Shayyamutrata (Enuresis) is an involuntary discharge of urine. In most of the cases the chief cause of enuresis is behavioral and emotional factors. It can also occur due to the urinary tract infection, food allergies, obstructive sleep, apnea, chronic constipation etc. The prevalence of enuresis is about 15-25% of children at 5 years of age, 8% of 12 years old boys and 4% of 12 years old girls. Srotovarodha and vitiation of Sadhaka, Tarpaka Kapha, Pachaka Pitta, Manovaha Srotas and Atinidra are the factors responsible for development of Shayyamutra. Ayurveda suggest importance of pharmacological as well as psychological treatment for the disease. This article describes some ancient view on Shayyamutrata.
Keywords: Shayyamutrata; Behavioral problem; Psychotherapy; Kaumarbhritya
Child health need great care to be taken since their physical and mental status help them to built the future of them and nation as well as. The behavioral problem like enuresis in young children is common.
Enuresis is defined as the voluntary or involuntary repeated discharge of urine into clothes or bed. This problem greatly affect psychosocial life of child as well as family members. It affects small to middle age group of children mainly. It is considered as multifactorial behavioral disorder. In Ayurvedic classics, the brief description regarding Shayyamutra is found in Sharangadhara and Vangasena © Samhita. This disease mainly involved Vata (Apan Vayu), Pitta (Pachaka), Kapha (Tarpaka), along with Manasika Dosha Tama. There are many treatment option are now available for disease but traditionally very less information was available for the same. Ayurveda considers patient counseling, diet control and Prakrati towards the disease control. This article describes role of counseling and utilization of herbal therapy for the treatment of disease as per ancient text of Ayurveda [1, 2].
Aavartaki Pushpa was found to have significant role in Shaiyyamutra. Study was conducted on Avartaki Pushpa (Cassia auriculata Linn.) to evaluate the efficacy of Avartaki Pushpa Vati in Shaiyyamutra shows that it increases the bladder control and tone of bladder muscles. The effect of Avartaki Pushpa on bladder control attributed to its properties like; Grahi, Stambhana and Mutrasangrahaniya [3].
Divyadi Yoga is an ayurvedic formulation traditionally prescribed for many diseases including urinary disorders. Studies were conducted to evaluate the efficacy of Divyadi Yoga in Shayyamutra shows that it possesses relief in Shayyamutra significantly. Study also reveals that Divyadi Yoga works appreciably along with counseling in the management of Shayyamutra [4].
Crataeva nurvala is a deciduous tree found in most parts of India along river banks. The stem bark is mostly used and contains saponins (eg diosgenin), flavonoids and plant sterols (lupeol). Anciently it has been established as remedy for urinary disorders like Shayyamutra. [5]
Barosma betulina have clinical importance for the treatment of the bladder disorder, irritable conditions of the urethra, urinary discharges and prostate disease. It contains the chemical like monoterpene, diosphenol. Research reveals that due to the presence of biological active phytoconstituents buchu oil may use for the treatment of enuresis. Traditionally it has been recommended to control involuntary urination in children [5].
Many researchers work on various herbal combination for the treatment of Shaiyyamutra. Herbs like; Centella asiatica, Shankha pushpi, Glycyrrhiza glabra, Tinospora cordifolia, Syzygium cumini, Sesamum indicum, Kharjoora (dried), Strychnos nux-vomica Linn were evaluated to treat Shaiyyamutra. These drugs showed urine holding properties (Mutrasan-grahaniya action) and play an important role in the Samprapti Vighatana of the disease. These herbs also help in improving the mental faculties as well as weak musculature of bladder especially sphinctric tone and provides better flow of urine during micturition and hence ultimately lesser amount of residual volume of urine. These all herbs are highly effective for managing this disorder since their combination works by dual action; control bladder urination and reduces mental and physical stress as well [6].
Study proves that in enuresis pharmacological treatments requires psychological support also. These works synergistically and effect of pharmacological treatment in enuresis were found to be more when assisted by psychological treatment. Studies confirmed that the psychological treatments are generally more effective than pharmacological treatments when performed individually. The patient counseling and let able him to feel normal are the best way of psychological treatment with medicine since the ultimate aim of treatment involve stress reduction and controlling involuntary bladder movement and these two can be best achieved when pharmacological treatment associated with psychological treatment [7].
Children problem not to be propagate in society.
Stressed should be especially mental stress.
Counseling through literature and proper orientation.
Patient should not make feel embarrass at any time.
Continuous counseling regarding to feel normal.
Shaiyyamutra is common problem amongst children and great care along with treatment need to be taken to control disease consequences in early age. Counseling along with drug therapy proved to be more effective treatment. However, more children improve from psychological than from pharmacological interventions. The various study established significant therapeutic role of traditional herbal therapy for the treatment of disease. Ayurveda also prescribe diet control and patient counseling as great tool for disease control. Various studies reveal that pharmacological treatment help patient more when associated with psychological treatment of Shaiyyamutra.