The Ayurvedic term of Mutramarga Sankocha correlates with the condition of urethral stricture. In terms of pathology, this is a health problem whereby the urethra becomes narrowed by fibrotic tissue, which causes obstruction in the flow of urine.
In Ayurvedic anatomy (Sharira Rachana) Mutravaha srotas includes Vrukka (kidney), Gavini (ureter), Mutrashaya (urinary bladder) and Mutramarga (urethra). According to Ashtanga Hridaya, urination is a function of Apana Vata, and its vitiation manifests in disturbed urinary functions. Rakta (blood) and Meda (fatty tissue) dhatus are also important as they play a key role in the formation of kidney structure.
Difficult and painful micturition or dysuria is referred to as Mutrakruccha. It is a condition with obstructive uropathology, provoked by a mechanical or functional reason, affecting either the upper or lower urinary tract resulting into partial or complete retention of urine – oliguria/anuria.
Symptoms of this condition include obstructed urine flow, straining, dribbling, and prolonged micturition. This is a chronic disease. Urethral strictures may be congenital, traumatic, inflammatory, and instrumental (repeated catheterization – risk of repeated scar – risk of fibrosis – urethral stricture).
Causes (etiology) according to Ayurveda
- Excessive physical exercise (hard training at the gym) – Vata Prakop or vitiation – increases dryness in the body tissues, which is a predisposing factor for scar formation, leading to pathology in the urinary tract.
- Jobs involving prolonged sitting and travelling – frequent and continuous driving for over 2 hours (routine observed in drivers or professional horse riders) – causes are the same (Vata Prakop); identical consequences as mentioned above.
- Drinking water or taking food while the bladder is full and urge to pass urine is present. This will overburden the bladder and urethral tissue. The abnormal stretching of tissue will lead to irritation. Repeated irritation can cause fibrosis.
- Suppressing micturition – it disturbs nerve functioning.
- Excessive indulgence in intercourse – it can imbalance the function of Apana Vayu.
- Eating flesh of birds (e.g. ducks) or invertebrates (e.g. crabs) inhabiting marshy water basins – it leads to the excessive accumulation of Kleda (a subtle waste product), which puts a burden on the urinary system.
- Exhaustion and injury leads to urinary bladder diseases.
- Trauma to the reproductive organs following surgery – Shastra, Kshar, and Agni (the post-procedure leads to excess fibrosis during the healing process).
Signs and symptoms of Mutramarga Sankocha (urethral stricture)
- Difficult, frequent, painful, prolonged micturition with straining and a small amount of urine;
- Signs of urine retention;
- Pain in the lower abdomen, buttocks, scrotum, or perineum;
- Hematuria (blood in the urine) with a burning sensation;
- Change in the urine color (becoming dark, yellowish, or reddish) – due to stagnation, the urine becomes more concentrated and there is a risk of a secondary infection;
- The urine stream is thin or bifurcated;
- Passage of flakes (desquamated epithelium) in the urine.
Ayurvedic pathogenesis of Mutrakruccha
Mutramarga Sankocha is a clinical entity where in Vata vitiation, specifically of Apana Vayu, sheltered in the Basti and Medhra occurs. Hetu-Sevana results in Vikruti of Apana Vayu; consequently, Chala, Ruksha, Khara Guna increases resulting into local constriction and hardening of tissues leading to constriction of the urethra.
The increase in Chala Guna leads to frequent micturition and causes pain. When Vayu is in the stage of Prakopa, it causes Mutra Sanga, Tod (throbbing pain), Sankoch (stricture), Shosha and Shoola.
Kapha Prakop is manifested with Sthairya as local stasis, Gaurav as heaviness in penis in Mutrasanga, Uplepa (narrowing of the lumen) due to hypertrophied scar tissues, bandha (obstruction to normal flow), and Chirkaritwa (chronicity). Hence, the combination of Vata and Kapha is a causative factor behind Mutramarga Sankoch (urethral stricture).
Treatment of urethral stricture
In modern science, the suggested treatment is urethral dilatation along with surgical treatment. It may cause complications such as bleeding, false passage, and fistula formation. Surgical interventions such as urethroplasty also carry a high risk of recurrence.
Treatment as per Ayurveda
Pathya (healthy diet)
- It is recommended to consume old rice, mung dahl bean, sugar candy, dates, and coconut water – these help facilitate digestion and avoid irritation;
- Include coriander, berries, plums, celery, cucumber, water melon, plums, and barley – these help to soothe the bladder and the urethra passage;
- Drinking enough water will support normal urination.
Apathya (Unhealthy diet)
- Excess meat (frequency should not be more than twice a week), cold food (e.g. from the refrigerator), canned food, refined flour, and salt;
- Avoid alcohol, fish, fresh ginger, fried food as well as excessively hot and pungent food;
- Avoid holding the urge to urinate;
- Excessive sex;
- Prolonged horse-riding as well as riding bikes or motorcycles over bumpy roads in the mountain, continuous travelling
Several Effective Ayurveda Herbs
Gokshur (Tribulus terrestris)
Gokshura is Rasayana and Balya – it is analgesic and Vatashamak, therefore helpful in neural weakness or painful conditions. It is anti-inflammatory and very effective for calculi and cystitis.
Punarnava (Boerhavia diffusa)
Punarnava pacifies all the three doshas, especially Kapha. Due to its Lekhana Karma (scraping action), it has the ability to reduce fibrotic tissues. It has anti-inflammatory properties and is a very good diuretic acting by increasing renal blood flow. Its name suggests that it can help regenerate tissues.
Usheer (Andropogon muricatus)
Usheer is an herb with a cooling effect that increases urine output with a diuretic action. It strengthens the brain, nerves and is a blood purifier. It also pacifies Pitta and Kapha. Usheer is very helpful in burning micturition and dysuria.
This herb helps in reducing deep inflammation and is used for inducing cleaning action. As Mutravaha srotas becomes free from Avarodha (in the form of Aghata) or Avarana caused by vitiated Kapha, vitiated Vata is restored to its normal state. Thus, it normalizes the physiology of Apana Vayu and results into the proper evacuation of Mutra in the form of increased urine flow rate.
The ingredients of Gokshuradi Guggulu are Shunthi, Maricha, Pippali, Musta, Guggulu, Gokshura, and Triphala. It also acts as Rasayana and Balya (gives strength) and helps to strengthen the muscles of Mutramarga.
The ingredients of Chandraprabha Vatika are Kachoor, Triphala, Sadhusana, Trijatak, Yavya kshar, Sarji kshar, Shilagatu, Guggulu, Vacha, Musta, Trivittra, Danti, etc.
Pharmacological action: thanks to the combination of Shilajit and Guggul, fibrinolysis takes place in the urethral stricture. Musta is Amapachak, so it corrects the pathology of Margavarodha Janya and Vata Prakop (cleans obstructions in the urinary system).
Triphala, Trivittra and Danti help in Vata Anuloman – these medicines are Rasayan for the urinary system so recurrence of the urethral problem will be avoided. This product is prescribed even after a surgical intervention in urethral stricture to avoid recurrence.
Other popular products to treat urethral stricture are:
- Trivanga Bhasmam
- Guggulu Panchapala Churnam
- Guggulu Tiktakaghritam
- Vastyamayantaka Ghritam
- Gulguluthiktham Kashayam
- Brihatyadi Kashayam
- Varanadi Kashayam
- Virataradi Kashayam
- Nimbamritadi Panchatiktam Kashayam
- Valiya Madhusnuhi Rasayanam
- Kanchanar Guggulu
Abhyangam and steam bath
The regular use of oil massages with steam bath is a good practice that prevents urethral stricture. Oil massages with Dhanwantaram Tailam are the best.
Avagah Sweda (bath tub)
Avagah Sweda is the most beneficial procedure for urethral stricture. For Avagah Sweda, apply warm Dhanwantaram Tailam oil and sit in a tub bath. Massage and warm fomentation help to pacify Vata and open the channels as well as making the bladder and urethral tissues soft and elastic.
Parisheka (medicated shower)
Pouring a continuous stream of medicated decoctions such as Dashmool oil on the lower abdomen helps to pacify Vata and Pitta. The urge for urination increases as the herbs soften the tissues. The treatment may help retain the effects of the urethral dilatation over a longer time period.
In case of urethral stricture, Uttarbasti can be administered through the urethral route by means of medicated oils, both to male and female patients. The Ushna and Snigdha Guna medicated oils pacify the increased Rukshatwa, Kharatwa and Chalatwa of Apana Vayu, restoring its normal function and thus bringing about Stroto Shodhana and local Snehana actions. Common oils such as Apamarga Kshar oil, Kasis oil, Saindhavadi Taila, and Chandanbala Taila are used in this procedure.
Basti (Medicated Enema)
Mutraghata is mostly a Vata-dominant condition in which Apana is vitiated the most. Basti is the best treatment for Vata and Apana. Your Ayurveda expert may prescribe you a course of Basti, which helps to pacify Vata and soften fibrotic tissues. The options are either Anuvasan Basti (Oil Enema) with Sahachar oil or Niruha Basti (Decoction Enema) with Dashamula.