Mutrakrcchra (Dysuria) is of eight types which are as follows;
1-4.Dysuria is caused due to aggravated vāta, pitta, and kapha individually, and all the doṣa aggravated simultaneously (sannipatika) , 5 . Dysuria is caused due to calculus in the urinary tract.
6. Dysuria is caused due to sarkara (granules) .]
7. Dysuria is caused due to diseases of semen .
8. Dysuria is caused due to kshata (trauma) to urinary tract.ver.
Significance of vata doṣa in normalcy and disease condition has been mentioned in Ca. Su. 12 and Ca. Ci. 28 but considering the disease affecting the three marma, vata needs to be understood for various somatic diseases. Vata is the primary doṣa in udavarta and later complicates into various psyco-somatic disorders. Similarly, in urine formation vata doṣa has significant role which may be understood as follows. Vyan vayu is the one which regulates the cardiac output thus maintaining the systolic pressure in the renal vessel. Saman vayu maintains the electrolyte and chemical balance by absorbing and filtering the electrolytes.The hydrostatic pressure gradient across the glomerular capillary wall is the primary driving force for glomerular filtration.Oncotic pressure within the capillary lumen, determined by the concentration of unfiltered plasma proteins, partially offsets the hydrostatic pressure gradient and opposes filtration. As the oncotic pressure rises along the length of the glomerular capillary, the driving force for filtration falls to zero before reaching the efferent arteriole.Several factors, mostly hemodynamic, contribute to the regulation of filtration under physiologic conditions. The energy required at cellular level is generated by converting the ADP to ATP and this is coordinated by udan vayu which is the stimulant (pravrittimulak) whereas Pran vayu is the controller as well as it is the receptor which understands the acid base balance within the blood. Autoregulation of glomerular filtration is the result of autonomous vasoreactive (myogenic) reflex in the afferent arteriole which is brought about by pran vayu. Lastly apan vayu has the role to help excretion. The action of apan is seen at the distal collecting duct level.
Susruta describes Pittaja and Kaphaja types of Mutraukasada as two different conditions. In Pittaja Mutraukasada he describes that on drying, the urine resembles Gorocana curna and in case of Kaphaja variety, on drying the urine becomes like Sankha curna.
Asmari (calculus) is of four type Vataja, pittaja, Kaphaja, sukraja.
Withholding the urge to urinate causes vāta to get obstructed in its normal pathway which causes Udāvarta (reversal of movements) and thereby the Mutra fills up in the Udara producing inconsistent pain, sense of indigestion, obstruction to the flow of Mutra.
Indulgence in sexual intercourse by a person with active urge to micturate causes affliction of the dislodged Sukra which flows either before or after the urine stream and this is called MutraKrcchra.
Mutrakriccha is defined as a condition where an individual finds it difficult to pass urine and it is associated with severe pain. The cause may be understood at two levels i) at the level of glomerular filtration or formation of urine and ii) at the level of the passage of urine i.e. in calices of kidneys, ureters, bladder, urethra, penis/ vagina.
Various types of crystals which pass through the glomerular filtration form an important cause for irritation of urinary tract cells. Crystals of uric acid, calcium oxalate, phosphate contribute to difficulty in passing urine. Increase acidic pH of urine also causes painfull and difficulty in passing urine.
Urinary tract infection: In the majority of UTIs, bacteria establish infection by ascending from the urethra to the bladder. Continuing ascent up the ureter to the kidney is the pathway for most renal parenchymal infections. Any foreign body in the urinary tract, such as a urinary catheter or stone, provides an inert surface for bacterial colonization. Abnormal micturition and/or significant residual urine volume promotes true infection. In the simplest of terms, anything that increases the likelihood of bacteria entering the bladder and staying there increases the risk of UTI. Bacteria can also gain access to the urinary tract through the bloodstream.
In women, vaginal ecology is an important environmental factor affecting the risk of UTI. Colonization of the vaginal introitus and periurethral area with organisms from the intestinal flora (usually E. coli) is the critical initial step in the pathogenesis of UTI. Sexual intercourse is associated with an increased risk of vaginal colonization with E. coli and thereby increases the risk of UTI. Nonoxynol-9 in spermicide is toxic to the normal vaginal microflora and thus is likewise associated with an increased risk of E. coli vaginal colonization and bacteriuria. Any condition that permits urinary stasis (vegadharan) or obstruction predisposes the individual to UTI. Foreign bodies such as stones or urinary catheters provide an inert surface for bacterial colonization and formation of a persistent biofilm. Thus, vesicoureteral reflux, ureteral obstruction secondary to prostatic hypertrophy, neurogenic bladder, and urinary diversion surgery create an environment favorable to UTI.
Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..