Evaluation of the change in Quality of Life of Cystocele Patients through Mutramarga Gata Uttarabasti with Shuddha Bala Taila- An Exploratory Study

**BACKGROUND:**Cystocele or prolapsed bladder is a common medical condition in which the urinary bladder herniates through the anterior vaginal wall and bulges in the vagina.It has a high impact on Quality of Life . It adversely affectsthe physiological as well as psychological health of the female and even interferes with their professional life.There are multiple underlying causes for the development of cystocele resulting in weakness of the muscles and the connective tissue surrounding the bladder and vagina or the pelvic floor support system. The main associated risk factors are obesity , increasing age, multiparity , heavylifting, pelvic muscle strain, chronically increased intra-abdominal pressure, collagen abnormality, family history of cystocele, and a history of pelvic surgery. The symptoms of cystocele include feeling of pelvic heaviness , a bulge in the vagina, 6 involuntary escape of urine in moments of stress on the pelvic floor such as hearty laughter, sneezing or coughing, frequency of urination, incomplete emptying of bladder, nocturnal awakening for the purpose of urination more than once or twice a night, urge incontinence and other symptoms of pelvic organ prolapse.

Conservative and surgical measures are available for its management in the contemporary science but they have their own drawbacks. The most commoncomplication of surgery is the recurrence of the prolapse and a need for further repair.Other complications include postoperative bleeding, hematoma, damage to the surrounding pelvic organs, infection of the operative site and dehiscence of the wound, infection of the urinary tract, pain during intercourse, urinary retention, and the formation of a vesicovaginal fistula.Conservative management has its own pitfalls. For example- vaginal pessaries can cause pain, erosion of the vagina, bleeding or infection. And, Kegels exercises have to be performed life-long and it is difficult to do these consistently due to busy schedule.

Due to the above-mentioned drawbacks, there is a clear need to explore and use Ayurvedic treatments given in Samhitas in order to minimize the complications and to provide a permanent cure. Ayurvedic classics have description of Mutramargagata Uttarbasti in Sushruta Samhita with Mutra dosha as well as Bastigata Roga as its indicationMutramargagata Uttarabasti is non-invasive, cost-effective, easily performed and can be done in OPD basis and is expected to give good results in a short time. Moreover, it has no complications or side effects. And Sneha is best for conditions in which Vata is deranged among which also, taila is best Vata shamaka. Moreover, in Shudhh Bala taila , taila is infused with Bala and ksheera and is therefore balya, brimhana and will work best for Apana Vayu Vaigunya.

OBJECTIVES OF THE RESEARCH PROJECT:

PRIMARY:

1. To assess the effect of Mutramarga gata Uttara Basti with Shudhha Bala taila on the quality of life of Cystocele patients through P-QOL status

2. To study the effect of Mutramarga gata Uttara Basti with Shudhha Bala taila on the signs and symptoms of Cystocele.

SECONDARY:

1. To study the changes in the symptoms of cystocele through P-QOL, UDI form-6, IIQ-7, and POPDI-6 scales.

2. Assessment of the effect on pelvic organ prolapse degree through Pelvic organ prolapse quantification system (POP-Q).

3. To understand Cystocele and its possible correlation in Ayurveda

METHODOLOGY

TYPE OF STUDY DESIGN Single arm open label exploratory study

STUDY TYPE- Interventional

INTERVENTION: There will be a single group in which Uttara basti will be given through urethral route with Shuddha Bala taila(14) in a dose of 96 ml (1 Prasruta) (15) consecutively for 7 days and the effects would be assessed

FOLLOW-UP:

At Baseline on 0th Day before coming for the Panchakarma Procedure, After Uttara basti on 7th day , After 14 days follow up (rest) period on 22nd day