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Neurogenic bladder and Homoeopathy

Neurogenic bladder is a condition in which the nerves of the urinary system don't work properly when the bladder is full. It can lead to different kinds of problems, including urine leakage if the muscles holding urine do not get the right message. For some, the muscles don't get the message the bladder is full and its time to let go. If the bladder becomes too full, urine may back up into the kidneys, and the extra pressure causes damage to the tiny blood vessels in the kidney. Urine that stays too long may also cause an infection of the bladder or ureters.

Risk Factors

These include an accident that causes trauma to the brain or spinal cord, exposure to heavy metal poisoning, diabetes, and acute infections. Some patients are born with nerve problems, which can keep a baby's bladder from releasing urine, leading to urinary infections or kidney damage.

Causes
Hypotonic (flaccid) neurogenic bladder is generally caused by damage to the spinal cord due to congenital causes such as lesions to the spinal cord. Spastic (contracted) neurogenic bladder is usually caused by brain or spinal cord damage that results in paraplegia or quadriplegia. Several diseases, including syphilis, as well as diabetes mellitus, brain or spinal cord tumors, stroke, ruptured intervertebral disk, and degenerating diseases such as multiple sclerosis and amyotrophic lateral sclerosis can also cause hypotonic and spastic neurogenic bladder.

Symptoms
Patients with hypotonic neurogenic bladders have flaccid and distended bladders and constantly leaking small amounts of urine (overflow dribbling). In patients with chronic hypotonic neurogenic bladder, urinary tract infections are common.

Patients with spastic neurogenic bladders from upper spinal cord lesions usually suffer from incontinence.

Diagnosis
Both the nervous system (including the brain) and the bladder itself are to be investigated. X-rays of the skull and spine and an EEG, a test where wires are taped to the forehead to sense any dysfunction in the brain may be needed.

Nerves and muscles of the bladder, including x-rays of the bladder and ureters may also be considered. Other tests may involve filling the bladder to see how much it can hold and checking to see if the bladder empties completely. A CMG (Cystometrography) may be done to evaluate tone of detrusor muscles.

Homeopathic Therapeutics

Ferrum phosphoricum: Incontinence of urine, if from weakness of the sphincter muscle. Wetting of the bed, especially in children. Enuresis nocturna, from weakness of the muscles, often seen in women, when every cough causes the urine to spurt. Cystitis, first stage, with pain, heat or feverishness. Suppression of the urine with heat. Excessive secretion of urine. Polyuria simplex. "Irresistible urging to urinate in the daytime, aggravated by standing and accompanied by pain along the urethra and neck of the bladder. Retention of urine with fever in little children, as well as involuntary spurting of urine with every cough." (M. Deschere, M.D.) Some varieties of red wine will cure nocturnal enuresis in children, owing to the iron contained therein. Dose night and morning. Diurnal enuresis depending on irritation of neck of the bladder and end of penis.

Kalium muriaticum: Cystitis, second stage, when swelling has set in (interstitial exudation), and discharge of thick, white mucus. "In this trouble there is no better internal remedy." (Peltier.) The principal remedy in chronic cystitis. Urine dark-colored, deposit of uric acid, where these exist torpor and inactivity of the liver.

Kalium phosphoricum: Cystitis in asthenic conditions with prostration. Frequent urination, or passing large quantities of water. Frequent scalding; nervous weakness. Incontinence of urine from nervous debility, bleeding from the urethra. Paralysis, affecting the sphincter muscle, causing inability to retain the urine. Enuresis in older children. Urine quite yellow. Itching in urethra. Cutting pain in bladder and urethra.

Kalium sulphuricum: According to Mitchell this remedy was used by Haerman, of Paris, and endorsed by the late T.F. Allen for Oxaluria. Magnesium phosphoricum Constant urging to urinate whenever the person is standing or walking. Spasmodic retention of the urine. Gravel. Pain after the use of the catheter, a sensation as if the muscles did not contract. Child passes large quantities of urine. [Page 334. ]

Natrium phosphoricum: Incontinence of urine in children with acidity. Polyuria. Urine dark-red, with arthritis. Frequent micturition. Diabetes. Atony of the bladder. Gravel. Schussler in his last edition claims that this is the chief remedy in catarrh of the bladder.

Natrium sulphuricum: Sandy deposit or sediment in the urine, gravel, lithic deposits, brickdust-like coloring matter in the water, associated with gout. Polyuria simplex, excessive secretion if diabetic. Urine loaded with bile. Wetting of the bed at night, or retention of urine.

Silicea terra: Urine loaded with pus and mucus. Red sandy deposit of uric acid. Enuresis from worms and in chorea. Must get up at night to urinate.

Calcarea sulphurica: Inflammation of the bladder, in chronic stage, pus forming. Red urine with hectic fever. Nephritis scarlatinosa. (S. Lilienthal.)

Calcarea phosphorica: Urine copious. Enuresis, wetting the bed in young children and in old people, as an intercurrent after Natrum sulph.. For gravel, calculous, phosphatic deposit. To check the reformation of stone in the bladder, also butter-milk or koumiss as a dietary help. Flocculent sediment in urine.

Natrium muriaticum: Polyuria, with much emaciation; haematuria after scurvy; cutting pain after urinating. Cystitis. Involuntary urination when walking, coughing, etc. Incontinence of urine. Cutting in urethra after urinating.

Calcarea fluorica: Copious urine with frequent urging. Urine scanty and high colored, and emits a pungent odor. Vaccination Should any bad results show themselves Kali mur. will give entire satisfaction. (Schussler.) If necessary, follow with Silicea.

 

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We need more information on this type of disability because the symptoms are so common.
New surveys show that urinary incontinence -- a problem with bladder control -- is quite common. Both surveys were reported at this week's annual meeting of the American Urological Association in San Antonio.
UCLA researcher Jennifer Tash Anger, MD, and colleagues with the Urologic Diseases in America Project analyzed data from the huge National Health and Nutrition Examination Survey.
Of the 23.5 million women surveyed, 38% said they'd suffered at least one episode of urinary incontinence in the last year. Among these women:
  • 13.7% of women with bladder control problems said they suffered incontinence every day.
  • 10% of women with bladder control problems said they suffered incontinence every week.
  • Bladder control problems were more common in non-Hispanic whites (41%) than in non-Hispanic blacks (20%) or Mexican-Americans (36%).
  • As women get older, daily incontinence is more common. Among women aged 60-64, 12% report daily incontinence. This increases to 21% of women aged 85 and older.
Ananias C. Diokno, MD, chairman of urology at Beaumont Hospital in Royal Oak, Mich., reported on data from a national sample of 21,590 men. They found that 9% of men reported a bladder control problem in the last 30 days. Among these men:
  • 29% of men with a bladder control problem reported stress urinary incontinence. That means they had trouble controlling their bladder when coughing, sneezing, laughing, or exercising.
  • 41% of men with a bladder control problem reported urge urinary incontinence. That means a strong, sudden urge to urinate followed by an involuntary bladder contraction and loss of urine.
  • 16% of men with a bladder control problem had mixed stress and urge incontinence.
  • 27% of men with a prostate condition had urinary incontinence.
There are lifestyle changes, exercises, and medications that can help improve bladder control:
  • Avoid drinking excess amounts of diuretics.
  • A popular set of exercises called Kegel exercises strengthens the muscles that are squeezed when trying to stop urinating midstream.
  • For those who smoke, stop smoking. Nicotine irritates the bladder.
  • Wearing protective devices such as absorbent products, underwear, and adult diapers or using bed pads can also help manage urinary incontinence
Urinary incontinence is quite embarrassing for all ages and limits people's freedom to interact and socialize. This must be accounted for in the remedy selection. As you stated, there are many reasons for bladder leakage, which may be considered different from pure incontinence. 
Thanks Debby. I shall work hard...
MAJOR REMEDIES

BENZOIC ACID

Affinities:

URINARY ORGANS (kidneys, bladder), JOINTS. Heart. Bowels. Left side. Left side then right. Right side then left.

Mind:

Dwells upon disagreeable occurrences, unpleasant things. 'If he saw anyone who was deformed it made him shudder.' (Vermeulen, 1996. p136) Hurry followed by fear. Sensitive to noise. Frequent omission of words in writing. Desires to be carried. Children will not be laid down.

Generals:

Alternating states. Inflammatory states of tongue, throat, tonsils, stomach and rheumatic manifestations. 'It is always characteristic of benzoic acid when the pains wander from one place to another when they vanish from the joints and extremities, then involve internal organs and reversely when the symptoms reappear in the joints with the improvement of the cardiac complaints, and when the urine periodically alters in regard to its amount, colour, specific gravity and odour in relation to the general symptoms of sleep, psyche, headache, and the urine is striking through its odour.' (Leeser, 1935. p690)

Urine:

Urine of a very repulsive odour, of a changeable colour. Strong hot dark brown urine; foul, ammoniacal or odour of horse's urine, immediately on voiding. Enuresis nocturna with penetrating urinous odour. Sheets usually stained brown.


CAUSTICUM

Affinities:

NERVES (motor, sensory). MUSCLES (BLADDER, LARYNX, limbs). Respiration. Skin. Right side; face. Left side.

Mind:

Weeping from sympathy with others. Suffer with others. Ailments from grief. Internal suffering (kept in). Suffer from injustice in society. Immovable points of view. Indifference to dictates of conscience. Fear something will happen. Sensitive to authority. Fear of dark. Stammering. Anarchistic. Idealistic.

Generals:

Chilly, < cold air, cold dry weather. < wet weather, bathing. Burning pains, rawness, soreness. Local paralytic affections. Sensation as if muscles and tendons too short. Gradual paralysis on all levels. > sips of cold water. Craves smoked food.

Urine:

'Involuntary urination, particularly in children. This may take place either at night when they are asleep or in the day while awake. In nocturnal enuresis, the emission of urine takes place during the first part of the night, after they have hardly fallen asleep. At times this takes place even before they have slept and it comes on so easily that they are hardly conscious of it. All sensations are wanting, and they only make certain of it by feeling with their hands and finding themselves in a pool of urine. Then again, due to paralysis of the sphincter muscles, we have involuntary urination while coughing, sneezing and blowing the nose.' (Choudhuri)


EQUISETUM HYEMALE

Affinities:

GENITO-URINARY TRACT. Right side.

Mind:

Disposed to frown. Angry. Dreams of crowds. Abnormalities that remain because he has made a habit of it (eg biting nails).

Generals:

Disturbed sleep due to tiresome dreams. Worse at close of urination.

Urine:

Aching, full, tender bladder not relieved by urination. Constant desire to urinate; passes large quantities of clear, light-coloured urine without relief. Nocturnal enuresis, especially in first sleep, with irritable bladder. Dribbling of urine. Urine cloudy with great amount of mucous on standing. Excessive burning in urethra while urinating. Haematuria. 'This remedy is sometimes successful in cases which are not relieved by Cantharis ... there are larger quantities of urine discharged than with Canth, which has characteristically very small amounts, but often repeated, even but a few drops at a time. Equisetum, like Chimaphila, sometimes shows excess of mucous, and it is also very useful in enuresis' (Nash, 1913. p422)


KREOSOTUM

Affinities:

MUCOUS MEMBRANES (DIGESTIVE TRACT; gums; stomach; abdomen; female genitals; uterus). BLOOD. Teeth. LEFT SIDE.

Mind:

Fear of coition, fear and dreams of rape. Many problems around menstrual period. Every emotion attended with throbbing. Sadness and weeping from music.

Generals:

Excitement, restlessness, headache around menstrual period. Chilly. Corrosive, hot, foul discharges. Ailments from too rapid growth. Profuse haemorrhages from small wounds. Difficult dentition. Child screams the whole night; won't sleep unless caressed and fondled all the time.

Urine:

'It is one of our grand remedies for incontinence of urine. The urging is so great that the patient cannot get out of bed at night quick enough. The urine is chestnut brown, fœtid, alkaline and deposits a white sediment. It is a first class remedy for nocturnal enuresis of children. They wet the bed during the first sleep from which they are roused with difficulty. They frequently dream that they are passing urine in the proper place, but they wake up, also, to find out that it has been done in the most incompatible manner and in the most improper place.' (Choudhuri) 'Nocturnal enuresis from too profound sleep. Child cannot be awakened when taken up.' (Clarke, 1900. Vol II p178)


LAC CANINUM

Affinities:

NERVES. THROAT. Female organs. Breasts. ALTERNATING SIDES.

Mind:

Great lack of self confidence. Forsaken feeling. Self contempt (delusions, dirty, falling to pieces, being looked at, loathing of oneself, fear of failure). Hypersensitive amounting to hysteria. Forgetful and absent-minded. Aggression (cursing, malicious, rudeness, rage, hateful, scolding at slightest provocation). Many fears from strong imagination. Constant desire to wash hands. Aetiology disturbance in mother-child relationship. Sensation as if floating in air.

Generals:

Warm-blooded. Alternating sides. Desire for pungent things (pepper, mustard) and salt. > cold applications. Ravenous appetite. Glistening, shining parts (throat, chancres, ulcers).

Urine:

'Nocturnal enuresis especially in those children who have grown up to adolescence and kept this habit. I have learned to always refer to Lac Caninum in those cases and see if I could not get other corroborative symptoms. It is amazing how many of them you can get, and what fine work the remedy does.' (Dixon, Homeopathic Recorder) 'Nocturnal enuresis (specific). Bladder seems full after urination.' (Phatak) 'Urine bright coloured. Slight difficulty in urinating, but at times very profuse and light-coloured. Desire to urinate often, with difficulty. Urine unusually frequent and dark. Constant and urgent inclination to urinate in large quantities, though not at all thirsty; urine highly coloured; next day the same urgent inclination, but urine was scanty, very turbid, and left a reddish sediment.' (Swan)


PLANTAGO MAJOR

Affinities:

NERVES. Teeth, ears, spleen. Emmissions. Worms. Wounds.

Mind:

Irritable, morose disposition. Great mental prostration, < mental exertion, causing rapid respiration and anxiety. Restlessness, pacing back and forwards. Intolerant of contradiction. Dullness > walking in open air. Hurry, desire to do several things at once. Undertakes many things, perseveres in nothing.

Generals:

Considerable clinical reputation in earache, toothache, enuresis. Neuralgia of ears, teeth, face. Sudden boring pains < right side. Sharp darting pains in left side. Shifting pains. Restlessness especially of lower extremities. < sitting, > moving about. Frequent attacks of sudden sneezing with profuse watery bland coryza. Tongue white coated, breath putrid. Eructations tasting of sulphur. Thirst. Grinding of teeth during sleep. Weariness and prostration with desire to yawn and stretch. Abdominal colic > eating.

Urine:

Profuse flow. Nocturnal enuresis, especially where lax condition of sphincter vesicae. Frequent emission of large quantities of pale urine, hot, scalding. Profuse, colourless urine, depositing white sediment < midnight to morning. 'It is especially applicable to the nocturnal enuresis of children, particularly when depending on laxity of sphincter vesicae. In most of these cases the children secrete a large quantity of pale, watery urine, and though great pains are taken to have the bladder thoroughly emptied before retiring, yet the pressure on the weak sphincter will cause its escape before morning. It is of no use when enuresis is due to paralysis of the sphincter.' (Choudhuri)


TUBERCULINUM

Affinities:

LUNGS. Mind. Head - occiput. Glands. Larynx. Blood. Right side.

Mind:

Need for change, desire to travel. Maliciousness, destructive when change frustrated. Compulsive, ritualistic, superstitious. Irritability on waking. Fear of dogs, cats. Precocious children. Romantic longing.

Generals:

< before storm, cold damp weather, closed room. > open air, dry warm weather. Strong craving for smoked foods, fat, cold milk. Ravenous hunger at night. Profuse perspiration at night from slight exertion. Tendency to take cold. Marked disposition to respiratory ailments. Grinding of teeth during sleep. Constantly changing symptoms. Dark hair along spine in children. Rolling head to get to sleep. With every little ailment whines and complains.

Urine:

Urine stops and starts, intermittent flow. 'The remedy Tuberculinum is the best friend that parents of a bed wetter can have. This remedy has cured more children of the embarrassing, socially stigmatising disorder than any other remedy in the materia medica. The problem may be lifelong or only have begun after an acute illness such as an upper respiratory infection or a fever: a statement such as "After receiving the treatment for the illness, he began to have bed-wetting spells," is a common tip-off to Tuberculinum. The bed-wetting may occur at any time from the first sleep of the evening to the deep sleep of the early morning; or more typically, several times during the night, some urinating every hour. The urine has a very strong odour that can remain in the bedding long after the child quits the habit. It is common for parents to tell the doctor that they took the child to the bathroom to urinate during the night but that it accomplished nothing, as the child wet the bed later anyway. It can be difficult for parents to waken the child. They may pick the child up from bed, carry him to the bathroom, hold him over the toilet, and tell him to urinate. The child often remains asleep during this whole procedure, grinding his teeth or thrashing about, but will urinate profusely when bidden. For most children the cause of the problem is that they cannot rouse themselves from a deep sleep to get up and go to the bathroom. This is especially true with Tuberculinum, but it is not the only reason: there is a lack of inhibition that makes urinating in bed a meaningless event to the child. It is commonly found that after the remedy has acted the sleep is not as profound and the child will awaken if needed.' (Herscu, 1991. p334)
Thanks with Regards Dr. Sarswat.

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