming it is unrelated to Parkinson’s.
Sleep problems
Sleep is often disrupted in Parkinson’s. Insomnia is common and can lead to excessive daytime sleepiness, and sleep may be broken by tremor, stiffness, pain or restless legs. Some people have REM sleep behaviour disorder, in which they act out their dreams – sometimes vigorously – while asleep; this can even predate the diagnosis. Excessive daytime sleepiness can also be a side-effect of medication, which is another reason to discuss sleep with your team. Good sleep habits help, and because poor sleep affects mood, energy and daytime function, tackling it can make a real difference to how you feel overall.
Fatigue and pain
Fatigue – a persistent lack of energy that is different from sleepiness – is a recognised and often underestimated symptom of Parkinson’s. Pain is also common and can come from several sources, including muscle stiffness and rigidity, cramping or dystonia, and nerve-related pain, which the NHS describes as unpleasant sensations such as burning, coldness or numbness. Restless leg syndrome can occur too. Neither fatigue nor pain should be dismissed as something you simply have to live with; both can often be eased once the cause is understood, so describe them to your care team, who can look into what is driving them.
Loss of smell and other symptoms
A reduced or absent sense of smell is one of the earliest signs of Parkinson’s and can precede the movement symptoms by years, though on its own it has many other causes. Excessive sweating is another recognised non-motor symptom. There can also be changes in swallowing and speech, and in thinking and memory, which are covered in other guides in this series. The breadth of these symptoms reflects how Parkinson’s affects many systems beyond movement. Keeping a note of any new symptoms to raise at appointments helps ensure they are not overlooked and can be addressed.
Why raising them matters
Perhaps the most important point about non-motor symptoms is that they are frequently under-reported, often because people do not realise they are connected to Parkinson’s, or assume nothing can be done. In fact many are treatable or manageable, and addressing them can improve quality of life considerably. Your Parkinson’s nurse and specialist would rather know about a symptom than have you struggle with it silently, so bring these things up, even the ones that feel minor or embarrassing. A simple list of what you have noticed, taken to your review, helps make sure nothing important slips through.
When to seek prompt help
While most non-motor symptoms are managed in routine care, some situations need prompter attention. Marked dizziness or fainting on standing raises the risk of a serious fall and should be reviewed. A sudden worsening of confusion or alertness, rather than the gradual changes of Parkinson’s, can signal delirium from an infection or another problem and needs urgent medical assessment. New or severe pain, or a significant change in bladder or bowel function, is also worth reporting promptly. As always with Parkinson’s, do not stop or change your medication yourself; instead, contact your care team to discuss what is happening.
Related Parkinson’s topics
- Living with Parkinson’s
- Understanding Parkinson’s: causes, symptoms & stages
- Medication & managing treatment
- Movement, mobility & preventing falls
- Exercise & staying active
- Speech & swallowing
- Mental health & mood
- Eating well & nutrition
- Caring for someone with Parkinson’s
- Neurologists in Singapore
Sources
- Parkinson’s Foundation – Non-movement symptoms: parkinson.org
- NHS – Parkinson’s disease symptoms: nhs.uk
- Parkinson’s UK – Eating, swallowing and managing saliva: parkinsons.org.uk
- NHS – Parkinson’s disease: nhs.uk