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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.
47
© 2022 Indian Journal of Ayurveda and Integrative Medicine KLEU | Published by Wolters Kluwer - Medknow

Department of Stri Roga Evam Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India
Address for correspondence: Dr. M. D. Divyamol, Department of Stri Roga Evam Prasuti Tantra, All India Institute of Ayurveda, Mathura
Road, Sarita Vihar, New Delhi - 110 076, India.
E-mail: divyadam16@gmail.com
Submitted: 14-Dec-2021,  25-Apr-2022, Accepted: 14-May-2022, Published: 15-Jun-2022
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 classied 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.
Key words: Ayurveda, basti roga, urinary incontinence
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
An Eective Approach through Ayurveda in the Management of
Urinary Incontinence: A Case Study
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How to cite this article: Dhiman K, Divyamol MD. An effective approach
through ayurveda in the management of urinary incontinence: A case
study. Indian J Ayurveda Integr Med 2022;3:47‑50.
Case Report
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Dhiman and Divyamol: Ayurvedic management of urinary incontinence
48 Indian Journal of Ayurveda and Integrative Medicine KLEU / Volume 3 / Issue 1 / January-June 2022
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 ndings
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.
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Dhiman and Divyamol: Ayurvedic management of urinary incontinence
49
Indian Journal of Ayurveda and Integrative Medicine KLEU / Volume 3 / Issue 1 / January-June 2022
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].
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].
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
Table 1: Treatment protocol
Medicine Dose Anupana Time of administration
Chandraprabha vati[15] 500 mg Water Twice a day after food
Vishathintuka vati[16] 65 mg Water Thrice a day after food
Smritisagar rasa[17] 250 mg Water Twice a day after food
Ashwaganda churna[18] 3 g Milk Twice a day after food
Table 2: Outcome assessment
Assessment Before treatment After treatment
ICIQ‑UI‑SF index 13 4
Cough stress test Positive Negative
Bladder diary Urine leaks ‑ Small amount
Urgency ‑ Moderate
Urine leaks ‑ Nil
Urgency ‑ Mild desire
ICIQ‑UI‑SF index ‑ International Consultation on Incontinence Modular
Questionnaire‑Urinary Incontinence Short Form 6 questionnaire
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Dhiman and Divyamol: Ayurvedic management of urinary incontinence
50 Indian Journal of Ayurveda and Integrative Medicine KLEU / Volume 3 / Issue 1 / January-June 2022
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.
Conicts of interest
There are no conflicts of interest.
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ResearchGate has not been able to resolve any citations for this publication.
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Withania somnifera (Ashawagandha) is very revered herb of the Indian Ayurvedic system of medicine as a Rasayana (tonic). It is used for various kinds of disease processes and specially as a nervine tonic. Considering these facts many scientific studies were carried out and its adaptogenic / anti-stress activities were studied in detail. In experimental models it increases the stamina of rats during swimming endurance test and prevented adrenal gland changes of ascorbic acid and cortisol content produce by swimming stress. Pretreatment with Withania somnifera (WS) showed significance protection against stress induced gastric ulcers. WS have anti-tumor effect on Chinese Hamster Ovary (CHO) cell carcinoma. It was also found effective against urethane induced lung-adenoma in mice. In some cases of uterine fibroids, dermatosarcoma, long term treatment with WS controlled the condition. It has a Cognition Promoting Effect and was useful in children with memory deficit and in old age people loss of memory. It was also found useful in neurodegenerative diseases such as Parkinson’s, Huntington’s and Alzeimer’s diseases. It has GABA mimetic effect and was shown to promote formation of dendrites. It has anxiolytic effect and improves energy levels and mitochondrial health. It is an anti-inflammatory and antiarthritic agent and was found useful in clinical cases of Rheumatoid and Osteoarthritis. Large scale studies are needed to prove its clinical efficacy in stress related disorders, neuronal disorders and cancers. Key words: Withania somnifera, rejuvenator, adaptogen / anti-stress, anti-tumor, neuroregenerative, anti-arthritic. doi: 10.4314/ajtcam.v8i5S.9
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Urinary incontinence is a prevalent condition in elderly women with significant associated morbidity. Incontinence can by grouped into several types: stress incontinence, urgency incontinence, overflow incontinence, functional incontinence, and mixed urinary incontinence. Careful evaluation, including history and physical examination, is critical to making the correct diagnosis and guiding therapy. A variety of nonsurgical treatments, including behavioral therapies, pelvic floor muscle exercise, medications, and other treatments, are available; can be successful for many older women; and may preclude the need for surgery. Working closely with the patient, understanding her goals of care, and targeting treatments accordingly are essential for success.
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Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. The initial evaluation occurs in the family physician's office and generally does not require urologic or gynecologic evaluation. The basic workup is aimed at identifying possible reversible causes. If no reversible cause is identified, then the incontinence is considered chronic. The next step is to determine the type of incontinence (urge, stress, overflow, mixed, or functional) and the urgency with which it should be treated. These determinations are made using a patient questionnaire, such as the 3 Incontinence Questions, an assessment of other medical problems that may contribute to incontinence, a discussion of the effect of symptoms on the patient's quality of life, a review of the patient's completed voiding diary, a physical examination, and, if stress incontinence is suspected, a cough stress test. Other components of the evaluation include laboratory tests and measurement of postvoid residual urine volume. If the type of urinary incontinence is still not clear, or if red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections are present, referral to a urologist or urogynecologist should be considered.