Recurrent Fever and Urinary Retention in Parkinson's Patients

Urinary retention causing recurrent fever?

Director Lin: Hello, my father is 65 years old and has had Parkinson's disease for 19 years.
Recently, for the past month, he has frequently felt the urge to urinate but is unable to produce much urine or urinate at all.
On June 21, he suddenly developed a fever and fainted, requiring emergency medical attention.
The doctors stated that the fever was due to an unknown infection.
After the fever subsided, he was unable to urinate the fluid in his abdomen, so the nurses performed catheterization and drained 7,800 cc of urine.
After that, he became much more alert and comfortable.
During his hospital stay, blood tests, urine tests, and a chest X-ray all came back normal, but he still could not fully empty his bladder.
Two days after discharge, he again experienced a sudden high fever (39.5°C) and was readmitted to the hospital.
Once again, after the fever was treated and catheterization was performed, he felt better.
He was hospitalized for a week, but the doctors still could not identify the problem, so they discharged him.
Two days later, he had another sudden fever (40°C) and was taken to the hospital again.
I would like to ask you, what could be causing this situation? The doctors have tested his blood and urine and found no signs of infection.
A urologist examined his bladder and said it was more sensitive, which could explain the frequent urination, but he still feels bloated and unable to urinate, along with recurrent sudden fevers.
Please advise, thanks!

vivi, 30~39 year old female. Ask Date: 2005/07/13

Dr. Lin Mingfeng reply Internal Medicine

The patient experienced three episodes of fever.
The first two episodes resolved after catheterization and medication, but the details of the first episode are incomplete.
The results of the urinalysis are closely related to whether antibiotics were used, and the urine culture results are also unknown.
The blood culture results from all three fever episodes should be monitored.
Generally, a fever exceeding 39°C is indicative of a severe infection, and recurrent episodes may suggest incomplete treatment or an underlying condition that has not been addressed.
It is recommended that your father have a urinary catheter placed in the short term.
For further details, it is advisable to gather previous examination results and conduct a thorough evaluation in the outpatient clinic.

Reply Date: 2005/07/13

More Info

Understanding recurrent fever and urinary retention in Parkinson's patients is a complex issue that requires a multifaceted approach. Your father's situation, characterized by frequent urges to urinate but an inability to do so, coupled with recurrent fevers, is not uncommon in patients with Parkinson's disease.
Parkinson's disease can lead to a variety of complications, including autonomic dysfunction, which affects the body's involuntary functions, such as bladder control. This dysfunction can manifest as urinary retention, where the bladder does not empty completely, leading to discomfort and the sensation of needing to urinate frequently. The inability to void effectively can cause significant distress and may contribute to urinary tract infections (UTIs), which could explain the recurrent fevers your father is experiencing.
The fact that your father has been hospitalized multiple times with high fevers, yet tests for infection have returned negative, suggests that the fever may not be due to a typical infectious process. In Parkinson's patients, fever can sometimes be a result of non-infectious causes, such as dehydration, medication side effects, or even the disease itself. The autonomic nervous system's involvement in regulating body temperature can be disrupted in Parkinson's, leading to episodes of fever without a clear infectious source.

The urinary retention and the subsequent need for catheterization to relieve the bladder can also contribute to discomfort and potentially lead to further complications, such as bladder distension or even kidney issues if the retention is severe and prolonged. The fact that your father feels better after catheterization indicates that the urinary retention is a significant factor in his overall discomfort and may be contributing to his febrile episodes.

Given the complexity of your father's symptoms, it is crucial to work closely with his healthcare team. A urologist may provide insights into managing his urinary symptoms more effectively, possibly considering medications that can help relax the bladder or improve bladder function. Additionally, a neurologist specializing in Parkinson's disease may help adjust his Parkinson's medications, as some drugs can exacerbate urinary retention.

In terms of managing recurrent fevers, it may be beneficial to monitor his temperature regularly and keep a detailed log of when the fevers occur, their duration, and any associated symptoms. This information can be invaluable for his healthcare providers in identifying patterns and potential triggers.
Lastly, ensuring that your father stays well-hydrated and maintaining a balanced diet can help support his overall health and potentially mitigate some of the urinary issues. If he is experiencing significant discomfort or if the fevers continue to recur, it may be necessary to revisit the hospital for further evaluation, including imaging studies or consultations with specialists in infectious diseases or internal medicine.

In summary, your father's recurrent fevers and urinary retention are likely interconnected issues stemming from the complexities of Parkinson's disease. A collaborative approach involving multiple specialties will be essential in addressing these challenges effectively.

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