Abstract

AYURVEDIC MANAGEMENT OF CYSTOCELE A CASE STUDY

Dr. Vidya Ballal* and Dr. Divyashree G.

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Abstract

Pelvic organ prolapse refer to Protrusion of the pelvic organs into or out of the vaginal canal. Uterine prolapse is one of the common clinical conditions met in day-to-day gynaecological practice and seen in multiparous women. It is seen occurring in women of any age, and also affects in pre-menopausal and post-menopausal women who had one or more difficult or prolonged vaginal deliveries. According to WHO estimation, the global prevalence of uterine prolapse is 2-20%.[1] Uterine prolapse is observed when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus, resulting either further slipping down into or protruding out of the vagina. The causes are many like birth injury, pudendal nerve injury during child birth, delivery of a big baby, congenital weakness and menopausal atrophy etc. Prolonged or difficulty vaginal deliveries with consequent injury to the supporting structures is the single most important acquired predisposing factors in producing prolapse and vaginal prolapse can occur independently without uterine descent also. Prolapse of the Anterior wall of vagina is referred to as cystocele. Cystocele is formed by laxity & descent of the upper 2- 3rd of the anterior vaginal wall, which when not managed properly may further pull the uterus down and out. Cystocele is formed among types of descent which complicates with symptoms like dragging pain in the pelvis, dyspareunia, retention of urine, painful micturition, urgency, frequent micturition and sometimes incomplete emptying of the bladder and feeling of mass per vagina. If not taken care of in the initial stage may revert to malignant changes in chronic stage. Prasramsini Yonivyapad[2], one among the Yonivyapad’s, characterized by the prolapse of the uterus and vaginal wall arises due to vitiated Pitta and Vata. Among the nidanas the prolapse of the anterior or posterior vaginal wall is seen only when the woman indulges in straining (Pravahana), excessive bearing down (Dukha Prasava)[3] at the time of labor and Vegadharana. According to Susruta the same disease also prevails with other features of Pitta i.e. burning sensation, heat etc. The basic treatment principles in both Ayurveda and contemporary science remains the same, emphasising on re-positioning of prolapsed part. Further contemporary science has stressed more upon surgical management by performing vaginal hysterectomy, Fothergill’s operation and Anterior Colporrhaphy, Ayurveda manages the same with different modalities of treatment controlling Vata and Pitta doshas in relation to the Sthana. When the degree of prolapse is mild then the conservative line of treatment are Vatapitta Shamana Chikitsa and Sthanika Chikitsa like Yoniprakshalana[4], Yoni Abhyanga and Yonipichu.[5] These Sthanika chikitsa emphasised after a Sharira Shodana seems to be more beneficial, cost effective and psychological benefit to the patient from the fear of surgery.

Keywords: Prasramsini yoni vyapad, cystocele, Hysterectomy, Mutramarga uttara basti.