Yoga for neurogenic bladder dysfunction

Patil et al. Effect of integrated Yoga on neurogenic bladder dysfunction in patients with multiple sclerosis-A prospective observational case series. Complement Ther Med. 2012 Dec;20(6):424-30. 

BACKGROUND: Neurogenic bladder dysfunction (NBD) is a common distressful symptom in multiple sclerosis (MS) affecting quality of life. Yoga has been widely used in treating various symptoms of patients with MS.

OBJECTIVES: To evaluate the effect of integrated Yoga for NBD in patients with MS as an adjunct to standard medical care.

DESIGN: This open arm, pre-post study design assessed the outcome measures at base line and after 21 days of integrated Yoga intervention. Setting: study was conducted at the center for neurological rehabilitation at KWA-Klinik Stift Rottal in Bad Griesbach, Germany. Eleven MS patients with NBD (mean age 46.7±11.24 years) with mean duration 17.2 years volunteered to participate in the study. Interventions: integrated Yoga which includes preparatory yogic loosening and breathing practices, Nadishuddi pranayama (alternate nostril breathing), moola bandha (anal lock), kapalbhati (rapid nostril breathing) and deep relaxation technique was given for 2h per day for continuous 21 days. Outcome measures: ultrasound scanning for post void residual urine volume (PVR), micturition check list (MCL), incontinence impact questionnaire-7 (IIQ-7) andurogenital distress inventory-6 (UDI-6) were used.

RESULTS: Paired sample t-test showed significant improvement in post void residual urine (62.34%, p<0.05), scores on micturition frequency checklist (25%, p<0.05), incontinence impact questionnaire-7 (32.77%, p<0.05) and uro-genital distress inventory-6 (26.33%, p<0.05).

CONCLUSION: This study points to the safety and effectiveness of integrated Yoga for bladder symptoms as an adjunct to standard care in multiple sclerosis patients with neurogenic bladder dysfunction. 

The recommended non-drug techniques for bladder dysfunction are pelvic floor muscle training, electromyographic biofeedback, craniosacral therapy and neuromuscular electrical stimulation.  
This study tested eleven MS patients in an open (non-blinded) way pre and post a series of twice daily one hour session of yoga exercises in conjunction with standard medical care. Except for the Post void residual urine volume (PVR), the other measures were self rated: Micturition Check List (MCL),  Incontinence Impact Questionnaire-7 (IIQ-7), Urogenital Distress Inventory-6 (UDI-6). 

Yoga stretches in general are described to promote body control and planning of complex movements and reduce spasticity, depression and fatigue. Meditation has shown some benefit in management of fatigue. The specific yoga interventions used in the study are not what you would get in your routine yoga class at the gym. Further, the two hour a day practice is more intense than most people would be prepared to try. 

The results of the study were statistically significant, which is remarkable for a study with such small number of participants, in particular for PVR, an objective measure of bladder function. 
Ultimately, complementary therapies have a role in the care of complex patients: cognitive behaviour therapy has a clear benefit for depression and coping ability, mindfulness meditation is useful for improving the quality of life (HRQOL) and reducing depression and fatigue.