Urinary incontinence is the inability to control the release of urine from your bladder. It is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when coughing or sneezing and to urge to urinate sudden and strong before getting in to a toilet in time.

Key words: Urinary incontinence, stress incontinence, Staphysagria

INTRODUCTION:

The disorder is greatly under recognized and underreported. , affecting about 30% of elderly women and 15% of elderly men.

Untreated, incontinence can cause physical and emotional disturbance. Incontinence can also affect patient’s self-esteem and cause depression and social withdrawal. Individuals with long-term incontinence suffer from Urinary tract infections and dermatitis. There are numerous invasive and noninvasive treatment options for Urinary incontinence. Drugs include anticholinergics and antimuscarinics, Surgery is a last resort, usually used only for younger patients with severe urge incontinence refractory to other treatments.(m).Homoeopathy has good say in urinary incontinence As treatment is based on individualisation. Causticum, Apis Mellifica , Nat-Mur, Nux-Vom, Phosphorus, Pulsatilla , Sepia ,Squila etc are few important remedies in urinary incontinence. In one case of urge incontinence causation was taken as basis in selection of a remedy (post surgical urinary incontinence), case was cured with Staphysagria. Prescription on bases of causation gave breakthrough in the case. Knowingly or un knowingly we commit mistakes in selecting a remedy. But timely reviewing the case helped me in successfully treating the case.

During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine. Urine may escape with less pressure than usual if the muscles are damaged, causing a change in the position of the bladder (Fig). The urethra is supported by fascia of the pelvic floor. If this support is insufficient, the urethra can move downward at times of increased abdominal pressure, allowing urine to pass.

Types of urinary incontinence (1,2,):

Stress incontinence: This is due the increase in intra abdominal pressure is exerted on bladder by coughing, sneezing, laughing, exercising or lifting something heavy. It occurs when the sphincter muscle of the bladder is weakened in women due physical changes resulting from pregnancy, childbirth and menopause due to development of atrophic urethritis.It is also seen in obese people because of pressure from abdominal contents on the top of the bladder. It is the second largest cause for urinary incontinence in women.

. Urge incontinence: This is a sudden, intense urge to urinate, followed by an involuntary loss of urine, bladder muscle contracts and gives a warning of only a few seconds to a minute to reach a toilet. Urge incontinence may be caused by urinary tract infections, bladder irritants, bowel problems, Parkinson's disease, Alzheimer's disease, stroke, injury or nervous system damage associated with multiple sclerosis. If there's no known cause, urge incontinence is also called overactive bladder.

According to G Chiara, Patients suffering from urge incontinence showed higher degrees of inner anger and anger trait than those suffering from stress or mixed incontinence. Whereas irritability and general hypochondria prevailed in patients suffering from urge incontinence. Such patients tend to develop psychosomatic reactions that may contribute to the severity of their symptoms.(3)

Overflow incontinence: is the 2nd most common type of incontinence in men. In this condition dribbling of urine occurs from an overly full bladder. Quantity of urine is small, but leaks may be constant, resulting in large total losses. It is due damaged bladder, blocked urethra or nerve damage from diabetes and in men with prostate gland problems.

Functional incontinence: Commonly seen in older adults, incontinence before patients who unbutton his or her pants quickly enough. This is called functional incontinence. It is due dementia or stroke. Due to cognitive or physical impairments the patient may not recognize the need to void, may not know where the toilet is, or may not be able to walk.

Mixed incontinence: If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence.

Transient incontinence :Severe constipation with impacted stool, urinary tract infections, Medications etc can trigger Transient incontinence.

Women suffer more than men with stress incontinence. In menopausal period estrogen levels are decreased which leads to atrophic urethritis and atrophic vaginitis which leads to decreasing urethral resistance. Childbirth can weaken the pelvic muscles and cause the bladder to lose some support from surrounding muscles, resulting in stress incontinence. Any surgery involving the urogenital tract runs the risk of damaging or weakening the pelvic muscles and causing incontinence like Hysterectomy. Due to prostate gland problems male are prone for urge and overflow incontinence. With aging, bladder capacity decreases, ability to inhibit urination declines. Involuntary bladder contractions. Incontinence isn't normal at any age. Obesity increases the pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when coughing or sneezing. Smoking can cause episodes of incontinence, which aggravates cough and puts stress on your urinary sphincter, leading to stress incontinence. Even certain Kidney disorders and Diabetes are part of risk factors. Interstitial cystitis, multiple sclerosis, stroke, spinal cord injuries, or a brain tumor can cause the bladder to contract involuntarily. Carbonated drinks, tea and coffee with or without caffeine, artificial sweeteners, corn syrup, and foods and beverages that are high in spice, sugar and acid, such as citrus and tomatoes, can aggravate bladder. Anti hypertensive drugs, Diuretics, Ca channel blockers, antihistamines, antipsychotics blockers,

And other medications may contribute to bladder control problems.

Symptoms: Urinary incontinence is the inability to control the release of urine from your bladder. Some people experience occasional, minor leaks or dribbles of urine. Others wet their clothes frequently

Lab investigations:

Urine analysis, cystometry and post void residual volume, measurement of bladder capacity Testing: Cystometry may help diagnose urge incontinence

Complications:

Skin problems. Repeated Urinary tract infections. Psychological problems like anxiety and depression

The following are few rubrics taken from Synthesis 8.1 V, Repertory ,and Radar 10 software.

BLADDER - URINATION - dribbling - enlarged prostate, with

Aloe. Dig. Nux-v. Puls. Staph.

BLADDER - URINATION - dribbling - involuntary

Agar. All-c. Arg-n. ARN. Ars. Bar-c. Bell. Camph. CANTH. CAUST. CLEM. Dig. Dulc. Gels. Hyos. Mag-m. Mur-ac. Nux-v. Op. Petr. Puls. Rhus-t. Sel. Spig. Staph. Stram. Sulph. Tab. Uran-n. Verb.

BLADDER - URINATION - dribbling - urination – after

CANN-I. . Caust. Chinin-s. CLEM. Con. Graph. Helon. HEP. Kali-c. La Nat-m. Petr. Petros. Sel. Sep. Staph. Thuj.

BLADDER - URINATION - flatus, with

puls. sars. sulph.

BLADDER - URINATION - frequent - coffee, after

cain. cob. ign. olnd.

BLADDER - URINATION - involuntary

AIL. APIS ARG-N. ARS. ARS-I. BELL. CAUST. DULC.LYC. NAT-M. NUX-M. PHOS.. PSOR. PULS. RHUS-T. SEP. . STAPH.

BLADDER - URINATION - involuntary - accompanied by - Prostate gland; swelling of

pareir.

BLADDER - URINATION - involuntary - cough, during

APIS CAUST. NAT-M. . NUX-V. PHOS. PULS. SEP.SQUIL. .

BLADDER - URINATION - involuntary - exertion, during

Bry. Nux-v.

BLADDER - URINATION - involuntary - old people, in - men with enlarged prostate

All-s. Aloe Cic Iod. . Pareir. Sec. Thuj.

BLADDER - URINATION - involuntary - pregnancy, during

ARS. PULS.

BLADDER - URINATION - involuntary - sneezing, when

Calc. CAUST.. Ferr. Kali-c. Kreos. Lac-c. Nat-m. Nux-v. Ph-ac. Psor. Puls. Ruta Squil. Staph. Verat.

BLADDER - URINATION - involuntary - surgical operation; after a

staph.

BLADDER - URINATION - involuntary - stool - straining – while Alum. Lil-t.

BLADDER - URINATION - involuntary - labor, after

Arn. ARS.

BLADDER - URINATION - involuntary - catheterization, after

arn. mag-p. staph.

BLADDER - URINATION - involuntary - delivery; after

bry. equis-h. mag-m. staph.

Case :

Ms LBV,Patient aged 49,femal sex, cook by occupation, moderate built with 62.5 Kgs weight, who was diagnosed as urge incontinence came to my clinic Sept 2008, with following symptoms, on interrogation she said as she is cook in a orthodox family.

Presenting complaints: depressed look, pain in lower back, < sitting prolong time, > walking, suddenly dribbling of urine < night mostly occasionally day also, cold perspiration on either physical or mental exertion,

Past history: Menorrhagia, late menopause.

Family history: mother OA patient,

Past treatment history: Hysterectomy in 2007 underwent various treatments for urinary incontinence without any benefit for one year.

Personal history

Appetite: good, Thirst: thirst less, desires and Aversions: NP, bowel movement: regular /satisfactory, urination: normal flow, occasional urge incontinence, perspiration: cold perspiration on either physical or mental exertion, habits: nil, Sleep: refreshing, Dreams: occasional, thermal state: not able to express and menstrual history: Status Hysterectomy

life space investigation: parents belongs to lower middle class family, 3 brothers and three sisters, she is second, educated up to middle school level, , discontinued studies, started working as helper in houses, married at 18 the year blessed with 3 children, husband is a heart patient, for his health she has incurred heavy expenditure. Family in financial crisis.

Physical examination: Not Anemic, no Jaundice, no Clubbing, no edema

With pulse rate of 70 PM, regular, Blood pressure: 126/80 mm Hg

Provisional diagnosis: Urge Incontinence

Results of repertorisation:

Choice of remedy: Sepia Sepia covered first four symptoms(10), including mind symptom(2)

Sepia 200c, 3doses were given, Rubrum for 15 days were given, case was followed every 15 days, there was no improvement, and Sepia 200C to 10M was given up to without any relief. case was reviewed, causation was taken as important factor in selection of remedy (urinary incontinence was after Hysterectomy). BLADDER - URINATION - involuntary - surgical operation; after a staph. was only single remedy 3^rd grade. Staphysagria suits all three of the miasms, Staphysagria 200c was given on above reason, followed by rubrum for 30 days. The number of involuntary urination has came down; she stopped treatment on 20^th july 2009, reported back after three months with out any incontinence (4)

In above case causation was considered which gave breakthrough in the case. Knowingly or un knowingly we commit mistakes in selecting a remedy.

Etiology has been defined as a study or theory of the causation of any disease: the sum total of the knowledge regarding causes. Etiology does not concern itself with synthesis of causative factors in the pathogenesis of a disease to enable an observer to form a comprehensive picture of the development of the disease in all its stages.

Dr. P. Sankaran tried to select a remedy which fitted in with and covers the symptom totality of the patient as well as the cause, but he took the cause as the starting point as well as the most important symptom of the case. He tried to find out from a patient the cause, source or origin of the illness or the circumstances in which it started. And he gave very great importance to this etiology. Sometimes he based his prescription mainly or solely on this etiology and he cured many cases this way. For example if after an operation or mortification, Staphysagria(7)

According to George Vithoulkas These causation symptoms can be considered very strongly. They are the starting points to finding the remedy and a remedy must often be given that fits that causation even if it means ignoring other symptoms(8)

The following are the views of our stalwarts on urinary symptoms of Staphysagria According to Lippe, during and after micturition burning in the urethra, after micturition urging, as if the bladder were not emptied. , According to Phatak materia medica frequently urging to urinate; with scanty or profuse discharge of watery urine; urinates in thin stream of drop by drop. According to Synoptic key, Cystitis after catheterization. Pain bladder [or abdominal colics] after surgical operation . Boericke says Cystitis in Lying-in patients. Ineffectual urging to urinate in newly married women. Pressure upon bladder; feels as if it did not empty. Sensation as if a drop of urine was rolling continuously along the channel. Burning in urethra during micturition. Prostatic troubles; frequent urination, burning in urethra when not urinating. According to Louise Mclean This remedy highlights ferocity in human emotion which society has tried to groom out of us (9) Staphysagria is one of our most commonly used polycrests, in this remedy the prescription is often based entirely on the basis of the "essence" or Causation underlying cause of illness in the Staphysagria patient is suppression. Is most noted in our literature for suppression of anger. It is an important remedy in patients whose complaints originated from anger or insults which have been swallowed. (4,910)

****Detailed article published in Homeopathic Journal: Volume: 3, Issue: 4, Feb, 2010,Homeorizone.com