Behavioral Therapy to Treat Urinary Symptoms in Parkinson Disease

Inclusion criteria

• Clinical diagnosis of Parkinson's disease determined by a board-certified neurologist with specialty training in movement disorders
• ≥ 4 weekly episodes of UI and at least one episode per week associated with feelings of urgency, where urgency is defined as the complaint of a sudden compelling desire to void which is difficult to defer
• Willingness to attend clinic visits
• Willingness to keep 7-day bladder diaries throughout the study period

Exclusion criteria

• Significant cognitive impairment, as indicated by a Montreal Cognitive Assessment (MoCA) score of < 18.
• Inability to produce an interpretable 7-day bladder diary at baseline
• Previous intensive PFME training
• Clinically significant depression as measured by a Geriatric Depression Scale-Short Form score ≥ 10 which could affect motivation to fully engage in the intervention
• Use of an indwelling urinary catheter
• Bladder outlet obstruction defined as having been prescribed in-and-out catheterization in the past 12 months, having a post-void residual urine volume by bladder ultrasound of ≥ 200 mL or a peak voiding flow rate of ≤ 4 mL/min on a void ≥ 125 mL in volume
• Severe uterine prolapse past the vaginal introitus
• Poorly controlled diabetes defined by a hemoglobin A1c (HgbA1c) of >8.0%
• Chronic renal failure and on hemodialysis
• Poorly controlled congestive heart failure or poorly controlled chronic obstructive pulmonary disease on physical exam
• Genitourinary cancer with ongoing surgical or external beam radiation treatment
• Any unstable health condition expected to result in hospitalization or death within in the next 3 months as determined by principal investigator.