by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
Silent bladder infections, also known as asymptomatic bacteruria, may result in generalized ill health or may lead to acute cystitis or to pyelonephritis, a potentially life-threatening kidney infection. Hence it is important to appreciate the groups affected by silent bladder infection, as well as how to make an Ayurvedic diagnosis of this condition and give appropriate chikitsa.
Bladder infection, also known as cystitis, is typically diagnosed when there is a complaint of frequency of urination, dysuria (burning pain on urination) nocturia and discomfort suprapubically, in the bladder area. Urine may be cloudy or foul smelling. If there is fever, rigors, nausea and headache, the infection may already have spread to the kidney. However, many cases of cystitis and even some cases of pyelonephritis have silent or imperceptible symptoms. In this case, accurate Ayurvedic diagnosis can prevent some of the potentially dangerous outcomes of this lingering condition. A variety of faecal organisms can cause cystitis if spread to the bladder, since mutravahsrotas, the urinary tract, is vulnerable to these organisms. E. coli, staph, klebsiella, enterobacter, enterococcus and pseudomonas are commonly implicated in cystitis and asymptomatic bacteruria. Candida albicans can also grow in the urinary tract, leading to silent bladder infection and predisposing to bacteruria or symptomatic cystitis.
Baby girls are prone to bladder infections, so much so that it is quite typical for a girl to experience as many as two bladder infections under the age of five. Many of these infections may be silent, or may go undiagnosed because the baby cannot describe her symptoms. Pregnant women have a relatively high incidence of asymptomatic bacteruria. If untreated, this will lead to symptomatic cystitis in approximately 30 percent of patients and to pyelonephritis in as many as 50 percent. (1) Silent bladder infection is also associated with an intrauterine growth retardation and low-birth-weight infants.
Low oestrogen is connected with both silent and symptomatic bladder infections. This is thought to be caused both because the urethra is thinner when oestrogen is low and because the vagina becomes more susceptible to colonization by faecal bacteria, which may then spread to the urethra and bladder. Low oestrogen occurs in nursing mothers, as well as in menopausal and post menopausal women. As many as 25 percent of bladder infections in post-menopausal women are silent. Diabetics are another group which has a high incidence of silent bladder infections. Women on immunosuppressive therapy, such as those with MS, are especially vulnerable to silent bladder infections. Although women are in general more prone to bladder infection than men, older men with BPH are also a susceptible group.
The following case histories indicate the importance of effectively diagnosing and addressing silent bladder infections.
A thirty two year old pregnant woman, prakruti V3P2 K1, had had few health complaints other than pregnancy acne. However, her bladder pulse was persistently weak with pitta, and red margin of her tongue indicated pitta in rasa dhatu. Although she was treated throughout her pregnancy with herbs such as Vidari to support the placenta, she ultimately delivered a low-birth -weight infant by caesarean section. She was then hospitalized for septicaemia resulting from fragments of retained placenta and almost lost her life. This is a cautionary tale showing the importance of being proactive when the bladder pulse has a pitta spike, an indicator of possible infection. Perhaps if her silent bladder infection was treated early on in her pregnancy, the subsequent difficulties could have been avoided.
A forty year old pitta woman with MS took immunosuppressant therapy whenever she had an episode of neurological symptoms. During the heat of summer, she developed a bladder infection and was given antibiotics. Summer is a typical time for developing silent bladder infection both because it is pitta season and because it is difficult to stay sufficiently hydrated in hot weather. Following a round of antibiotics she took a formula which included Punarnava, Turmeric, Gokshura and a small amount of Neem. The anupan for this formula was Cumin, Coriander Fennel tea, since these spices also soothe the urinary tract. A month later, she had no symptoms of bladder infection but still had red margins of the tongue, indicating pitta in rasa dhatu, as well as coating of the tongue and a pitta spike in the bladder pulse. She continued CCF tea for bladder calming. Unfortunately, although her continuing bladder infection was easy to track by Ayurvedic pulse reading, her Western physicians remained unaware of it. We continued to track persistent silent bladder infection for an entire year, through the pitta spike in the bladder pulse. During this time she took several rounds of the formula mentioned above. However, because of her major medical condition, she would have benefited from some further antibiotic treatment as a complement to her Ayurvedic formula. The following July, during a heat wave, she developed loss of function of both legs such that she could scarcely walk. This episode was treated as a MS relapse and she was given cortisone. However, cortisone, as an immunosuppressant, only served to further exacerbate her bladder infection. In fact, what she experienced was not a genuine relapse but a typical episode of pseudo symptoms resulting from bladder infection. Pseudo symptoms arise when excess ushna quality leads to pitta provocation in myelin that has been previously affected by MS. Hot weather and fevers, particularly urinary infections, are typical sources of excess ushna. When bladder infection is the precipitating factor, pseudo symptoms typically occur in the lumbar area, due to tiryaga (horizontal) movement of pitta from the bladder to the lumbar spine. Following this experience she became more proactive about using herbs such as Gokshura and Punarnava whenever she had a pitta spike in the bladder. She could also use Kidney Formula, which contains bladder-soothing and pitta pacifying herbs such as Gokshura, Punarnava and Guduchi.
A sixty six year old diabetic kapha woman was doing well on her Ayurvedic regimen, noting an excellent, steady drop in her blood sugar readings. From blood sugars as high as 200 mg/dl, she was stabilizing at a near optimal range of under 130 mg/dl. Suddenly, during a May heat wave, her blood glucose went back up to its old levels. We noted that her bladder pulse, which had been normal at every previous visit, was now weak with vata pushing pitta. Thus we suspected a silent bladder infection in this post-menopausal diabetic woman. Bladder infection could account for the elevated blood sugar because of the added physiological stress of dealing with the infection. She was given a formula which included Gokshura, Myrrh, and Hibiscus, all of which act to cleanse and soothe mutravahasrotas. Sure enough, after she took this formula for ten days, her blood sugar returned to optimal levels and her diabetes continued to improve incrementally.
A fifty seven year old woman, prakruti V3P1K2, complained of urgency of urination, thirst, pain in the renal angles, brain fog and fatigue. She had a long history of systemic candidiasis. Thirst is a symptom of depleted rasa dhatu, and there is a great functional integration between rasavahasrotas, ambuvahasrotas, (the water carrying channels) and mutravahasrotas, since all are involved in fluid balance. Her bladder pulse was weak with vata pushing pitta. She was given kidney formula, which improved her symptom of urgency. Unfortunately she then fell away from Ayurveda and was seeing other practitioners who attributed her renal pain to her adrenals, rather than to chronic renal infection secondary to candida in her bladder and bacteruria. She returned over two years later, still with renal pain, urgency, thirst and vata pushing pitta in the bladder. This history illustrates how long a yeast-related silent bladder infection can persist unless addressed long term with appropriate herbs. She is now taking kidney formula and Purnarnava Guggulu and should see an improvement if she can overcome her vata tendency to jump practitioners.In giving Ayurvedic chikitsa for bladder infections, agni is, as always, the first consideration. By following proper food combining and meal timing and avoiding allergens, a healthy bowel flora can be sustained. Bowel dysbiosis, or presence of undesirable microflora in the gut, provides the opportunity for the urethra to be invaded by pathogenic organisms from the colon. Yeast overgrowth should be addressed by cutting out sugar, sweets and vinegar. Next, it is important to ensure proper hydration through drinking sufficient water. The indicator of hydration is urine colour. Although the early morning urine is normally yellow because urine concentrates during the night, daytime urine should be essentially colourless in a properly hydrated condition. Clients often need encouragement to drink sufficiently, particularly in the summer. Aloe Vera juice can be added to the water to pacify pitta and soothe the bladder. In addition to drinking plain water, bladder soothing teas can also be used. Hibiscus tea is beneficial for both the bladder and the menstrual cycle, while Cumin-Coriander-Fennel tea is beneficial for bladder, digestion and hormonal balance. Turmeric is also useful as a home remedy for bacterial infections and can be taken half a teaspoon twice a day in honey. Proper bladder emptying is essential for bladder health and can be supported by asanas such as cat/cow, pelvic rocks, gentle twists, fish pose (matsyasana), butterfly (baddha konasa) and shoulder stand (sarvangasana ). Ashvini mudra and mula bandha help prevent dribbling and stress incontinence due to bladder infection. Moon Salutations (chandra namaskar) help calm pitta and prevent inflammation. Herbs that have affinity for mutravahasrotas include Gokshura, which soothes the urinary tract and improves urine flow, Punarnava, which also soothes the urinary, tract, supports urine flow and helps protect the kidneys, and Manjista, which also reduces pitta and kapha in the bladder. Blood purifying and pitta soothing herbs such as Anantamula and Guduchi will also help eliminate bacteruria. For candidiasis-related bladder infections, Musta has a specific anti-Candida activity. Indications of candida overgrowth in the bladder include persistently cloudy urine and a history of vaginal yeast infections, excess sugar consumption or multiple courses of antibiotics. As the case studies quoted above illustrate, it may be necessary to continue herbs for mutravahasrotas for many months, using either an individualized formula or Kidney Formula. Silent bladder infections may have no perceptible symptoms and yet can lead to kidney infections or to exacerbations of chronic health conditions. A kidney/bladder formula should be continued as long as there is a pitta spike in the bladder.
- Kass EH. Pregnancy, pyelonephritis and prematurity. Clin Obstet Gynecol 1970;13:239-54
- Harris RE, Thomas VL, Shelokov A. Asymptomatic bacteriuria in pregnancy: antibody-coated bacteria, renal function, and intrauterine growth retardation. Am J Obstet Gynecol 1976;126:20-5.
Alakananda Devi (Alakananda Ma) is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal teacher of Alandi School of Ayurveda, a traditional ayurvedic school and apprenticeship program. She can be reached at 303-786-7437 or by email at: firstname.lastname@example.org.