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
does the autonomic nervous system fit into this discussion? - (the first
question of the neural therapist!)
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.
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.
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
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
In response to some requests, I will be offering a two day seminar:
Introduction to Neural Therapy
November 13th and 14th, 2009
limited enrollment course is designed to teach the basics of neural
therapy - enough for immediate incorporation into your practice. More
information to follow.