I suppose we all know what the term “irritable bladder” means. It is one of those expressions that is neither symptom nor diagnosis, but which we employ to describe a constellation of symptoms. The term overlaps with many others – bladder instability, overactive bladder, painful bladder syndrome, interstitial cystitis, urge incontinence, etc. Of course within these terms exists a spectrum of symptoms, from a mild increase in the frequency of urination to incontinence and severe pain on voiding.
Theories abound as to causes. Urodynamic studies show that sensory urgency, detrusor overactivity, hypotonic urethra, hyporeactivity of sphincter musculature, and involuntary relaxation of the urethra all occur – in isolation or in combination. Altered mechanics such as prolapse (of uterus and/or vagina) or prostatic hypertrophy no doubt often play a role. Jonathon Wright teaches that enuresis in children is usually related to food sensitivities: “asthma of the bladder”. The Interstitial Cystitis Association advises its members to identify dietary “triggers” that exacerbate symptoms. A good collection of abstracts on the above subjects can be found at their website at: http://www.ichelp.org/ResearchCenter/LiteratureReview/tabid/409/Default.aspx
Where does the autonomic nervous system fit into this discussion? – (the first question of the neural therapist!)
Anatomically, we know that the bladder receives both parasympathetic and sympathetic innervation. Parasympathetic fibers cause contraction of the detrusor muscle and relaxation of the trigone and urethra thereby facilitating voiding. Sympathetic fibers also innervate the bladder wall, but have opposite effects. They cause relaxation of the detrusor and contraction of the trigone – important in allowing filling of the bladder. In addition, sympathetic fibers modulate activity in the parasympathetic ganglia embedded in the bladder wall.
One clue relating the autonomic nervous system to bladder irritability is the common association of irritable bladder with irritable bowel syndrome. Although other mechanisms may also explain this relationship, it seems likely that ANS disturbance is the common factor.
The osteopathic profession has long recognized bladder irritability to be related to somatic dysfunction of the pelvis, especially of the pubes. These can be treated quite simply by manipulation.
In neural therapy, bladder irritability is often found to be related to an interference field in the bladder itself or to a kidney or a lower thoracic sympathetic ganglion. Scars or incisor teeth are other possibilities. I have found quaddles injected over the bladder area to be quite effective when the interference field is in the bladder. Dosch’s textbook also recommends quaddles over the sacrum, injections into the bladder neck through the abdominal wall to behind the pubes, paraurethral injections through the anterior vaginal wall, and injections of the prostate capsule, pelvic plexus, or presacral ganglia.
Having said that, I have found that the more severe cases of interstitial cystitis do not respond lastingly to neural therapy alone. However some encouraging reports have appeared in the literature of responses to bladder irrigation with procaine in combination with alkalinizing agents and other substances.
It is interesting that electrostimulation using a variety of techniques and frequencies, (from 5 to 50 Hz) has been shown to be effective in a large number of trials. I cannot help but notice the resemblance to neural therapy, using the Tenscam device. The Tenscam delivers an 8 Hz “energy” (neither electrical nor magnetic) and seems to have similar effects to that of procaine. So it would seem that the electrostimulation is working in a similar way to neural therapy i.e. modulating and regulating the autonomic nervous system.