Article by Dr Raghuram Y.S MD (Ay)
Urge to void urine is a natural reflex and body’s command when it wants to throw away the excess fluid in the system. The pressure from a ‘filled urinary bladder’ is very difficult to ignore. The urge frustrates you until you let it go.
Some know how important it is to attend the natural calls. But still many of us try to hang on with the urge when we are in the middle of some important work. Work is important, accepted that it is also worship but prioritising it over our health will be too expensive affair!!
Holding on to the urine reflex once or twice is fine, but when we do it on regular basis, the urinary bladder which knows how to evacuate urine will gradually learn to hold it!!
The organ gets damaged in due course of time, so does its pathology. Urine is a metabolic waste; it carries many unwanted things, fluid and toxins while getting voided from our system. Holding on to the reflex of urine will put retrograde pressure on the organs of urine production and voiding and in due course of time will cause many diseases related to uro-genital system and also many systemic disorders.
One of the strangest and awkward feel we all would have experienced is when we have the urge and urgency to evacuate our bowels and when we are not able to do it!!
So what do you do?
Well, it is not a complicated affair to understand, it is very simple!! When the body gives a signal, just address it, acknowledge it, spare a minute or two; pee-off and relax!!
When the body wants to expel something which is harmful to our body, we should obey the signals and facilitate the mechanism to go on in a smooth way. We should never meddle with the ‘smooth functioning of our body’. By doing so, we become the culprits and hostile to our own system.
When body gives a call for natural urges, just obey and respect them against all the priorities. By doing this we would be facilitating and co-operating with the natural cleansing and detoxification process of the body. This is the key to enjoy ‘health at its best’.
Forcibly suppressing the ‘urge to urinate’ is called ‘mutra vega dharana’ in Ayurveda. This has a bad impact on the body-mind health.
Vega is body’s expression to ‘discharge something or put some undesired thing out of the body’
These impending reflexes are called ‘Adharaneeya Vegas’ or the urges of the body (natural calls) which should not be held back forcibly.
Vegas are signals of auto-detoxification –
The body needs to keep itself in pure, sterile and healthy condition. For this to happen, the body needs to throw some unwanted things regularly out of the system, as and when they are produced. By doing so, the body protects itself against damages and diseases caused from retaining those things.
If these unwanted things are held back, they might produce damage to the system in due course of time by contaminating the body elements.
With this, the body conducts a self servicing and self maintenance of itself, monitored by the basic inbuilt intelligence of the ‘body-mind-system’.
What to do when the vegas are manifested?
When these vegas are manifested, we should not hold them back, in fact help them out. We have to attend the urges as and when they arise.
On the other hand, these reflexes should not be artificially created!!
Mutra Vega Dharana
Impact of Mutra Vega Dharana on body-mind health –
Mutra is a metabolic waste and according to Ayurveda, is formed as an end product of digestion. Mutra is one among the 3 malas, i.e. 3 forms of metabolic wastes. Pureesha (stools) and Sweda (sweat) are the other 2 malas. Body cleanses itself of unwanted materials, and toxins by evacuating them through these 3 forms of mala. Solid waste is expelled through stools and liquid wastes are expelled mainly through urine and a small part of it is expelled through sweating process.
‘Mutrasya Kleda vahanam’ is the function of mutra. This means to tell that Mutra helps in expelling the kleda (unwanted fluid) from the body. This unwanted fluid is formed during metabolism, a large part is formed during the gut metabolism (digestion in the stomach and intestines) and a small part of it is formed during cellular metabolism.
The food which we take is acted upon by Pachaka Pitta located in the amashaya (stomach and upper part of intestine). This Pitta is also known as Pachaka Agni or digestive fire. This fire digests the food and bifurcates it into sara and kitta bhaga i.e. useful and waste components.
The sara bhaga becomes rasa (nutritional essence, lymph or plasma) and doshas (vata, pitta and kapha).
Waste parts are bifurcated into solid waste (pureesha) and mutra (urine).
Thus, urine is formed as an end product of digestion, which is later processed, scanned and voided through mutrashaya (kidneys and urinary bladder), which are considered as mutravaha srotas (channels which carry the urine out of the body).
Urine is thus the unwanted water or fluid component of the body which is voided on daily basis.
When the mutra gets filled in urinary bladder, it creates pressure on the walls of the bladder and there is an urge to void. This urge to void the urine is called ‘mutra vega’.
The expulsion of Mutra takes place with the help of a properly functioning Apana Vata. Apana Vata is one of the 5 sub-types of Vata which is located in the lower portion of the body and is responsible for the excretion of urine and faeces. It is also responsible for ejaculation of semen and menstruation, coordinated movements of the lower parts of the body, the lower back and joints of the lower limbs.
Apana Vayu controls the functions of uro-genital system and large intestine, sexual functions and menstrual functions and coordinated movements of lower back and limbs. All these functions take place in a coordinated and balanced way if apana vayu is at its functional best.
Thus Mutra is formed by the coordinated functions of Pachaka Pitta and its helper Samana Vayu (which lay in the proximity of pachaka pitta) and is voided with the help of apana vata.
Apana vata dysfunctions lead to excessive or scanty urination, obstruction of urine too.
When we try to hold on to the reflex of urination on regular basis, it becomes habituated. With passage of time, the apana vayu gets disturbed due to regular suppression of urinary urge.
When we forcibly suppress the natural urge to urinate, we would be disturbing the normal functioning of Apana Vayu. The Vayu gradually learns to hold the urine, faeces and gases instead of expelling them. The muscles and layers of the urinary bladder also are trained to hold the urine over a period of time. This may lead to urinary obstruction, hypertrophy of urinary bladder, uro-genital disorders, impotence, benign prostatic hypertrophy (in men), menstrual disorders (in women), diabetes and other serious systemic disorders. By imparting pressure on the colon, the urinary bladder may cause constipation and other disorders of large intestine. Since apana vayu controls the functions of all these organs, they will all be afflicted when Apana Vayu gets disturbed.
Colon is not only the chief site of vata, but also is the controlling station of all the activities of the body. It is also a control station and coordinating point of all the subtypes of vata.
When we practice holding on to the ‘urination reflex’ it not only will disturb the functioning of apana vata but will also impact on the smooth functioning of the other subtypes of vayu, pitta and kapha.
Udavarta – The apana vayu disturbed and vitiated as a consequence of repeated and habituated ‘mutra vega dharana’ will tend to move haphazardly in abnormal directions, mainly in the upward direction. This abnormal movement of Vayu will impart pressure on the abdominal and thoracic viscera and will impair their functions.
This abnormal movement of Vayu will also put pressure on urinary bladder, uterus, and genital system leading to various disorders related to these systems. This condition of upward movement of Vayu is called Udavarta.
The Udavarta caused by the forcible suppression of mutra vega is called ‘Mutravega Avarodha Janya Udavarta’ i.e. ‘pathological movement of vayu in upward direction due to habituated forcible suppression of urge to urinate’.
This will not only create disorders related to urinary bladder or kidneys, but will also have a disturbing and damaging impact on the whole system.
Mutra vega – urge to pass urine, urge for urination, effects of suppression
Vasti Mehanayoho shoolam mootra krichchram shirorujaa
Vinaamo vankshana aanaahaha syaat lingam mootra nigrahe (Ref – Charaka Sutra 7/6)
Mootrasya vege abhihate naraha tu kruchchrena mootram kurute alpam alpam
Medhre gude vankshana mushkayoho cha naabhi pradesheshu athavaa api moordhni
Aanaddha vastihi cha bhavanti teevraaha shoolaha cha shoolaihi iva bhinna moortehe (Ref – Sushruta Uttara 55)
The symptoms of forcible suppression of ‘urge to urinate’ are as below mentioned –
- Vasti shulam – Pain in the urinary bladder (hypogastric region), below navel region
- Mehana / Medhra shulam – Pain in the penis (genitals)
- Mutra krichchram – Difficulty in urination, dysuria
- Shirorujam / Murdhni Shulam – Headache
- Vinaama – Bending of the body due to severe pain
- Vankshana anaha – Swelling and discomfort in the lower abdomen and groins due to distended bladder
- Alpam alpam mutram – scanty urination with frequency of urination
- Guda shulam – Pain in the anal region
- Vankshana shula – Pain in groin
- Mushka shula – Pain in testes
- Nabhi shula – Pain in the navel region
These symptoms are caused due to obstruction in the urinary bladder.
Common principles of management of disorders arising due to forcible suppression of vata (flatus), pureesha (stools or faeces) and mutra (urine) vegas –
Sweda abhyanga avagaahaaha cha vartayo vasti karma cha
Hitam pratihate varchasya anna paanam pramaathi cha (Ref – Charaka Sutra 7/9)
The above said conditions should be managed by administration of –
- Swedana – sweating therapy, fomentation, sudation
- Abhyanga – herbal oil massage (general body massage and local massage around the pubic area, abdomen, pelvic region and around the genitals can also be done)
- Avagaha – tub bath or sitz bath in herbal liquids like decoctions, oil, milk etc
- Varti (rectal and or urethral suppositories)
- Vasti karma – therapeutic enemas with medicated (herbal) decoctions, oils, ghee and or milk
- Pramathee anna pana (Vid bhedi annapana) – foods which help in easy passage of stools
Specific management of disorders caused due to forcible suppression of ‘urge for urination’
Sweda avagaahana abhyangaan sarpishaha cha avapeedakam
Mootre pratihate kuryaat trividham vasti karma cha (Ref – Charaka Sutra 7/7)
Mootrajeshu tu pane cha praag bhaktam shasyate ghrutam
Jeernaantikam cha uttamaaya maatrayaa yojanaat dwayam
Avapeedakam etat cha sanjgnitam (Ref – Ashtanga Sangraha Sutra 5)
The specific treatments for diseases occurring due to forcible suppression of urge to urinate are:
- Swedana – Sudation
- Avagahana – Tub bath
- Abhyanga – herbal oil massage
- Avapeedana Ghrita – Ghrita or medicated ghee should be administered before the food. Again, after the digestion of the food, the medicated ghee should be given in uttama matra or larger dose. This is called as avapeedana ghrita or avapeedana sarpi.
- Trividha Vasti Karma – 3 types of medicated enemas should be administered in this condition. They are:
Uttara Vasti (enema wherein medicated oil or ghee or medicated milk or decoction will be administered through urethra (urinary passage) or vaginal (birth passage) routes
Abhyanga (massage) and Swedana (sudation) –
This combination is antagonistic to vata. They combat Udavarta and set right the movements of vata. The combination also helps in combating urinary obstruction, constipation and other symptoms caused due to vata vitiation.
The unctuous nature of medicated oils and ghee are antagonistic to the rukshatwa (dry nature) of Vata. Similarly the ushna (hot quality) guna of swedana is antagonistic to the sheeta guna (cold quality) of Vata.
Thus Snehana in the form of Abhyanga along with Swedana combats vata and help in alleviating the symptoms caused by mutra vega dharana.
The pressure and strokes given during Abhyanga, especially over the tummy will normalize the movements of Apana Vayu.
The dual treatment –
- Opens up the blocks in the channels
- Relaxes the nerves, enhances the blood circulation
- Relax the muscles
- Open up the channels and release the pressure on the viscera caused by upward movement of vata.
- Normalises Vata and reverses the pathology of Udavarta
- Relieves colic
- Releases pressure on the organs of thorax and abdomen and pelvis
Avagaha (Tub bath) –
Avagaha or body immersion in a tub comprising of hot medicated fluids is a good treatment for these conditions. The large tub, broad and long enough to accommodate one’s body completely is used for Avagaha. We call it Avagaha droni or avagaha tub. It is similar to the bath tub. In this tub is filled the medicated decoctions or milk which is processed with vata alleviating herbs.
The patient is subjected to abhyanga and made to sit in the tub filled with medicaments for 30-45 minutes. Avagaha is a type of swedana because the medicinal liquids are usually hot (tolerable).
This combination of abhyanga and avagaha also acts in a similar way as abhyanga and swedana. The combination bestows the same benefits and destroys the bad effects and symptoms caused by mutra vega dharana.
Internal treatments –
Varti (Rectal suppositories) –
Varti or medical suppositories are wicks made up of medicinal herbs (paste of the herbs), usually of vata alleviating or vata expelling or laxative herbs. Their length and breadth permit their entry into the rectum. They are smeared with medicated ghee or oil and inserted into the anal opening, after smearing the anal orifice with ghee or oil (this facilitates the easy entry of varti into the rectum). The varti is left in place for a couple of hours.
The suppositories stimulate the bowel movements and ease the excretion of stools and flatus (fart). They facilitate free movement of apana vayu in its normal course (downward). With regression of udavarta, the pressure on the urinary bladder and other organs are released. This helps in reestablishment of physiology in the entire body since the vata morbidity is taken care of in its prime centre i.e. colon. This is helpful in addressing apana vayu vitiation and releasing pressure on all the inter-related organs i.e. bladder, bowel and uterus, because when one of these is afflicted with morbidity, it imparts a bad effect on the other organs in the vicinity.
Urethral suppositories can also be used to relieve the pressure in urinary bladder, to relax the muscles and to facilitate easy output of urine and cure retention.
Trividha Basti Karma –
Medicated enemas are unparalleled treatments for combating vitiated vata. These are the treatment in which the medicated decoctions (kashaya vasti), oil and or ghee (sneha vasti) or milk (ksheera vasti) are introduced into the bowel (colon) through the anal route.
In the disorders manifesting due to the forcible suppression of urinary urge, all 3 types of enemas (trividha vasti) should be administered. It doesn’t mean that all 3 have to be simultaneously administered. It is left out to the judgement of the physician. The choice of vasti or vasti combinations shall be made only after considering the nature of pathology and the quantum of vitiation of dosha or doshas.
Both Niruha (decoction) and Anuvasana (oil or ghee) enemas should be administered in combination for better results. The enemas can be given through the anal and urinary tracts. This will address the apana vayu vitiation and also will cure udavarta. The urinary bladder subjected to udavarta in this condition will impart a disturbing effect on the colon also. Thus, uttara vasti also is needed.
The enemas can be skilfully combined to combat and expel vata at its prime centre i.e. colon and thus normalise the movements and activities of vata, reverse udavarta, release the pressure over the visceral organs and colon, helps in excretion of fart, stools and urine and establish health.
Vasti helps in effective cure of symptoms and complications arising from mutra vega dharana.
Pramathi annapana or vid bhedi annapana (foods which help in breaking the composition of obstructed faeces and in easy expulsion of stools) –
The food which by the virtue of its natural potency removes the accumulated morbid doshas and wastes (excreta including faeces) from the channels and also expels them is called pramathi dravya or pramathee aushadha. Thus, pramathee dravya can be of 2 types, foods which act as pramathee or foods processed with medicinal herbs which have pramathi quality.
The pramathi dravyas expel the stagnated morbidity from the body and cleanses the channels. On the other side, they also help in regularizing the movements of vata following the removal of morbidity. This reverses the udavarta process and alleviates the symptoms caused by the pureesha, mutra and apana vayu vega dharana.
Avapeedana Ghrita –
This is a type of administering medicated ghee. The medicated ghee is given before the food. The ghee shall be processed with the herbs which are ‘vata-alleviating’ and which rectify the pathology of mutravaha srotas (channels forming and carrying the urine) i.e. mutra rogahara dravyas.
A second dose of medicated ghrita should be administered after the food. This dose would be in a larger dose in comparison to the first dose.
Thus in Avapeeda ghrita, the medicated ghee is administered twice, i.e. before and after the food.
This will control the apana vayu functions and works well in rectifying udavarta. Ghrita is good for vayu and pitta. The medicated ghee will also remove the inflammation occurring in the organs due to vitiation of pitta and vayu. Ghrita also acts as a good laxative and help in easy expulsion of stools, fart and urine.
What does modern science say about ‘holding in pee
The habit of holding the pee can lead to grave consequences over a period of time.
All those periods of retention of urine while holding pee as a habit, can produce severe urinary infections, bacterial infections that affect the urinary tract and causes the diseases therein. This happens of the germs which settle in the bladder for long duration. In due course of time and when this condition is neglected, the infection can ascend to spread to the kidneys. This will lead to much more serious conditions. They are as follows:
Kidney stones – People who have already suffered and or treated for kidney stones and those prone for developing stones should be cautious and should never hold their pee. This can lead to stone formation in urinary tract. Kidneys eliminate excess sodium and calcium from the body on regular basis. If the pee is held for long times as a habit, the kidney will not be able to flush these things out of the body. These minerals which do not get expelled from the body through urine get deposited and form stones. These stones when grow up in size will produce severe pain and other complications.
Prone to infections – Holding in large amounts of urine for an extended period of time also exposes your body to potentially harmful bacteria, which can increase your chances of getting Urinary Tract Infection (UTI) or bladder infection. Later you become prone to frequent infections.
Cystitis – means inflammation of the bladder. It chiefly affects the women. It presents with pain in the pelvis, burning sensation and pain while passing urine. Frequency of urine is more and the sufferer is forced to visit the washroom many times. The quantity of urine is minimal.
Weakening of bladder walls and urinary retention – Constantly holding your pee can weaken your bladder muscles which could lead to urinary retention, the dreaded condition that prevents you from being able to fully empty your bladder when you pee, which means you feel like peeing a lot.
Other consequences and adverse effects –
- Constant and strong pain while urinating
- Shivering chills (cold)
- Tummy pain
- Difficulty concentrating on anything other than the desire to pee
Related reading – http://steptohealth.com/problems-holding-your-pee/
Curious case of Brahe’s Bladder Burst –
Tycho Brahe, was a Danish astronomer and alchemist belonging to 16th century. He was a good scientist who has contributed to the scientific literature on everything from supernovae, comets, and planetary orbits. The cause of his death is ridiculous. He reportedly refused to leave a banquet to relieve self because he believed it to be a breach of etiquette, but once he got home, he found he was unable to pee at all. He descended into delirium and died soon after when his entire bladder burst.
If bursting happens, it’s almost always because the bladder was already damaged for some reason. The good news is that Brahe’s bladder was not like most – in the majority of cases like this, a person will just wet selves before any bursting occurs. There have been cases where people’s bladders burst because they were too drunk to notice the signal from their brain telling them to pee.
Who generally hold the urge to pee?
Those who give top priority to mails, messages, conferences and discussions, at the peak of which they consider attending the natural urges including that of peeing secondary. They just want to finish the works and the go to the washroom.
Many people, especially women who do not like to evacuate their bladder while in someone else’s company like dating, or in a party or public function or celebration and also feel shy to ask someone to provide their restroom for peeing.
Reluctance of using public toilets or toilets in ‘open areas’ or in trains (while in travel) because of fear of ‘unclean toilets and chances of hiring infection’
Those habituated of holding the urinary urge while prioritising other works like women in ‘morning blues of finishing the household works and dispatching family members to work’, students in classroom, etc
Those who have bathroom procrastination, an obsessive habit of postponing going to the bathroom due to laziness
Just before finish –
We need to allow the body to function normally, without intervening into any of its proceedings. When they are let alone to get expelled from time to time, the vegas will help us maintain our health.
‘Just listen to your body language and respond accordingly, don’t meddle with its functions and enjoy good health’.
Remember, ‘When you need to pee, just pee…nothing else!!’
Click to Consult Dr Raghuram Y.S. MD (Ayu) – email/ skype