![2. Kosthagata vata
Symptoms=ित्र क ष्ठ श्रििे दुष्टे ननग्रह मूत्रिचिस ोः||२४||
ब्रध्नहृद्र गगुलम शिोःप श्ििशूलं च म ुजिे| ch.chi.28
Treatment=विशेषितिु क ष्ठतथे ि िे ष रों [१] वपबेन्नरोोः||८९||
प चनैदीपनैयुिक्िैरोम्लैि ि [२] प चयेन्मल न ्| ch.chi.28
[१] ‘षीरों’ इनि प .|
[२] ‘प चनीयै रोसैयुिक्िैरोन्यैि ि’ इनि प .|](https://image.slidesharecdn.com/neurogenicbladder-190904140130/75/Neurogenic-bladder-An-Ayurveda-Corelation-33-2048.jpg)
![4. Gudagata vata
Symptoms= ग्रह विण्मूत्रि ि न ं शूल ध्म न श्मशकि रो ोः||२६||
ाङ्क्घ ुजत्रत्रकप रपृष्ठरो गश षौ [१] गुदस्तथिे|
ch.chi.28
[१] ‘...रो गश थौ’ इनि प .|
Treatment=गुदपक्ि शयतथे िु कमोद िििनुद्श्रधिम ्||९०||
ch.chi.28](https://image.slidesharecdn.com/neurogenicbladder-190904140130/75/Neurogenic-bladder-An-Ayurveda-Corelation-35-2048.jpg)
Uploaded byProf. Surendra Soni
Neurogenic bladder- An Ayurveda Corelation.
This document provides information on neurogenic bladder. It begins with the anatomy and physiology of normal bladder function controlled by the brain and spinal cord. It then defines neurogenic bladder as any bladder dysfunction caused by disruption of normal bladder innervation, which can be congenital or acquired. The main types of neurogenic bladder are described as spastic or flaccid, depending on whether the lesion is above or below the lumbosacral spinal cord. Causes include spinal cord injury, multiple sclerosis, and congenital conditions. Symptoms vary between types but include issues with storage and emptying of urine. Treatment aims to preserve kidney function and typically involves medications, injections, or surgery to manage symptoms. Ayurved
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Neurogenic bladder- An Ayurveda Corelation.
- 1. Neurogenic Bladder *Presented by:Dr. Prachi P. Kakkad P.G. 1ST Year Kayachikitsa **Guided by: Dr. M. N. Shaikh M.D.(Ayu.) Principal Govt. akhandanand ayurved college, Ahmedabad, Gujarat.
- 2. Index- Anatomy &physiology Introduction Defination Types Causes Symptoms Investigation Examination Treatment Ayurvedic corelation & treatment
- 4. Anatomy and physiology Anatomically, the bladder which consists of smooth muscle, and the base, which includes the trigone and bladder neck that are intimately connected to the pelvic floor. The bladder outlet has two urethral sphincters, the internal (smooth muscle) sphincter and the external (striated muscle) sphincter. Females have a less complex urethral sphincter mechanism that surrounds a shorter urethra.
- 5. Cont… Regulation of micturitioninvolves cortical, subcortical, spinal cord, and bladder mechanisms , Cortical control areas in the frontal and cingulate gyri as well as subcortical areas provide inhibitory influence on micturition at the level of the pons and excitatory influence on the external urinary sphincter. This allows voluntary control of micturition so that normally bladder evacuation can be delayed until an appropriate time and place to void are chosen. The pontine micturition center (PMC, also known as Barrington’s nucleus or M-region) is essential for the coordination of micturition.
- 6. Cont… Normal voluntarymicturition includes bladder filling, storage, and emptying . The kidneys filtering 180L per day though only approximately 800 to 2000 ml per day is excreted as urine. This filtrate is transported through the ureters to the bladder. The ureters, which are approximately 25– 30cm in length, pass obliquely through bladder wall at the ureterovesicular junction to form a one-way valve that serves to prevent retrograde reflux of urine to the kidneys during bladder filling and emptying stages.
- 10. Introduction Neurogenic bladderrefers to all types of bladder dysfunction caused by an interruption of normal bladder innervation. Condition may be congenital or acquired No cure but can be managed Subsequent complications include: urinary incontinence, residual urine retention, urinary tract infection, calculi formation, and renal failure. A neurogenic bladder can be – 1. spastic (hypertonic, reflex, or automatic), 2. flaccid (hypotonic, atonic, nonreflex, or autonomous) Most cases managed with medication and surgical treatment. The primary goal of the physician is to maintain and preserve renal function!
- 11. Definition Neurogenicbladder is the name given to a number of urinary conditions in people who lack bladder control due to a brain, spinal cord or nerve problem. This nerve damage can be the result of diseases such as multiple sclerosis (MS), Parkinson's disease or diabetes. It can also be caused by infection of the brain or spinal cord, heavy metal poisoning, stroke, spinal cord injury, or major pelvic surgery. People who are born with problems of the spinal cord, such as spina bifida, may also have this type of bladder problem.
- 12. Type 1- spastic(reflexor automatic) neurogenic bladder caused by UMNL Any lesion of the cord above the voiding reflex arc. Most common cause are trauma,tumor & MS. Voiding is interrupted,involuntary,& incomplete. Hypertrophy of the detrusor develops,often leading to vesicourethral reflux. Dilatation of the internal sphinter occur. The external sphincter and perineal muscles becomes spastic & obstructive,causes incearsed resistance to the flow urine and results in an impaired stream and residual urine.
- 13. Uninhibited neurogenic bladder (mildspastic NB) These type of NB may develop following a cerebral vascular accident or arteriosclerotic degeneration in spinal cord. It may occur as the first sign of MS. The lesion is centered either in the inhibitory centers of cortex or in pyramidal tract (UMN). Therefore,facilitative impulse passing continually down the cord keep sacral centers so excitable that even a small quantity of urine elicits an uncontrollable micturation reflex,thereby promoting frequent urination.
- 14. Spastic type NBshowing: ‘Christmas tree’ or ‘pine tree’ effect.heavy trabeculation,cellules and small diverticula in cystography
- 15. Type 2- Flaccid(atonic/nonreflex or autonomous) neurogenic bladder It will caused by lower motor neuron lesion. Most common cause of flaccid neurogenic bladder is trauma,tumors,herniated intervertebral disks,tabes dorsalis,poliomyelitis & congenital defect. Vesical dysfunction arises when there is injury to center of micturition in cord (S2-4), cauda equina, sacral roots or nerve there by interrupting the sacral reflex arc. Loss of perception of fullness permits overstretching of the detrusor and atony of the muscle and these contributes to weak and inefficient detrusor contraction.
- 16. The flaccid NBseen seen on cystography showing oval shaped bladder
- 17. Difference Type 1 spastic Vertebral level- lesion above L1 Symptoms-urgency,frequency,urgency incontinence,hesistancy,retension Bladder scan- -/+rasied postvoid residual urine Uroflowmetry-interrupted flow Detrusor- overactivity,detrusor muscle dyssynergia Bladder capacity-low Risk-back pressure changes Type 2 flaccid Lesion at/below L1 Hesistancy,retension Postvoid residual urine >100ml Low Underactivity,sphincter insufficiency High stasis
- 19. icourethral reflux:- Vesicoureteral reflux (VUR)is a condition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys. ..
- 20. Causes Diseases Spinal cordtrauma Tabes dorsalis DM MS Cord tumors Herniated intervertebral disk Stroke Alzheimer’s disease Neuronal Herpes zoster Congenital anomaly Myelomeningocele Absence of the sacrum
- 21. Nerve damage maybe result of: Child birth Pelvic injury Brain and spinal cord injury Herniated disc Heavy metal poisoning or tumors of the brain, spinal cord or pelvis.
- 22. Symptoms of NB Overactive bladder Frequent urination,in the daytime and night Stress incontinence Urge incontinence Inability to urinate(urinary retention) Underactive bladder-bladder is unable to signal when full
- 23.
- 24. Laboratory studies: Urinalysis Urinecytology MRI of spine & brain Radiological evaluation
- 25. Investigations Noninvasivebladder investigation post void residual volume –in out catheterization ultrasound uroflowmetry Cystometry Sphincter EMG Neuroimaging Cystoscopy
- 26. Treatment Anticholinergic drugs Cholinergicdrug and alpha blockers Electric stimulation botulinum toxin injection Sphinctreotomy Catheterization
- 27. Pharmacologic Interventions Tricyclic Antidepressant Drugs : Imipramine not only reduces bladder tone through its strong anticholinergic effects and antispasmodic properties but it also increases bladder internal sphincter tone through α- adrenergic agonist effect to further facilitate urine storage. Additionally, imipramine has a local anesthetic effect on bladder mucosa, which may further reduce bladder contractility through spinal reflex mechanisms.
- 28. Cont… Anticholinergic (Antimuscarinic)Medications: This class of medication reduces reflex (involuntary) detrusor activity by blocking cholinergic transmission at muscarinic receptors and is the first-line option for treating neurogenic detrusor overactivity (NDO) Cholinergic Agonists: Urecholine is a synthetic muscarinic agonist with no significant nicotinic effects. It can be used to promote detrusor contraction in lower motor neuron lesions. Alpha-2 Adrenergic Agonists: This class of medications can be used in neurogenic bladder dysfunction when the internal urinary sphincter is spastic, which occurs with detrusor sphincter dyssynergia in upper motor neuron bladder dysfunction
- 29. Surgical Interventions Proceduresto Enhance Detrusor Storage : Neuromodulation for Neurogenic Detrusor Overactivity. Enterocystoplasty. Bladder Sphincter Procedures to Enhance Emptying : Sphincterotomy Urethral Stents and Balloon Dilatation Sling surgery
- 30. Ayurvedic aspect ofneurogenic bladder Kosthagata vata Pakvashayagata vata Gudagata vata Mutraghat Mutrakruccha Mutravrutta vata Bastimarmaabhighat w.s.r. to bastikundala Vatavyadhi
- 31. Ayurvedic aspectof neurogenic bladder 1. Mutraveghavrodhjanya roga acc. to charaka (physiological aspect) Symptoms=बस्तिमेहनय ोः शूलं मूत्रकृ च्छ्रं शशरो ुजा | विन म िङ्क्षण न होः तय स्ललङ्क्गं मूत्रननग्रहे || ch.su.7/7 Treatment=तिेद िग हन भ्यङ्क्ग न ् सवपिषश्च िपीडकम ्| मूत्रे प्रनिहिे कु य िस्रत्रविधं बस्तिकमि च ||
- 32. Cont… In the ancienttime our acharya Charak has mentioned the pathology of mutravega vidharan(Suppression of Natural urinal urge). The sign and symptoms illustrated equally represent the pons & lumbar, thoracicand sacral segment of spinal cord’s pathology. Voiding Reflex Centre Sign & Symptoms Pons शिरोरुजा Lumbar segment बस्तिमेहनयोोः िूलं Thoracic segment विनामो Sacral region मूत्रकृ च्छ्रं, मूत्रननग्रहे
- 33. 2. Kosthagata vata Symptoms=ित्र क ष्ठ श्रििे दुष्टे ननग्रह मूत्रिचिस ोः||२४|| ब्रध्नहृद्र गगुलम शिोःप श्ििशूलं च म ुजिे| ch.chi.28 Treatment=विशेषितिु क ष्ठतथे ि िे ष रों [१] वपबेन्नरोोः||८९|| प चनैदीपनैयुिक्िैरोम्लैि ि [२] प चयेन्मल न ्| ch.chi.28 [१] ‘षीरों’ इनि प .| [२] ‘प चनीयै रोसैयुिक्िैरोन्यैि ि’ इनि प .|
- 34. 3. Pakvashayagata vata Symptoms=पक्ि शयतथ ऽन्त्रकू ां शूल ट पौ करो नि च||२८|| कृ च्छ्रमूत्रपुरोीषरिम न हं त्रत्रकिेदन म्| ch.chi.28
- 35. 4. Gudagata vata Symptoms= ग्रह विण्मूत्रि ि न ं शूल ध्म न श्मशकि रो ोः||२६|| ाङ्क्घ ुजत्रत्रकप रपृष्ठरो गश षौ [१] गुदस्तथिे| ch.chi.28 [१] ‘...रो गश थौ’ इनि प .| Treatment=गुदपक्ि शयतथे िु कमोद िििनुद्श्रधिम ्||९०|| ch.chi.28
- 36.
- 37. 5. Mutraghat w.s.r.to vatkundalika रोौक्ष्य द्िेगविघ ि द्ि ि युरोन्िरोम श्रििोः | मूत्रं चरोनि सङ्क्गृह्य विगुणोः कु ण्डलीकृ िोः ||५|| सृाेदलप लपमथि सुजातकं शनैोः शनैोः | ि िकु ण्डशलक ं िं िु व्य श्रधं विद्य ि् सुद ुजणम ् ||६||su.ut.58 गनिसङ्क्ग दुद िृत्तोः स मूत्रतथ नम गिय ोः| मूत्रतय विगुण ि युर्िग्नव्य विद्धकु ण्डली||३९|| मूत्रं विहस्न्ि संतिम्र्र्ङ्क्गगौरोििेष्टनैोः| िीव्रुजङ्क्मूत्रविट्सङ्क्गैि ििकु ण्डशलके नि स ||४०||ch.si.9
- 38. 6. Mutrakruchha मूत्रत्रितयव्यि य त्तु रोेि ि ि द्धिं च्छ्युिम ्| पूिं मूत्रतय पश्च द्ि स्रिेि् कृ च्छ्रं िदुच्छ्यिे||३२|| ch.si.9 ि िेन वपत्तेन कफे न सिैतिथ ऽशर्घ िैोः शकृ दश्मरोीभ्य म ् | िथ ऽपरोोः शकि रोय सुकष्ट मूत्र पघ िोः कश्रथि ऽष्टमतिु ||३|| अश्मरोीं च सम श्रिरय यदुक्िं प्रसमीक्ष्य िि् | यथ द षं प्रयुञ्ाीि तनेह ददमवप च क्रमम् ||१६|| su.ut.59
- 39. Difference मूत्र घ िमूत्र िरो धोः……………………(absence of urination) मूत्रकृ च्छ्रं दुोःखेन मूत्रप्रिृवत्तोः…………(difficulty in urination)
- 40. 7.Mutravrutta vata Nidana=िेगसन्ध रोण द म दशर्घ ि दर् ान ि्||१७|| मम िघ ि द्गा ष्र श्िशीघ्रय न पिंसन ि्| ch.chi.28 Lakshana= मूत्र प्रिृवत्तरो ध्म नं बतिौ मूत्र िृिेऽननले||६९||ch.chi.28 Treatment= यूषैग्र िम्य म्बुा नूपरोसैि ि तनेहसंयुिैोः| प यसैोः कृ शरोैोः स म्ललिणैरोनुि सनैोः||७७||ch.chi.28
- 41. 8. Bastimarmabhighat बतिौ िु ििमूत्रिचोननग्रहिङ्क्षणमेहनबस्तिशूलकु ण्डल द िििगु लम ननल ष्ठील पतिम्र्न शर्कु क्षषगुदि णिग्णग्रह दयोः ……….. Ch.si.9/6 Treatment : Kumbhisweda Niruha basti/anuvasan basti Virechan
- 42. Bastikundala द्रुि ध्िलङ्क्घन यस दशर्घ ि ि् प्रपीडन ि्| तितथ न द्िस्तिुजद्िृत्तोः तथूलस्तिष्ठनि गर्ििि्||४४|| Treatment द ष श्रधक्यमिेक्ष्यैि न ् मूत्रकृ च्छ्रहरोैाियेि ्||४९|| बस्तिमुत्तरोबस्तिं च सिेष मेि द पयेि ् |
- 43. अलपम ंसश णिग्णिऽभ्यन्िरोिोः कट्य ं मूत्र शय बस्तिोः, ित्र वप सद्य मरोणमश्मरोीव्रण दृिे, ित्र प्युर्यि शर्न्ने न ाीिनि, एकि शर्न्ने मूत्रस्र िी व्रण र्िनि, स िु यरनेन पक्र न्ि रो हनि; ि णीक ण्डय ुजपय िशय च्छ्छ दनौ प श्ि िन्िरोप्रनिबद्धौ ननिम्बौ, ित्र धोःक यश ष दौबिलय च्छ्च मरोणं; Basti marma प श्ििय ािघनबदहर् िगे पृष्ठिंशमुर्यि कु कु न्दरोे, ित्र तपश िज्ञ नमधोःक ये चेष्ट पघ िश्च Kukundar marma Nitamb marma Ref. su.sa.6
- 44. Roga Swedan a Snehan a Basti KsharaDipana/ pachana Treatment like udavarta 1.Mutra- vegavrodha + + + (Trividha) - - - 2.Kostha- Gata vata - - - + + - 3.Pakwasha ya & gudagata vata - - - - - + 4.Basti avrutta vata - - + (Uttara) - - - 5.Mutravrutta vata - + + (Anuvasana) - - - Summery of Classical line of Management
- 45. Samprapti ghataka Dosa=Vata Dushya= Rasa to Majja & Mutra, Purisha Srotas= Majja-mutra-anna-purish pradhantah Srotodushti= Sanga Adhisthan= Vasti/mutrashaya Samutthan= Pakwashayotha Agni= Visham Sama/nirma= both Vyadhi= Ashukari/chirkari Sadhyaasadhyata= Kruchhasadhya/asadhya