By Dr MS Krishnamurthy and Dr Raghuram YS.
One symptom may be found in many diseases. For the patient, that symptom gives discomfort. But for a physician each and every symptom is important to understand the patho-pysiology (origin of the disease) and to exactly diagnose the case.
Dysuria – difficulty in urination (mutrakricchara) and urinary obstruction (mutraghata) are two such disease entities, where ‘difficulty in urination’ is the common feature.
Many a times, many diseases may have the same causative factors. But, based upon the nature of the individual, season of affliction, supporting food and habits, individual’s susceptibility and severity of the functional (often structural) entities, these two kinds of diseases are manifested.
Common causative factors of the disease urinary tract obstruction, its clinical features, disease classifications, probable line of treatment and common Ayurvedic remedies are discussed here below-
Obstructed urine (Mutraghata) is a diseased condition where ‘retention of urine’ is the cardinal feature, whereas in dysuria (mutrakricchara), difficulty in micturition is the typical characteristic feature. Obstruction and hence retention of urine may be caused by occlusion of the urinary tract or inflammation in the urinary pathway. Often injury, constriction / compressed stones or any other possible foreign bodies may result in this pathological condition.
Urinary obstruction causes
1. Vegadharana (suppression of natural urges)- Read a related article
2. Rooksha ahara (intake of dry food and less intake of water) – Rooksha means dry, Ahara means food.
3. Sroto rodha (obstruction to the urinary tract due to stones, gravel, foreign body etc). Sroto means body channel, rodha means obstruction.
Origin of Retention of urine
Due to the above said causative factors the Doshas get aggravated. It is predominantly Vata Dosha. The vitiated Doshas mix up with (samsarga) urine and hence obstruct the flow of urine. Here, due to the influence over Apana vata, cited at Basti pradesha (bladder) the pathology continues and the urinary retention is caused.
Common clinical features
Here, one can find several possibilities like interrupted flow of urine, complete obstruction of the urinary tract, non production of urine, reduced or incomplete production of urine, incomplete or complete excretion of urine etc.
Classification of urine obstruction
Based upon the clinical features, Ayurvedic text books explain 3 kinds of urinary obstruction.
1. Vata kundalika
Due to dry food, less intake of water or suppression of natural urges, Vata dosha is vitiated and it is lodged in the bladder. As it vitiates urine, it is retrograded (kundalikrita) and drive the urine in interrupted manner.
It is common in the people who work in night shift and in those who take junk and spicy food excessively.
Roukshyaat vega vighaataad vaa vaayuhu vastau sa vedanaha
Mootram aavishya charati vigunaha kundalee krutaha
Mootram alpa alpaam athavaa sa rujam sampravartate
Kundalikaam taam tu vyaadhim vidhyaat sudaarunam (Ref – Sushruta Uttara 58)
The vata getting vitiated in the urinary bladder due to excessive consumption of dry foods and withholding the natural urges / reflexes of the body causes obstruction to the passage of urine and causes a condition called Vatakundalika.
Its symptoms are:
Pain in the bladder
Dysuria and scanty urination
Retention of urine
This disease is said to be difficult to treat
2. Ashteela (Vatashteela)
Specific causes aggravate Vata dosha and hence obstruct the urinary pathway by distending the bladder and rectum. This causes severe pain during urination as well as defecation.
This is common in the people who are used to a sedentary lifestyle.
Aadhmaapayan vastim gudam rudhdhwaa vaayuhu chala unnatam
Kuryaat teevra artihi ashtheelam mootra vin maarga rodhineem
The Vata vitiated in the urinary bladder causes distension in the bladder and anus. In the process, the vayu produces a mass which resembles a stone. This mass causes obstruction to the passage of urine and stools. This disease is called Ashteela.
3. Vata basti
Due to constant suppression of urinary urge (due to various personal factors), aggravated Vata obstructs the urethral orifice of the urinary bladder. Thus, it inhibits the excretion mechanism of urine. This leads to partial or full retention of urine in the bladder. Ultimately it causes pain in the abdomen and supra pubic (lower abdomen) area. Often itching or irritation may be also associated as there is relaxation of muscular coat and contraction of sphincters.
It is very common in working women, executives and people who travel for long.
Vegam vidhaarayet yaha tu mootrasya akushalo naraha
Nirunaddhi mukham tasya vastehe vasti gato anilaha
Mootra sango bhavet tena vasti kukshi nipeeditaha
Vaata vastihi sa vijneyo vyaadhihi kruchra prasaadhanaha (Ref – Sushruta Uttara 58)
The vayu aggravated in the urinary bladder due to suppression or withholding of urine, blocks the exit route of the urine. This condition is called Vatavasti.
Its symptoms are:
Obstruction to the passage of urine (retention)
Pain in the bladder
Pain in the flanks and abdomen
This condition is said to be difficult to treat
Withholding (suppression) the urinary urge for longer duration or post pone of the urge results in gradual (slow) excretion of urine when one goes for urination. This is called mutrateeta. In this condition often pain may complain passing little by little urine. This is usually caused due to fatigue of the muscles and sphincters due to constant withholding of urine.
This is common in women, drivers, executive officers, managers and those with high profession who are busy due to their work schedule.
Chiram dhaarayato mootram tvarayaa na pravartate
Mehamaanasya mandam vaa mootraateetaha sa uchyate
When we withhold the urine for a longer time, the urine does not come out in one flow when we urinate. Rather, it comes very slowly, in bits and parcels. This condition is called Murtaateeta.
5. Mutra jatara
Constant suppression of urinary urge leads to back pressure and hence the bladder is distended. Further, vitiated Apana Vata occupies the whole bladder and nearby organs and causes severe distension due to exerted pressure. Thus, it creates excruciating pain in the lower part of the bladder. Often gaseous distension of abdomen and constipation are also associated. When the individual goes for urination, large amount of urine is passed with difficulty in prolonged time period. It is common in school children, security guards and officers, accountants, bank employees, painters etc.
Mootrasya vege abhihate tad udaavarta hetukaha
Apaanaha kupito vaayuhu udaram poorayed bhrusham
Naabhehe adhastaad aadhmaanam janayet teevra vedanam
Tat mootra jatharam vidhyaat adho vasti nirodhanam (Ref – Sushruta Uttara 58)
Due to the habit of withholding the urge to urination, the Apana Vayu located in the urinary bladder gets vitiated and starts moving in a reverse or retrograde direction (upward). This condition is called Mutrajathara.
Its symptoms are:
Distension of the abdomen
Severe distension with pain below the navel
Obstruction to the passage of urine
When the urine is obstructed in the bladder or urethra for longer duration, due to various factors (functional or structural), there will be hematuria (blood with urine). Or else little urine is passed with difficulty (dribbling) or with pain. Such a condition is known as Mutrotsanga. Obstruction due to foreign bodies or urinary stones may also lead to such a condition.
This is commonly witnessed in patients with long standing diseases of urogenital system like urinary calculi, recto-vesicle fistula, chronic kidney disorders etc.
Vastau vaa api athavaa naale manau vaa yasya dehinaha
Mootram pravruttam sanjaate sa raktam vaa pravaahataha
Sravet shanaihi alpa alpam sa rujam vaa atha neerujam
Viguna anilajo vyaadhihi sa mootra utsanga sangnitaha (Ref – Sushruta Uttara 58)
When the Vayu gets vitiated in the urinary bladder, it causes a condition called Mutrotsanga.
Its symptoms are:
The urine, on its way out gets stagnated in the urinary bladder, penis and the glans penis
If pressure is applied to bring out the urine, it comes out mixed with blood
Urination takes place slowly, in less quantity (scanty) with or without pain
In the individuals who are physically exhausted, those who suffer from dehydration (primary or secondary), the aggravated Vata and Pitta Doshas occupy the bladder. Due to this, the quantity of output of urine is reduced and hence pain and burning sensation are associated with the main complaint of dysuria. This condition is called Mutrakshaya in Ayurvedic classics. Kshaya means decrease. Mutra means urine.
This is common in the labourers who work near fire and in chemical factories, mines etc.
Rookshasya klaanta dehasya vastisthau pitta maarutau|
Mootra kshayam sa ruk daaham janayetaam tad aahvayam (Ref – Sushruta Uttara 58)
The vitiated Pitta and Vata located in the urinary bladder of a person who is debilitated due to diseases cause a disease called Mutrakshaya.
Its symptoms are:
This condition can be compared with anuria or suppression of urine or acute nephritis.
Due to the respective factors rakta (blood), vata and kapha are vitiated and they are lodged in the urethral orifice causing a cystic or nodular growth. Due to this, the person passes the urine with much difficulty. The patient will feel excruciating pain similar to the pain caused during urinary calculi. The condition is known as Mutra granthi.
This is commonly witnessed in bed ridden patients.
Antaha vasti mukhe vruttaha sthiraha alpaha sahasaa bhavet
Ashmaree tulya rug granthihi mootra granthihi sa uchyate (Ref – Ashtanga Hridaya Nidaana)
A small, rounded and firm cyst like structure resembling a stone getting manifested within the urinary bladder is called Mutragranthi.
This condition can be compared to enlarged prostate or prostatitis.
Shukra means semen. The person who indulges in sex, while he is having the urge of urination, will ejaculate the semen mixed with urine or excretes the urine before or after seminal ejaculation. In this condition, the semen appears like ash dissolved in urine.
This disease condition is found only in men and in those who have severe sexual urge and unplanned sexual indulgence.
Mootritasya striyam yaato vaayunaa shukram uddatam
Sthaanaat chyutam mootrayataha praak paschaad vaa pravartate
Bhasma udaka prateekaasham mootra shukram tad uchyate (Ref – Ashtanga Hridaya Nidaana)
When a person has sexual intercourse with a woman in the presence of urinary urge or reflex, his Vayu gets vitiated and causes Mutrashukra.
Its symptoms are:
The semen propelled from its site and not yet been ejaculated gets obstructed by this vitiated Vayu and gets discharged either before or after urination
Colour of the urine – similar to lime water.
10. Ushna Vata
Heavy exercise, long walk under extreme sunlight cause the aggravation of pitta and vata dosha. The aggravated doshas are lodged in the urinary pathway. There, it causes inflammation in the nearby areas – bladder, urethra, rectum etc. This leads to yellowish urine or blood mixed urine. In this condition, the individual passes urine with difficulty (dysuria) and very frequently. Severe pain is also associated. It is observed in outdoor workers, labourers, sports persons etc.
Vyaayaam adhva aatapaihi pittam vastim praapya anilaanvitam
Vastim medhram gudam cha eva pradahet sraavayet adhaha
Mootram haaridram athavaa sa raktam raktam eva cha
Kruchraat punaha punaha jantoho ushnavaatam bruvanti tam (Ref – Sushruta Uttara 58)
Due to excessive exercise and exertion, walking long distances and exposure to heat of sun, the Vayu vitiated along with Pitta gets lodged in the Vasti (bladder) and causes Ushnavata.
Its symptoms are:
Burning sensation in the urinary bladder, penis, anus
Colour of urine will be of turmeric colour, blood stained or blood mixed.
Vitiated pitta and kapha doshas together gets lodged in the urinary bladder. There, the urine is concentrated and consolidated by Vata dosha. It produces reddish yellow (hematuria) urine which is often associated with solids (cast cells). Burning sensation, dysuria and itching are also associated in this condition.
It is common in the patients with chronic renal failure or dehydration conditions.
Pittam kapho dwau api vaa samhanyete anilena chet
Kruchraat mootram tadaa peetam shvetam raktam ghanam srujet
Sa daaham rochana shankha varnam bhavet tu tat
Shushkam samasta varnam vaa mootra saadam vadanti tam (Ref – Ashtanga Hridaya Nidana)
Mutrasada is a condition in which pitta and kapha – either individually or together gets dried and solidified due to the affliction of vitiated Vayu.
Its symptoms are:
Colour of the urine: yellow, white, red or will have the colours of all the Doshas
Consistency of the urine: Thick
Appears like the colour of: Gorochana (Bile of the cow) or Shanka churna (Conch powder)
Vit means faeces, Vighata means obstruction.
In the individuals with dry nature (vata prakriti) and who are debilitated, often vata aggravates and the stools are derived upwards (retrograded). Meanwhile, vitiated Vata moves through the urinary tract and enters the bladder. Due to this, the individual excretes urine with the smell of stools. Difficulty in micturition is associated with mild pain.
It is found as surgical complication in few of the surgeries related to the abdominal organs or uro- genital system.
Rooksha durbalayoho vaatena udaavruttaM shakrut yadaa
Mootra sroto anupadhyeta vit samsrushtam tadaa naraha
Vid vgandham mootrayet kruchraat vid vighaatam vinirdishet (Ref – Ashtanga Hrudaya Nidaana)
When the vitiated Vayu carries the stools of an emaciated or weak person in a reverse (retrograde) direction and reaches the urinary bladder, the person suffers from a disease called Vidvighata.
Its symptoms are:
Passing of urine mixed with faeces
Passing of urine having smell of faeces
This condition can be compared to Recto-vesical fistula
13. Basti kundala
Long travelling or heavy brisk walk, jumping, falling, physical exertions, injury etc may cause the disposition / prolapse of the urinary bladder. Due to this, the bladder will bulge and attain upward protrusion. This causes severe pain, pulsation, burning sensation and distress. This ultimately leads to interrupted urine, pain and stiffness, cramps, distress in the lower abdomen (supra pubic area), heaviness etc.
This is common in accidental injuries, sports injuries, wrestling, stampede etc.
Drutam adhwa langhanam aayaasaihi abhighaataat prapeedanaat
Sva sthaanaat vastihi udvruttaha sthoolaha tishtati garbhavat
Shoola spandana daaha arto bindum bindum sravati api
Peeditaha tu srujet dhaaraam samstambho udveshtanam artimaan
Vasti kundalam aahuhu tam ghoram shastra visha upamam
Pavana prabalam praayo durnivaaram a buddhibhihi (Ref – Sushruta Uttara 58)
The Basti (urinary bladder) will get displaced from its place in an upward direction or will get inverted and starts looking like a foetus when the below said are done on a regular practise
Exertion exercises or activities
Or due to injury or pressure
Such a bladder presents the below said symptoms:
- Dribbling of urine
- Urine comes out in stream when the bladder is pressed
- Stiffness of the body
This disease is called Vastikundala.
This is a dangerous disease. It is harmful like a sharp instrument or poison. Vayu predominantly causes this condition and it is difficult to treat.
General line of treatment of obstructed urine
The general line of treatment of urinary obstruction includes oleation (snehana), sweating therapy (swedana), oleaginous purgation (snigdha virechana), enema (basti) and urethral enema (uttara basti). Among the oral medications, priority is given for soothing, coolant, sweet and unctuous- diuretic (mutrala) substances.
Single drugs useful in urinary retention / obstruction
1 Punarnava – Boerhavia diffusa Linn.
2 Usheera – Vetiveria zizanioides (Linn.) Nash.
3 Sariva – Hemidesmus indicus Schult.
4 Chandana – Santalum alba Linn.
5 Gokshura – Tibulus terrestris Linn.
6 Pashanabheda – Bergenia ligulata (Wall.) Engl.
7 Bala – Sida cordifolia Linn.
8 Shatavari – Asparagus racemosus Willd.
9 Phalgu – Ficus carica Linn.
10 Ikshu – Sugar cane – Saccharum officinarum Linn.
11 Durva – Cynodon dactylon (Linn.) Pers.
12 Guduchi – Tinospora cordifolia (Willd.) Miers.
Formulations recommended in Urinary retention / obstruction:
1. Gokshuradi guggulu
3. Punarnavadi guggulu
5. Chandraprabha vati
6. Trinapanchamoola kashaya
7. Chandrakala rasa
8. Veerataradi kashaya
9. Godanti bhasma
10. Vastyamayantaka ghrita
11. Varunadi ghrita
12. Trikantaka ghrita
Wholesome diet in obstructed urine
1. Sugar cane juice (ikshurasa)
2. Milk (dugdha)
3. Warm water (ushnodaka)
4. Dry grapes – raisins (draksha)
5. Alkaline substances (kshara)
6. Water melon (karkati)
7. Musk melon (mamsa karkati)
8. Cucumber (trapusa)
9. Ash gourd (kooshmanda)
10. Fruit juice (phalarasa)
11. Thin rice gruel (manda)
12. Rest (vishrama) etc
Unwholesome diet in obstructed urine
1. Heavy exercise (vyayama)
2. Spicy food (vidahi ahara)
3. Exhaustion (shrama)
4. Dry food (rukshahara)
5. Junk food (paryushiata ahara)
6. Sexual indulgence (vyavaya)
7. Awakening / reduced sleep (jagarana)
8. Suppression of natural urges (vegarodha)
9. Bitter gourd (karavellaka)
10. Pulses – dicotyledons (shimbi dhanya)
11. Frozen beverages (ati shaityata)
12. Incompatible food stuff (viruddhashana) etc
Dear easy Ayurveda readers, I find pleasure in narrating all the hidden facts related to the simple but grave complaints like urinary retention. Even though the symptom may remain the same, the underlying patho-physiology is quite severe. This appears true in many diseases. So it is told in classical Ayurveda literature that the enemies (enmity) and diseases should be checked as and when they originate and one should not wait till it completely flares up.