An effective approach through ayurveda in the management of urinary incontinence: A case study

Kamini Dhiman; MD Divyamol

doi:10.4103/ijaim.ijaim_26_21

CASE REPORT

Year : 2022 | Volume : 3 | Issue : 1 | Page : 47-50

An effective approach through ayurveda in the management of urinary incontinence: A case study

Kamini Dhiman, MD Divyamol
Department of Stri Roga Evam Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India

Date of Submission	14-Dec-2021
Date of Decision	25-Apr-2022
Date of Acceptance	14-May-2022
Date of Web Publication	15-Jun-2022

Correspondence Address:
M D Divyamol
Department of Stri Roga Evam Prasuti Tantra, All India Institute of Ayurveda, Mathura Road, Sarita Vihar, New Delhi - 110 076
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijaim.ijaim_26_21

Abstract

Micturition or urination is a complex and multisystem involved process. Many alterations to this system are possible which a health-care worker may get encountered with during routine practice. Among them, urinary incontinence (UI) symptoms are highly prevalent among women, in which the patient is unable to hold urine voluntarily and can broadly classify it into stress UI, urge UI, and mixed UI. As per Ayurveda, urinary disorders can be classified as mutra apravrtti rogas and mutra atipravritti rogas. UI is considered one among the latter one. A 38-year-old married woman presented with involuntary urination of 1-month duration along with urinary urgency and frequency lasting for 3 months. She was also having abdominal pain with this. After thorough examinations and investigations, the patient was treated with ayurvedic medications for 42 days.

Keywords: Ayurveda, basti roga, urinary incontinence

How to cite this article:
Dhiman K, Divyamol M D. An effective approach through ayurveda in the management of urinary incontinence: A case study. Indian J Ayurveda lntegr Med 2022;3:47-50

How to cite this URL:
Dhiman K, Divyamol M D. An effective approach through ayurveda in the management of urinary incontinence: A case study. Indian J Ayurveda lntegr Med [serial online] 2022 [cited 2023 May 29];3:47-50. Available from: http://www.ijaim.in/text.asp?2022/3/1/47/347499

Introduction

Urinary symptoms and diseases are very common in women approaching health-care system. It is identified as a potential cause which affects the quality of life in them. The International Continence Society has defined urinary incontinence (UI) as the complaint of any involuntary leakage of urine and which is a social or hygienic problem.^[1] The prevalence of UI increases with age. Moderate-to-severe UI affects 7% of women in 20–39 years of age, 17% of 40–59 years of age, 23% of 60–79 years of age, and 32% of ≥80 years of age.^[2] Although it is one among the common complaints, the magnitude of the problem is underrated due to the lack of reporting of the issue or neglect by the caregivers. Most of the women seek medical help in their severe stage.

The mechanism of micturition is a complex one. It is guided by different systems in the body and by their complex coordination. Disturbances in their normal functioning may be due to reasons such as childbirth, aging, trauma, and medicines. UI of women is widely classified into categories such as stress UI, urge UI, and mixed UI. In prior one, urine leaks out with some physical exertion and in the latter one, it happens with a sudden compelling desire to void. However, in most of the times, women present both the symptoms which may categorized as mixed UI.^[3] UI symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: Stress UI, in which urine leaks in association with physical exertion, and urgency UI, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed UI.^[3] Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of UI requires a medical history, physical examination, urinalysis, assessment of quality of life, and when initial treatments fail, invasive urodynamics. Interventions can include nonsurgical options (such as lifestyle modifications, pelvic floor muscle training, and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.^[3] The diagnosis is mainly done through urodynamic studies and other laboratory investigations. Laboratory tests should include a serum creatinine level, which may be elevated if there is urinary retention (overflow bladder) caused by bladder outlet obstruction or denervation of the detrusor. If not already performed to exclude acute urinary tract infection as a cause of reversible incontinence, a urinalysis should be obtained to rule out hematuria, proteinuria, and glycosuria, any of which require a diagnostic workup.^[4] A variety of nonsurgical treatments, including behavioral therapies, pelvic floor muscle exercise, medications, and other treatments, are available; can be successful for many women; and may preclude the need for surgery.^[5] However, a careful examination and intelligent workup with treatment planning are very essential for successful cure of the condition because complete recovery is not that common in most of the cases.

Basti is considered the substratum for all urinary disorders.^[6] Acharya has detailed the same and mentioned that basti (bladder) is directed downwards and is being filled with urine from both sides through mutravahi sira mukha.^[7] The Dosas which enter through this siras causes different vasti rogas (urinary disorders).^[7] The physiology of mutrapravartti (micturition process) is coordinated by different entities in the body. Mutra and Mala are separated by Samana Vayu and excreted out by the coordinated function of Prana (pontine center for micturition), Vyana (autonomic functions of vyana vayu), and Apana Vayu (parasympathetic action originated from sacral origin).^[8] Broadly, they may be classified into mutra atipravartti rogas (diseases due to excess micturition) and mutra apravrtti rogas (diseases due to retention of urine). Acharya Vagbhata has given this classification and the disease Prameha comes under the first group whereas Ashmari, Mutrakricchra, and Mutraghata fall under the second group. Involuntary urination can be considered as one among the mutra atipravartti roga. Atipravrtti is one of the lakshanas of srotodushti and in mutravaha srotodushti, acaryas have mentioned the lakshanas such as atisrishta (excessive micturition), abhikshna (frequent micturition), and bahala mutrapravrtti (excessive quantity of urination).^[9] Some authors have interpreted the condition of incontinence of urine as Mutrateeta which is one of the types of Mutraghata according to Ayurveda.^[10] Chikitsa mentioned for these disorders are same as that of mutrakrchra roga.^[11]

Case Report

A 38-year-old married, moderately built multiparous woman visited the outpatient department with the chief complaints like urine leakage associated with a sudden compelling desire to void urine and increased frequency of urination along with pelvic pain of 3 months. She also suffered with involuntary leakage of urine for 1 month and recently with low backache for 1 week. A slight aggravation of her symptoms was noticed during menstruation and voiding of urine gave her some relief for a short period. Her family history was unremarkable, without any relevant past medical history. She was not either under any medications or with any medical illnesses or comorbidities.

Her menstrual history was regular on every 28–32 days with a duration of 5–6 days and along with moderate pain and average menstrual flow. Dyspareunia was present. The patient was multiparous, with all normal vaginal deliveries. The bowel was constipated with decreased appetite. Complaints of the patient regarding bladder habits include increased urgency and frequency of urination, alongside involuntary leakage in association with coughing and sneezing. Bladder discomfort was present.

Clinical findings

She was with moderate built and average nourished body. Slight pallor was present. Cardiac and pulmonary evaluation did not reveal any abnormalities. Neurological examinations carried out to rule out possible underlying causes for incontinence. Abdomen examined for surgical scars, hernias, masses, organomegaly, and distended bladder after voiding of urine. Nothing suspicious was there. On abdominal palpation, tenderness was present in hypogastric and suprapubic region. A pelvic examination was conducted to rule out any local pathology. On inspection of the external genitalia, no peculiar abnormalities were noted. Tenderness over the urethra was present. Bimanual pelvic examination revealed tenderness over the anterior vaginal wall.

Further laboratory investigations were carried. The patient's Hb level was 11.2 g/dL. Blood glucose level was within normal range. Complete urinalysis and urine culture and sensitivity were normal. Ultrasound of lower abdomen and pelvis was performed and not detected any abnormalities. Cystoscopy findings of the patient suggested postdistension glomerulations and reduced bladder capacity.

Dasavidha pareeksha

Prakruti (~body temperament) of the patient on analysis revealed Vatapitta predominance and Vikruti (~morbidity) as Vata pradhana tridosha vikriti. Sara (~excellence of tissues), Samhanana (~compactness of organs), Satmya (~suitability), Satwa (~psyche), and Vyayama shakti (~power of performing exercise) were found to be Madhyama. Vayah (~aging) fell in Madhyama kala. Abhyavaharana shakti (~ power of food intake), Jarana shakti (~power of digestion), and Pramana (~measurement of body organs) were avara.

Timeline

Medicine was given to the patient for 42 days.

Diagnostic assessment

The assessment was done based on a Bladder diary,^[12] Cough stress test,^[13] and International Consultation on Incontinence Modular Questionnaire-UI Short Form 6 questionnaire.^[14] A 3-Day Bladder diary was established before starting the treatments and after completion of it. It is used as a pretherapy diagnostic tool and posttherapy outcome measure. Cough stress test and International Consultation on Incontinence Modular Questionnaire-UI Short Form 6 questionnaire were used to assess the morbidity both before and after the treatments.

Therapeutic intervention

After initial assessment, the patient was administered with ayurvedic medicines for 6 weeks [Table 1].

Table 1: Treatment protocol

Click here to view

Follow-up and outcome

There were 3 follow-ups during the whole course of treatment in which the first two were in a gap of 21 days and the last one was after 1 month of stoppage of medicines. Considerable remission of signs and symptoms was noticed from the first follow-up itself, even though the medicines were continued for 21 days more. After stoppage of the medicines, the patient was on observation for 1 month and during which she did not take any medicines but followed all pathya and apathays. Treatment outcome was assessed after this period based on Incontinence Questionnaire-UI Short Form index, Cough stress test, and Bladder diary [Table 2].

Table 2: Outcome assessment

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Discussion

Urinary problems are very common in women and a condition which highly demands management in regular practice. Its underlying cause varies from a very complicated one to a comparatively manageable one. This condition was overviewed with a consideration of underlying possible cause of an inflammation and neurogenic involvement. In the text, Ashtangahrudaya, it has mentioned in detail about urinary disorders and involvement of three dosas in such disorders. He has mentioned that basti (urinary bladder) gets filled from its sides through mutravahi siramukha through which the dosas enters and causes diseases. Apana vayu governs the working of kidneys, colon, rectum, hence facilitating the elimination of waste products like stool, urine, etc., from the body. Any derangements to the mutravaha srotas will cause symptoms such as urination associated with pain and voiding of too much of urine. The condition requires a chikitsa which covers both the vata vikriti (derangement of vata) as well as mutrashaya sopha (edema of the urinary bladder).

In this patient, the treatment was given for 42 days. Medicines were included both herbal and mineral preparations. Chandraprabha vati is a herbo-mineral preparation which has multidimensional action and shows specifically on mutravaha srotas (urinary system). It is a katurasa (pungent taste) and ushna virya (hot potency) medicine with visada (conspicuousness) and sookshma (penetrating) gunas (attribute), which brought its action on sookshma mutravahi sira more effectively. Most of the drugs in this preparation have sulaghna and nephroprotective actions as it is effective in Mutrakrchra, Mutraghata, and Ashmari roga. Adhobhaga (lower part) of sarira (body) is controlled mainly by vata dosa and its cala guna is deranged here which accounts for the involuntary urination. Vishatintuk vati is a preparation which pacifies kaphavata-originated diseases and it cures Vasthishaithilya thereby reducing the symptoms such as urinary urgency and increased frequency of urination. Ashvagandha is a drug having laghu and snigda (unctuous) guna as well as rasayana (rejuvenating) and balya (strengthening) karma which are contributed to improving the tone of the bladder.^[19] Smritisagar rasa is a katu rasa pradhana medicine with vyavayi (penetrating) guna, and properties such as Akshepashamana and Balya which has shown its effect by normalizing the deranged vata here. It also alleviated the anxiety of the patient as it is having properties like Medhya and Sangyasthapana.^[20] Medicines given to this patient have shown their combined and promising effects.

Conclusion

UI is the inability to hold urine voluntarily by the person. First-line management of such concerns includes lifestyle and behavioral modifications with pelvic floor exercises and bladder training. In maximum cases, the management of such conditions requires a feasible but effective solution, and which push the patients to seek alternate systems of medicines for the same. This case was managed in less duration with easily available and minimum number of medicines which makes the treatment more effective and acceptable for patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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