Urinary Difficulty after Childbirth

CHAPTER 48 Urinary Difficulty after Childbirth



AETIOLOGY 615

PATHOLOGY 615

IDENTIFICATION OF PATTERNS AND TREATMENT 616
Spleen-Qi deficiency 616

Kidney-Qi deficiency 618

Injury to the Bladder 619

Liver-Qi stagnation 619

Bladder-Heat and Kidney-Yin deficiency 621

Lung- and Spleen-Qi deficiency 622

PROGNOSIS AND PREVENTION 623

Urinary Difficulty after Childbirth includes a range of urinary problems, from difficulty in urination and retention of urine, to their opposites, frequency of urination and incontinence of urine. They can be dealt with together because the cause is always a deficiency occurring after childbirth, and addressing the underlying deficiency cures the urinary problems.


It is important to stress that the mother’s conditions included under this chapter’s heading are urinary problems without fever or pain; thus, from a Western point of view, they are urinary problems without a urinary infection. Strangely enough, modern Chinese obstetrics books do not seem to discuss urinary infections separately from the heading of Fever after Childbirth (see Ch. 51). As urinary infections (from the Chinese point of view Painful-Urination Syndrome) have very specific symptoms and treatment, I shall discuss them in this chapter rather than in that on fever after childbirth.



Aetiology




Excessive strain during labour


The strain of labour taxes the mother’s Qi greatly, and if labour is prolonged it induces a state of Spleen-Qi deficiency. Deficient Spleen-Qi fails to raise Qi and this affects the Bladder’s Qi which therefore sinks causing frequency of urination or even incontinence of urine. However, Qi deficiency affecting the Bladder may also work the other way and cause difficulty or retention of urine: this happens because the deficient Qi fails to transform and excrete fluids in the Bladder which are therefore retained.


Excessive strain during labour also taxes the Kidneys and, in women who might have a pre-existing Kidney deficiency, it causes a deficiency of Kidney-Qi. As the Kidneys provide Qi to the Bladder for its function of Qi transformation, the Bladder has not enough Qi to transform and excrete fluids and this may cause either frequency and incontinence of urine or its opposite, difficulty and retention of urine. The reasons why a deficiency of Kidney-Qi may cause opposite types of problems are the same as those explained for the Spleen above.



Injury to the bladder


The bladder itself may be injured by a prolonged labour or by surgical procedures during childbirth and therefore give rise to either retention or incontinence of urine, more usually the latter. In some cases, this may persist for a long time after childbirth. Injury to the bladder may also manifest with symptoms of Qi stagnation affecting the Bladder.



Pathology


The pathology of Urinary Difficulty after Childbirth, according to the traditional theory, is always one of deficiency and primarily of the Spleen or Kidneys. Deficient Spleen-Qi may cause sinking of the Qi of the Bladder and thus frequent urination or incontinence; or it may fail to transform and transport fluids so that urine is retained. Deficient Kidney-Qi fails to provide Qi to the Bladder for its function of Qi transformation, there is not enough Qi to hold the urine, and frequency and incontinence result. Alternatively, Kidney-Qi may be so deficient that there is no strength to push the urine out and retention of urine ensues. This type of Kidney-Qi deficiency always occurs against a background of Kidney-Yang deficiency.


However, according to my experience, urinary problems after childbirth may also manifest with symptoms of Qi stagnation. This may derive either from injury to the bladder or from emotional problems. The time immediately after childbirth is a difficult one for a woman who is exhausted from labour, has to cope with the demands of the baby on a physical and emotional level, and may have a feeling of anticlimax. All this may easily lead to stagnation of Liver-Qi, especially if there was some pre-existing Qi stagnation: the Liver channel and its Connecting channel flow to the external genitalia, urethra and bladder, and stagnation in these channels is a very frequent cause of urinary problems in women. After childbirth, it causes a slight difficulty in micturition, an uncomfortable sensation during it, and hypogastric pain and distension.



Identification of patterns and treatment


The patterns discussed are:


• Spleen-Qi deficiency

• Kidney-Qi deficiency

• injury to the Bladder

• Liver-Qi stagnation

• Bladder-Heat and Kidney-Yin deficiency

• Lung- and Spleen-Qi deficiency.


Spleen-Qi deficiency



Clinical manifestations


Slight retention of urine after childbirth, a feeling of fullness and distension in the hypogastrium, or frequency or incontinence of urine, tiredness, weariness, loose stools, poor appetite, pale complexion, sweating. Tongue: Pale. Pulse: Weak.



Treatment principle


Tonify Qi, strengthen the Spleen.



Acupuncture


Ren-12 Zhongwan, Ren-6 Qihai, Ren-3 Zhongji, ST-36 Zusanli, SP-6 Sanyinjiao, BL-22 Sanjiaoshu, BL-28 Pangguangshu, Du-20 Baihui, BL-20 Pishu. All with reinforcing method, moxa is applicable.




Explanation


– Ren-12, ST-36, SP-6 and BL-20 tonify the Spleen.

– Ren-6 tonifies Qi in general.

– Ren-3 strengthens the Bladder and regulates urination.

– BL-22 promotes the transformation and excretion of fluids in the Lower Burner.

– BL-28 tonifies the Bladder.

– Du-20 raises Qi and treats frequency or incontinence of urine.


Herbal treatment



Prescription



– BU ZHONG YI QI TANG Variation

– Tonifying the Centre and Benefiting Qi Decoction Variation


Explanation

This formula, already explained, tonifies and raises Qi and can treat urinary problems by promoting the ascending of clear Qi to the top: by doing this, it automatically causes impure Qi to descend and therefore regulates urination. For this reason, it can be effective both for retention and incontinence of urine.


– Dong Kui Zi drains Dampness from the urinary passages.

– Tong Cao removes obstructions from the Connecting channels of the urinary passages.

– Jie Geng directs Qi upwards: this stimulates the ascending of clear Qi and descending of turbid Qi.


Modifications


• If there is frequent urination and a feeling of distension in the hypogastrium, add Zhi Ke Fructus Aurantii and Xiao Hui Xiang Fructus Foeniculi.

• If the woman feels cold and the pulse is Deep, add Bu Gu Zhi Fructus Psoraleae and Rou Gui Cortex Cinnamomi.

• If there is pain on urination and the tongue is Purple, add Pu Huang Pollen Typhae, Hu Po Succinum and Ze Lan Herba Lycopi.

• If there is frequency and incontinence of urine, add Yi Zhi Ren Fructus Alpiniae oxyphyllae, Shan Zhu Yu Fructus Corni and Wu Wei Zi Fructus Schisandrae.


Three Treasures remedy



– SEPARATE CLEAR AND TURBID

This remedy is a variation of the formula Bi Xie Fen Qing Tang Dioscorea Separating the Clear Decoction which tonifies Kidney-Yang, warms the Bladder and promotes the transformation and excretion of urine. It has been modified to tonify Qi and to promote the ascending of clear Qi and descending of impure Qi so as to regulate urination. The tongue presentation appropriate to this remedy is a Pale body with a sticky coating. The recommended starting dosage is one tablet three times a day.




Summary



Spleen-Qi deficiency


Clinical manifestations

Slight retention of urine after childbirth, a feeling of fullness and distension in the hypogastrium, or frequency or incontinence of urine, tiredness, weariness, loose stools, poor appetite, pale complexion, sweating. Tongue: Pale. Pulse: Weak.



Treatment principle

Tonify Qi, strengthen the Spleen.



Acupuncture

Ren-12 Zhongwan, Ren-6 Qihai, Ren-3 Zhongji, ST-36 Zusanli, SP-6 Sanyinjiao, BL-22 Sanjiaoshu, BL-28 Pangguangshu, Du-20 Baihui, BL-20 Pishu. All with reinforcing method, moxa is applicable.



Herbal treatment


Prescription



• BU ZHONG YI QI TANG Variation Tonifying the Centre and Benefiting Qi Decoction Variation


Three Treasures remedy



• SEPARATE CLEAR AND TURBID


Case history


A 38-year-old woman had been suffering from slight urinary incontinence since the birth of her child 9 months before. Her labour had been long, forceps had to be used, her perineal muscles tore and she developed an infection. Her urination was frequent and she could not hold her urine for very long; occasionally, she would be slightly incontinent. Apart from this, she suffered from palpitations, backache, chilliness and dizziness. Her tongue was Pale and her pulse was Weak in general.



Diagnosis

This is a clear example of urinary incontinence from Spleen- and Kidney-Qi deficiency. The urinary incontinence is due to both Spleen- and Kidney-Qi sinking and being unable to hold urine. Since her Kidney pulse was not particularly weaker than the others, I concluded that Spleen-Qi deficiency predominated over Kidney-Qi deficiency.



Treatment principle

The treatment principle adopted was to tonify the Spleen and raise Qi. I treated her with both acupuncture and herbs.



Acupuncture

The points used were:


• Ren-6 with direct moxa cones to tonify and raise Qi.

• ST-36 Zusanli and SP-6 Sanyinjiao, with warm needle, to tonify and warm Spleen-Qi.

• Du-20 to raise Qi.

• BL-20 Pishu and BL-21 Weishu to tonify Spleen-Qi.


Herbal treatment

I used a variation of Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction as indicated above:


• Huang Qi Radix Astragali 9 g

• Ren Shen Radix Ginseng 6 g

• Bai Zhu Rhizoma Atractylodis macrocephalae 6 g

• Dang Gui Radix Angelicae sinensis 6 g

• Chen Pi Pericarpium Citri reticulatae 3 g

• Sheng Ma Rhizoma Cimicifugae 3 g

• Chai Hu Radix Bupleuri 3 g

• Dong Kui Zi Fructus Malvae 6 g

• Jie Geng Radix Platycodi 3 g

• Du Zhong Cortex Eucommiae 4 g


Explanation

The first seven herbs constitute the root formula Bu Zhong Yi Qi Tang which tonifies and raises Qi.


• Dong Kui Zi regulates the Water passages of the Bladder.

Related posts:

  1. Collapse after Childbirth
  2. Prolapse of the Uterus
  3. Acupuncture and Herbal Treatment in Midwifery
  4. Endometriosis

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Urinary Difficulty after Childbirth

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