Hegde Gajanana et al. Journal of Biological & Scientific Opinion · Volume 2 (1). 2014 JBSO 2 (1), Jan - Feb 2014 Page 91 Available online through www.jbsoweb.com ISSN 2321 - 6328 Case Study A CASE STUDY ON NEUROGENIC BLADDER VIS- A- VIS BASTIKUNDALIKA Hegde Gajanana 1 *, Bhat Priya 2 1 H.O.D, Department of Kayachikitsa, Government Ayurveda Medical College, Mysore, Karnataka, India 2 PG Scholar, Department of Kayachikitsa, Government Ayurveda Medical College, Mysore, Karnataka, India *Correspondence Dr Hegde Gajanana Govt Ayurveda Medical College, Mysore, Karnataka ABSTRACT Neurogenic bladder is impaired bladder function resulting from damage to the nerves that govern the urinary tract. Various nerves converge in the area of the bladder and serve to control the muscles of the urinary tract, which includes the sphincter muscles that normally form a tight ring around the urethra to hold urine back until it is voluntarily released. Damage to these nerve cells results in neurogenic bladder 1 . This can be viewed as bastikundalika, a type of mutraghata (obstructive uropathy) as per Ayurveda. There will be retention of urine due to apanavatadusti. Ayurveda propounds a holistic treatment approach in the treatment of neurogenic bladder. A patient of neurogenic bladder with subsequent urinary tract infection was treated with such treatment protocol. As there is no specific line of treatment mentioned for bastikundalika in classics of Ayurveda, the general line of treatment of mutraghata along with drugs acting on urinary system was administered for the duration of 2 months in successfully treating this case. Patient was completely relieved with the symptoms. The same has been presented as a case study in this article. Keywords: Neurogenic bladder, bastikundaleeka, mutrghata. DOI: 10.7897/2321–6328.02120 Article Received on: 09/12/13 Accepted on: 03/01/14 INTRODUCTION Neurogenic bladder is a disease characterised by dysfunction of the urinary bladder caused by a problem of the nervous system. A variety of factors can damage these nerves and cause urinary incontinence. It is also called neuropathic bladder. There are three different types of neurogenic bladder. They are spastic bladder, reflex bladder, and flaccid bladder. In some cases where there is spastic bladder, there will be spontaneous nerve impulses to the bladder triggering spastic unexpected bladder contractions, resulting in accidental voiding of sometimes large amounts of urine. In case of flaccid neurogenic bladder, the bladder may become flaccid and distended and cease to contract fully, resulting in only partial emptying and continual dribbling of small amounts of urine. Stagnant urine in the bladder also increases the risks of bladder stone formation and urinary tract infections and subsequently producing their respective symptoms. Such infections, when severe, can lead to life- threatening kidney failure 1 . Ayurveda describes a similar condition called bastikundalika 2 , one among 13 types of mutraghata described in our classics. This condition is characterised by retention of urine in bladder leading to its distension and bladder attains the shape of uterus. This produces severe pain, burning sensation, and distress on passing urine. Such individual discharges urine in interrupted stream or drop by drop associated with pain and distress in lower abdomen. Apanavata is the prime dosha involved in this disease. When it is associated with pitta dosha produces burning sensation and pain on passing urine. Also there will be discolouration of urine. Treatment to such condition in contemporary science includes catheterisation and surgery. Use of catheters increases the risk of urinary tract infections and abscess formation which further aggravates the condition. Hence a better management protocol is essential for the same. As per Ayurveda, the general line of treatment to any mutraghata is controlling apanavata by sneha virechana 3 (purgation with medicated oil/ghee) followed by shamanoushadis (oral medications elevating the disease) acting on mutravahasamsthana (urinary system). Present study was conducted on a patient who was diagnosed of neurogenic bladder at K R Hospital, Mysore, India 6 years back before approaching for Ayurvedic treatment. Patient was even catheterised. Following which he developed recurrent urinary tract infection. Though the patient was symptom free after taking allopathic medications, the symptoms reoccurred within a short period of time. Hence he had approached for Ayurvedic management. A male patient of 26 years, Hindu by religion, living in Mysore, India approached to OPD of government Ayurveda medical hospital, Mysore, India on 4/1/2012 with chief complaints of straining, incomplete emptying of bladder, weak stream, urgency and burning micturition since 6 years which aggravated since 1 week. As patient was unable to pass urine; he was catheterised since 3 months. For these complaints patient got admitted in special ward of hospital with IP no. 136. On examination all the general examinations were found to be normal.