By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Urethritis means inflammation of the urethra. Urethra is a tube which carries urine from the urinary bladder to outside the body. The main symptom of urethritis is pain with urination. It may be commonly caused due to infection by bacteria.
Read more about Urethritis – Modern View
Causes
E. coli and other bacteria present in the stools
Gonococcus – is transmitted sexually, causes gonorrhea
Chlamydia trachomatis – is transmitted sexually and causes Chlamydia
HSV-1 & HSV-2 (Herpes Simplex Virus)
Trichomonas – is transmitted sexually
Read – Upadamsha – Treatment For Sexually Transmitted Disease
Pathology
Bacteria enter the urethra from the skin around the opening of the urethra. The urethra may also be infected by one or the other organism mentioned above. Infection by these organisms will cause inflammation of the urethra. This condition is called urethritis. (Read more)
Symptoms
Pain with urination
Frequency – feeling the urgency to urinate
Difficulty in starting the urination
Itching, pain or discomfort – even when the person is not urinating
Pain during sex
Discharge from urethral opening or vagina
Blood in semen or urine
Read – Vaginitis: Ayurvedic Treatment, Medicines, Home Remedies
Treatment
Urethritis is usually treated by course of antibiotics.
Urethritis In Ayurveda
Probable Ayurvedic correlation
We cannot find an exact correlation for urethritis in Ayurveda texts.
Coined terms – Urethra, in Ayurveda is called mutrapraseka. In urethritis there is inflammation of urethra. Inflammation is called Shotha in Ayurveda. Combining these words we can call urethritis as ‘mutrapraseka shotha’ in Ayurveda terms.
Read – Dysuria: Causes, Remedies, Tips, Diet, Ayurvedic Treatment
Mutrakrichra – Since pain with urination / difficulty in urination is the chief symptom of urethritis, it can be compared to a similar condition named mutrakrichra in Ayurveda. Mutra means urine. Krichra means difficulty in passing urine or pain / discomfort while passing urine.
Out of eight types of mutrakrichra, vataja and pittaja types of the disease present with painful urination and frequency of urination.
Kaphaja type of the disease has discharges from urethra which is an important symptom in urethritis.
Sannipataja mutrakrichra is caused by all three vitiated doshas and has symptoms of aggravation of vata, pitta and kapha. It is said to be a difficult condition to cure.
The other types of the disease which is caused by shalya abhighata i.e. injury by a foreign substance, shakrut vighata i.e. by forcibly withholding the urge of defecation, ashmarija i.e. that caused by formation of stones in urethra and shukraja i.e. caused by semen afflicted by doshas shall not be considered for correlation since the modern texts too do not give these etiologies for urethritis. But if urethritis is caused due to any of these causes, the cause should be isolated and treated accordingly. Example, if stones are found in the urinary tract, treatment for stones (ashmari) shall be given and then followed by treatment of mutrakrichra. Similarly if constipation is causing pressure on the urethra and causing symptoms of urethritis, herbal laxatives shall be administered, constipation shall be dealt with and later the treatment of mutra krichra shall be administered.
When there is severe pain and urgency, it shall be considered as vata predominant. When there is severe burning sensation and other signs of inflammation, it shall be considered as pitta predominant. When there is itching and discharges from urethra, it shall be considered as kapha predominant. When the symptoms are in mixed proportions it is tridoshaja or sannipataja.
Mutrotsanga – Mutrotsanga is one of the 13 types of mutraghata i.e. ‘obstruction of urine’. It is said to be caused by vitiated vata. The urine in spite of being voided gets obstructed in the urinary bladder, shaft of the penis (urethra) or glans penis (incomplete evacuation). When the person tries to void the urine with force, the urine comes out in small quantities with or without pain mixed with blood. This may be a consequence of scar tissues formed in the urethra and subsequent stricture of urethra following gonorrhea.
Read – Urinary Obstruction: Causes, Types, Symptoms, Ayurvedic Treatment
Ushnavata – Ushnavata too is a type of mutraghata. It is said to be caused by vitiated vata and pitta causing inflammation of urinary bladder, penis and rectum / anus. In this there is passage of urine mixed with blood, only blood or urine having turmeric / yellowish color. Difficulty in passing urine and urination in small quantities is the chief complaints of this condition. This is caused by excessive exercise, walking and exposure to sun. This condition is considered to be manifested due to cystitis or urethritis following infection with gonococcus or any other organism.
Bhrushoshnavata – There is a condition called bhrushoshna vata explained in Madhava Nidana treatise and has been compared to gonorrhea. Some of the symptoms of the disease include pain in the penis and urethra, discharges, frequency and obstruction of urination. The treatment of the same has not been given in Ayurveda ancient texts.
Read – Effects Of Constant Holding Urine: Ayurvedic Treatment
Causative factors
All the etiological factors mentioned for the diseases mentioned in Ayurveda correlation of urethritis shall be considered in this context. Few important etiological factors are –
Excessive physical activities
Tikshna aushadha – strong medicines
Ruksha padartha – excessive consumption of dry (devoid of fats) foods
Excessive consumption of alcohol
Excessive indulgence in sexual activities
Druta prushta yana – quick rides on animal backs, regularly
Anupa mamsa – excessive consumption of meat of animals and birds living in marshy areas Adhyashana – eating too soon after a meal, before the previously taken food has been digested
Indigestion of food
Samprapti – Pathogenesis
Pathogenesis of mutrakrichra – The vata, pitta and kapha, on getting vitiated by their respective etiological factors, get vitiated either individually or all together and reach the urinary bladder. On reaching there, they cause constriction, compression or irritation of the urinary passages (urethra) and cause difficulty and pain during urination.
Doshas – vata, pitta and kapha, individually or all together
Dushya – mutra (urine), mamsa (fibromuscular layer of urethra)
Srotas – mutra vaha srotas i.e. channels of transportation of urine
Sroto dushti prakara i.e. type of contamination of channel – sanga i.e. obstruction to passage of urine
Read – Ayurvedic Home Remedy For Urine Infection And Painful Urination
Lakshana – Signs and symptoms
Vataja Mutrakrichra – severe pain in the groin, urinary bladder and penis, frequency of urination and discharge of urine in small quantities.
Pittaja Mutrakrichra – discharge of yellow colored or blood mixed urine, presence of pain and burning sensation during urination.
Kaphaja Mutrakrichra – heaviness and swelling of urinary bladder and penis and discharge of sticky urine (discharges).
Sannipataja Mutrakrichra – presence of the symptoms of all vata, pitta and kaphaja mutrakrichra in mixed proportions.
Chikitsa – treatment principles
Line of treatment of Mutrakricra –
General approach – since pain with urination is the chief complaint of this disease, it shall just be treated on general lines of treating mutrakricra
Dosha specific approach – depending on the symptoms of the disease, it shall be treated on the principles of treating vataja, pittaja, kaphaja or sannipataja mutrakrichra
Other principles
Mutraghata Chikitsa – line of treatment of obstruction of urine
Shotha Chikitsa – line of treatment for treating swelling and inflammation
Ashayapakarsha Chikitsa – line of treating pitta pulled (displaced) into the lower parts of the body which basically are seats of vata should be adopted. Pitta is pulled downwards by suction of vata, mainly apana vata. Here measures and medicines to alleviate vata and pitta should be adopted.
Panchakarma
Virechana and Vasti are the best Panchakarma options for treating chronic urethritis. While purgation combats vitiated pitta and helps reduce inflammation, enema combats vitiated vata and prevents recurrences.
In severe cases, virechana can be carried out methodically after giving oleation and sudation. If urethritis is a symptom of some systemic disorders associated with inflammation in many parts of the body, sudation shall be given in moderation. Trivrit Lehya is the best formulation and is a safe one too.
If urethritis is associated with mild to moderate symptoms, and if vata symptoms are predominant, snigdha virechana i.e. unctuous purgation using medicated oils shall be used. Nimbamritadi Eranda Taila or Gandharvahastadi Eranda Taila which are castor oil based purgation can be administered. Plain castor oil also shall be given. Nimbamritadi Eranda Taila fights both vata and pitta. Since these are effective purgatives, they also relieve constipation which causes urethritis due to pressure on urinary apparatus. These medicines can be given in small and effective doses of 5-15 ml at bedtime with hot water or hot milk after accessing the compatibility and dosha predominance. They can be given every day until the symptoms are relieved.
Other effective purgative medicines to control vata and pitta which can be given regularly are –
Avipattikara Churna – especially in pitta predominance
Sukumara Ghrita – 5-10 grams mixed in hot milk
Tiktaka Ghrita – 5-10 grams mixed in hot milk
Shatvari Ghrita – 5-10 grams mixed in hot milk
Drakshadi lehyam – 5-15 grams at bed time
Enema shall be given with Erandamuladi Ksheera Vasti or Dashamula Ksheera Vasti. On alternative days unctuous enema shall be given with Guggulutiktaka Ghrita, Ksheerabala Taila or mixture of both.
Upakarmas
Avagaha Sweda – tub or sitz bath in decoction of dashamula will relieve pain and dysuria.
Lepa – an anointment of paste prepared from the below mentioned herbs grinded in kanji i.e. fermented drink, over the region of urinary bladder enables quick and easy expulsion of urine and reduces pain.
Fruits of Tribulus terrestris
Radish
Vida salt
Seeds of Ervaru – Cucumis melo
Seka – the region of the urinary bladder should be applied with castor oil. Following this, the region should be sprinkled with warm / hot decoction of flowers of Butea monosperma. Hot water fomentation too will help.
Useful medicines and herbs
a. Classical formulations
Shatavari Ghrita
Vastyamayantaka Ghrita
Trikantakadi Guggulu
Chandraprabha Vati
Gokshura churna boiled with milk and mixed with ghee
Loha Bhasma – ash / calx of iron taken mixed with honey
b. Patent formulations
Tablet Bangshil
Syrup Chandansudha and Chandramshu
Tablet Gonanti
Mutrala Kwatha
Tablet Oruclyn
Capsule Rentone
Syrup Sariba
Capsule Calcurosin
Syrup Criston
Tablet Cystone
Tablet Diureston
Capsule Gravel
Capsule Oxtone
Tablet Aluretic
Capsule Ural
Immunocin
Capsule Nalcer
Capsule/tablet Step
Herbs and dietetic inclusions
Gokshura – Tribulus terrestris
Dashamula – ten herbs
Shatavari – Asparagus racemosus
Amalaki – Emblica offcinalis
Draksha – Vitis vinifera
Barley
Trina Panchamula
Shilajit
Yava Kshara
Dadima – Pomegranate
Ela – cardamom
Kharjura – dates
Ikshu – sugarcane
Chandana – sandalwood
Old rice and red variety of rice
Meat of animals living in desert regions
Soup of green gram
Sugar
Buttermilk prepared from milk of cow
Milk
Curds
Old-white variety of ash gourd
Pointed gourd
Coconut
Ghee
Exposure to cold air
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