Homoeopathy for Urinary Incontinence

Dr Mali Shreya Maruti

Abstract:
Urinary incontinence is involuntary loss of urine. Incontinence can occur at any age but is more common among the elderly and among women, affecting about 30% of elderly women and 15% of elderly men. Incontinence may manifest as near-constant dribbling or as intermittent voiding with or without awareness of the need to void. This article includes homoeopathic management of urinary incontinence, remedies with indications and various rubrics of urinary incontinence.

Keywords: Homoeopathy, Urinary incontinence, Therapeutics.

Introduction:
Urinary incontinence is defined as any involuntary leakage of urine. The disorder is greatly underrecognized and under-reported. Incontinence may occur or worsen with manoeuvres that increase intra-abdominal pressure.

Urge incontinence is uncontrolled urine leakage (of moderate to large volume) that occurs immediately after an urgent, irrepressible need to void.

Causes: Urinary incontinence is divided into Transient and Persistent incontinence.

Transient urinary incontinence:
Delirium, Infection of urinary tract, Atrophic senile vaginitis, Pharmaceuticals or drug induced, psychological causes like depression, Excessive urine output, Restricted mobility, Stool impaction, recurrent UTI, smoking, caffeine.

Persistent incontinence:
Pregnancy and child birth, hysterectomy, Menopause, Prostatic enlargement, Cancer of prostate, obstruction along the urinary tract are major causes contribute for persistent incontinence. Neurological disorders like Stroke, Parkinson’s disease, Multiple sclerosis, Brain tumours and Spinal injury can damage the nerve supply to bladder causing urinary incontinence.

Aetiology
As urine accumulates in the bladder during the storage phase, the sphincter tone gradually increases, but there are no significant changes in vesical pressure, detrusor pressure or intra-abdominal pressure. During voiding, intravesical pressure increases as a result of detrusor contraction and the sphincter relaxes, allowing urine to flow from the bladder until it is empty.

With aging, bladder capacity decreases, ability to inhibit urination declines, involuntary bladder contractions (detrusor overactivity) occur more often, and bladder contractility is impaired. Thus, voiding becomes more difficult to postpone and tends to be incomplete.

In postmenopausal women, decreased oestrogen levels lead to atrophic urethritis and atrophic vaginitis and to decreasing urethral resistance, length, and maximum closure pressure. In men, prostate size increases, partially obstructing the urethra and leading to incomplete bladder emptying and strain on the detrusor muscle.

In younger patients, incontinence often begins suddenly, may cause little leakage, and usually resolves quickly with little or no treatment.

Types:

1. Urge incontinence

It is uncontrolled urine leakage (of moderate to large volume) that occurs immediately after an urgent, irrepressible need to void. Nocturia and nocturnal incontinence are common. Urge incontinence is the most common type of incontinence in the elderly but may affect younger people. It is often precipitated by use of a diuretic and is exacerbated by inability to quickly reach a bathroom. In women, atrophic vaginitis, common with aging, contributes to thinning and irritation of the urethra and urgency.

2. Stress incontinence

It is urine leakage due to abrupt increases in intra-abdominal pressure (e.g. with coughing, sneezing, laughing, bending, or lifting). Leakage volume is usually low to moderate. It is the 2nd most common type of incontinence in women, largely because of complications of childbirth and development of atrophic urethritis. Stress incontinence is typically more severe in obese people because of pressure from abdominal contents on the top of the bladder.

3. Overflow incontinence

It is dribbling of urine from an overly full bladder. Volume is usually small, but leaks may be constant, resulting in large total losses. Overflow incontinence is the 2nd most common type of incontinence in men.

4. Functional incontinence

It is urine loss due to cognitive or physical impairments (eg, due to dementia or stroke) or environmental barriers that interfere with control of voiding. For example, the patient may not recognize the need to void, may not know where the toilet. Normal micturition occurs when bladder contraction is coordinated with urethral sphincter relaxation.is, or may not be able to walk to a remotely located toilet. Neural pathways and urinary tract mechanisms that maintain continence may be normal.

5. Mixed incontinence

It is any combination of the above types. The most common combinations are urge with stress incontinence and urge or stress with functional incontinence.

Some important rubrics related to Urinary incontinence:

• MIND- FEAR- urine- involuntary loss of urine; fear of
• MIND- JOY- urine- involuntary loss of urine from joy
• BLADDER- URINATION- involuntary- sitting- agg. – swing her foot constantly or the urine will escape; she must
• Bladder- involuntary, urination, acute diseases, after
• Bladder- involuntary, urination, catheterization, after
• Bladder- involuntary, urination, night
• Bladder- involuntary, urination, cough during
• Bladder- involuntary, urination, elderly people, in

Homoeopathic approach to urinary incontinence:
Based upon the causative factor and totality, the well indicated homoeopathic similimum can be given to the patient in management of Urinary incontinence and also avoiding the further complications.

Using various rubrics mentioned in Homoeopathic repertory for Urinary incontinence. Arsenic album, Apis, Argentum Nitricum, Dulcamara, Lycopodium, Natrum Muriaticum, Nux.Moschata, Phosphorus, Psorinum, Pulsatilla, Rhustox, Sepia and Staphisagria. There are many therapeutic indications as follows:

1. Apis Mellifica:

Incontinence of urine, with great irritation of parts.

Burning and smarting in the urethra, as if it were scalded.

Burning soreness when urinating, frequent desire, with passage of only a few drops, urine scanty and high coloured; thirstlessness. Incontinence of urine from coughing and other circumstances. Urine suppressed. Too profuse discharge of urine. Albuminuria of scarlatina. Urine often bloody, milky appearance; very dark and frothy; very fetid; sediment reddish brown, like coffee grounds.

2. Argentum Nitricum

Urine passes unconsciously and uninterruptedly, day and night. Emission of a few drops after having finished. Quick urging to urinate.; frequent and copious emission of pale urine. Urethra from meatus to bladder hot and burning. Urging to urinate, urine passes less easily and freely.

3. Belladonna:

Frequent desire to make water. Retention of urine. Continual dribbling of water. Frequent emissions of water., copious, pale, and watery, sometimes with profuse perspiration, thirst. Incontinence and involuntary emission of urine, even in the night and during sleep. Paralysis of neck of bladder. Sensation of motion in the bladder, as of a worm. Nocturnal pressure in the bladder.

• Causticum:

Involuntary emission of urine as in the cases of children who wet the bed at night; in woman, when urine spouts from them in coughing or walking. Frequent inclination to urinate, with thirst and scanty emission. More copious emission of urine. Emission of urine at night and wetting the bed. Acrid and corrosive urine, or pale aqueous of deep brown reddish colour. Sensation of burning in making water. Itching of orifice of the urethra. Paralysis of bladder from long retention of urine, and consequent incontinence. Involuntary passage of urine on coughing, walking, sneezing and blowing nose. Retention of urine after urine, after surgical operations. Insensibility of urethra while passing urine. Bed wetting, during first sleep, at night.

• Lycopodium Clavatum:

Involuntary micturition. Urgent want to urinate, with too frequent emission with discharge of large quantities of pale urine. Frequent micturition at night, with scanty and rare discharges by day. Old thickening of bladder with irritable urethra. Smarting when urinating. Itching in urethra during and after emission of urine. Shooting, pinching’s and incisive pains in the bladder and urethra. Frequent urge to urinate ameliorated by riding in cars. Involuntary urination specially in fever or from fright during coition.

• Natrum Muriaticum:

Involuntary emission of urine, sometimes on coughing, walking, laughing or sneezing. Frequent and urgent want to urinate day and night, sometimes every hour, with copious emission. Nocturnal emission of urine. Discharges of mucus after the emission of urine. After urination spasmodic contraction in abdomen; burning, drawing and cutting in urethra. During micturition stitches in bladder, smarting, burning in urethra. Polyurea, thirst for large quantities of water. Has to wait long for urine to pass in the presence of others.

• Phosphorus:

Increased secretion of watery urine. Frequent emission of a scanty stream of urine. Smarting and burning sensation when urinating. Involuntary urination during sleep. Profuse, pale, watery urine; frequent and scanty or completely suppressed urine. Tearing in the urethra. Periodical sick headaches sometimes are preceded by scanty urine and sometimes by a copious watery flow of urine.

• Pulsatilla Pratensis:

Involuntary micturition at night in bed, especially in little girls. Involuntary emission of some drops of urine when coughing, walking, sitting down, expelling flatus. Enuresis of old people with distended colon. Contraction of urethra with a very small stream of water. During micturition burning in urethra. Swelling the neck of bladder, with soreness when touched, intermittent stream of urine, and spasmodic pain in pelvis and thighs after urinating. Urine watery colourless, brown bloody. Involuntary urination while lying down, laughing, coughing; sneezing; hearing sudden noise; after a pleasurable surprise; shock; passing flatus.

• Sepia Officinalis:

Involuntary urination of during first sleep; aggravated by coughing, sneezing, laughing, hearing sudden noise, fright or inattention especially in woman. Slow urination with wearing down sensation above pubis. Shuddering when urging for urine is not attended to. Involuntary urination as soon as the child goes to sleep at night. Frequent, constant urging to urinate with milky urine that burns like fire and after standing a while a milk, greyish deposit will form which is hard to wash of the vessel.

• Staphysagria:

Involuntary emission of urine when coughing. After having urinated, a fresh want is felt, as if bladder were gain full. Burning sensation in urethra especially when urinating. Constant urging in young married women. Constant micturition at night. Pressure on bladder on waking from sleep. Very frequent want to urinate, with emission drop by drop, or else of a slender stream of deep coloured urine. Excessively painful emission of urine. Frequent emission of clear watery urine with much urging.

Conclusion:
Urinary incontinence can occur at any age. Incontinence greatly reduces quality of life by causing embarrassment, stigmatization, isolation, and depression. Homoeopathic medicine improves quality of life of patient, through individualized constitutional treatment. Homoeopathic medicine helps the patient in the condition of urinary incontinence without any side effects.

References:

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Dr Mali Shreya Maruti
PG Scholar, Department of Medicine
Guide: Dr M.K. Kamath. MD (HOM)
Father Muller Homoeopathic Medical College and Hospital
Deralakatte, Mangalore. 575018