Dysuria: Causes, Remedies, Tips, Diet, Ayurvedic Treatment

By Dr Raghuram Y.S. MD (Ay).
We feel relieved when we urinate and empty our bladder. Urination is often painful and troublesome for many reasons. Pain (and difficulty) in passing urine is called Dysuria.

What is Dysuria?

Pain, trouble or difficulty in passing urine is called Dysuria. When you have dysuria you will have one or all of the below said symptoms while urinating

• Pain
• Discomfort
• Burning sensation.

Important points

Dysuria is common in women than in men.
In men, it is more common in old age than in younger men.

Tips to prevent dysuria

• Drinking plenty of fluids – flushes the urinary tract
• Urinate at bedtime
• Urinate after sexual intercourse
• Not holding the urge of urine for an excessive amount of time
• Good hygiene
• Women should wipe from front to back after having a bowel movement. They should urinate soon after sexual intercourse to flush bacteria out of the urethra
• Women should keep their genital area clean and dry, change tampons and sanitary napkins frequently and should avoid using irritating soaps, vaginal sprays and douches. To avoid irritation in female children, limit bubble baths, wash girls thoroughly but gently after playing in the sand and be wary of extended play in wet swimsuits, all of which can lead to irritation and redness of the vulva (vulvitis)
• Avoid any irritating product on the outside of your genitals if you are experiencing dysuria
• To help prevent dysuria caused by STD’s, practice safe sex. This includes always using a condom unless you have one steady sexual partner.

Recommended foods

Best foods for Dysuria (Mutrakrichra) as per Ayurveda:

• Puratana Loha shali – Old red rice
• Mudgarasa – soup prepared from green gram
• Sita – sugar
• Takram – Buttermilk
• Paya – Milk
• Dadhi – Curds
• Purana Kushmanda phala – Ash gourd (Old Benincasa hispida)
• Patola – Pointed gourd
• Kharjura – Dates
• Narikela – Tender coconut
• Amalaki – Emblica officinalis
• Ghrita – Ghee
• Prateera neeram – Water of river banks
• Himavaluka – cold sand

Foods to be avoided

Contraindications in Dysuria as per Ayurveda:

• Madyapanam – Alcohol
• Parishramam – Exertion
• Maithunam – Excessive sex
• Yanam – Riding animals like elephant and horse
• Viruddha bhojana – Incompatible foods
• Vishama asana – Uncomfortable seating
• Tambula Bhakshana – Betel leaves
• Matsya – Fish
• Lavanam – salt
• Ardrakam – Wet ginger
• Taila bhristam – Fried foods
• Pinyakam – Dishes prepared from the paste of sesame seeds
• Hingu – Asafoetida
• Tila – Sesamum
• Sarshapa – Mustard
• Mutravega – holding the urge for urination
• Masha – Preparations of black gram
• Teekshna-vidahi-ruksha-amla ahara – Food which is intense and irritating in nature, produces burning on consumption, dry and stale and having a sour taste.

Ayurvedic home remedies

Ayurvedic home remedies for Dysuria:
Home remedies can offer you first-hand remedy in Dysuria as they do in many diseases. They are useful when the symptoms are new and little. Remember that they don’t replace a Doctor’s advice or prescription of an ideal medication. In spite of trying the home remedies for a few days, if Dysuria keeps troubling you constantly, it is wise to consult a doctor.

Gokshura kwatha

The decoction of the whole plant of Tribulus terrestris should be taken mixed with sugar and honey.
It is useful in all types of Mutrakrichra (and Ushnavata type of Mutraghata).

Among the drugs – Gokshura (Tribulus terrestris), Punarnava (Boerhavia diffusa) and Durva (Cynodon dactylon), available ones are taken and decoction is prepared. This is administered twice or thrice daily. It relieves burning micturition.

Guda-Ksheera

Jaggery mixed with hot milk and taken many times alleviate dysuria.
It is also useful to treat Sharkara (urinary gravel) and Vata disorders.

Eladi Yoga

The powder prepared by mixing equal quantity of the powders of:
Cardamom
Gokshura – Tribulus terrestris
The above said powder is taken with honey.

Tree turmeric with Amla

Daruharidra along with the juice of Amalaki – Phyllanthus emblica mixed with honey is useful in curing Paittika type of Dysuria. – Charaka Chikitsa Sthana 26/53

Abhyanga and Avagaha

Massage your lower abdomen with lukewarm sesame oil or some Vata alleviating oil like Ksheerabala taila, castor oil etc
Sit in a tub filled with warm/hot water or with herbal decoctions like Dashamula Kashaya.

Varuna – Crataeva nurvula

is excellent in relieving dysuria
Its decoction is given in 40-50 ml dose, 2-3 times a day.
Varuna twak churna (Powder of the bark of Crataeva nurvula) + Gokshura Churna (Powder of Tribulus terrestris) – are taken in equal quantities and mixed properly. Take 1 spoon of this mixture with water twice daily.

Amalaki – Indian gooseberry

Amalaki (Indian gooseberry) juice (3-4 spoons) mixed with sugar candy powder (1 spoon) – 2-3 servings per day
Dip Amalaki powder, smashed raisins and sugar candy in water overnight and drink this water, the first thing in the morning.

Yava (Barley)

It is one of the best remedies in urinary disorders and diabetes.
Water boiled and cooled with Yava – gives coolant effect, reduces burning sensation and pain associated with dysuria.
It should not be taken after 6 pm because it is a good diuretic and may initiate urination all through the night and mess up with your sleep schedule.

Pashanabheda (Bergenia ligulata)

It is the drug of choice for stones (calculi). If calculi or gravel is the cause for dysuria it is really handy.
1 teaspoonful of its powdered root is given thrice daily.
Decoction can also be prepared with its roots and given for 2-3 servings a day in 40-50 ml doses.

Tulasi kashaya

Boil 10-15 Tulasi leaves (Ocimum sanctum – Basil leaves) in 1 cup of water for 15 minutes.
Strain it through a sieve or sterile cloth.
Add 1 spoon honey and consume warm.
Take at least 2-3 times in a day.

Takra: Buttermilk

Take a lot of buttermilk. Make sure it is not sour. Remove its fat contents and dilute it with twice the quantity of water before taking. Buttermilk should not be refrigerated before use.
1 glass of buttermilk with a pinch of black pepper and / or cumin seeds powder can be taken at regular intervals, around 4-5 times a day.

Cucumber

It relieves burning sensation during urination. Cucumber also brings down the body heat.
Cucumber juice – To 1 cup of juice,  add 1 tsp each of honey and lemon juice. You can also add pepper and salt to it. Take 1-2 servings per day.

Coconut juice

Coconut juice or tender coconut juice
Tender coconut juice is good for dysuria.
Tender coconut water added with with jaggery and/or coriander powder can be used.

Fresh ginger juice

Ginger juice should be taken with honey, it is known for its anti-inflammatory and anti-bacterial properties.
Ginger paste mixed in warm milk or honey helps in dysuria. It should not be taken too frequently.

Carrot juice

Taking carrot juice every day builds up immunity and improves metabolism. It maintains normal pH level of urine and reduces burning sensation.

Radish juice

1 spoon of radish juice 1-2 times a day

Durva – Cynodon doctylon

Durva grass juice (Cynodon doctylon) 1- 1 ½ spoons mixed with warm or fresh milk (1 glass) – 1-2 servings per day
Aloe vera – Juice of aloe vera with warm water or honey relieves dysuria when taken regularly.

Other useful juices

Watermelon juice
Ridge gourd or its juice
Bael juice (juice of Aegle marmelos)

Tamarind

Tamarind pulp mixed with warm water or with tender coconut powder.

Shunti – Dry Ginger

ry ginger powder with sugar candy mixed in warm milk – 1-2 servings per day.

Drumstick

Paste of drumstick leaves mixed with jaggery.

Dhanyaka – Coriander

Coriandrum sativum (Coriander seeds)
Coriander seeds – Have anti-inflammatory properties, protects from infections
1 spoon of coarse powder of coriander seeds is boiled in 1 glass of water. Filter it through a sieve or sterile cloth. Consume when warm.
1 spoon of the powder is soaked in water overnight. It is filtered in the morning and consumed as the first thing – mixed with sugar candy powder. It cures dysuria and burning sensation.

Cardamom

• It is one of the best diuretics. Thus it relieves dysuria. It removes toxins from the blood, prevents bladder stone formation and water retention. 1 spoon of cardamom powder (soft) can be taken with 1 glass of lukewarm milk.
• ¼ to ½ tsp of cardamom powder mixed in a glass of lukewarm milk. Take 2-3 servings per day. It reduces pain and burning sensation.
• Cardamom powder, powder of roasted cumin seeds and sugar should be taken in equal proportions and mixed. 1 spoon of this mixture is taken, mixed with honey or butter, consumed once or twice a day is useful in dysuria.

Cranberry juice – Oxycoccus palustris

Heals UTI, helps recover from bacterial infection.

Honey water, lemon juice

Madhudaka: Frequently taking honey mixed in water.
Lemon juice: Lemon juice mixed in lukewarm water.

Lifestyle and diet changes

Lifestyle changes and diet modulations – Changing lifestyle and food can reduce the chances of Dysuria.

• Water: Drink lots of fluids, especially water, say around 4 litres a day. Hot or boiled and cooled water is the best in removing infections and toxins. It relieves dysuria.
• Sun: Avoid exposure to Sun for long.
• Katu-Amla-Lavana: Avoid Katu (pungent, spicy), Amla (sour) and Lavana (salty) food. They can increase the acidity in your system and also can make your urine more acidic. They increase Pitta and Vata which are chief wrecks in the causation of Mutrakrichra.
• Fruits and vegetables: Take lots of fruits and vegetables.
• Habits: Avoid smoking, alcohol and or caffeine as much as possible.

Causes for dysuria

Infections:
Urinary tract infections (UTI) – They are one of the common and leading causes of painful urination. Infections can occur in any part of the urinary tract including Kidneys, Ureter, Urinary bladder and Urethra.

Infection of Kidneys – Upper urinary tract infection (pyelo-nephritis or kidney infection) – A kidney usually becomes infected because bacteria has travelled to the kidney from an infection in the bladder.

Kidney infections occur more commonly :
During pregnancy
In men with an enlarged prostate
In people with diabetes
In people with abnormal bladder function
In people with persistent kidney stones
In children with an abnormal backflow of urine from the bladder to the kidneys (vesico-ureteral reflux) or an obstruction related to abnormal development of the urinary tract
Pyelonephritis is more common in women than in men.

Infection of Ureters (Tubes carrying urine from the kidneys to the urinary bladder)

Infection of urinary bladder – Lower urinary tract infection (cystitis or bladder infection) – Dysuria is a common symptom of a bladder infection (cystitis). Cystitis is very common in women of 20-50 years age group.

Infection starts when bacteria enters the opening where urine comes out (urethra), during sexual intercourse, wiping with toilet tissue from back to front and other unhygienic activities. From the urethra, bacteria travel upwards to reach the urinary bladder.

In men over 50 years of age, a bladder infection is usually associated with an enlarged prostate or prostate infection.

• Urethra (tube from the urinary bladder which carries the urine out of the body) – Urethritis is an inflammation of the urethra. It is usually caused by sexually transmitted diseases or STD’s (such as Chlamydia and gonorrhoea). Urethritis can be caused by contact with an irritant chemical (antiseptic, bubble bath, spermicides) or by irritation from an object such as a tube (catheter) inserted to drain urine.

Bacteria which gain entry into the urinary tract through the urethra usually cause UTI’s.

Thus, the most common types of infections are:

• Cystitis (infections of the urinary bladder)
• Pyelonephritis (infection of kidney or upper urinary tract infection)
• Prostatitis (infection of prostate)
• Urethritis (infection of urethra)

Risk factors

Risk Factors (Factors that increase your chances of developing a UTI):
Being a woman – Cystitis is very common in women between age groups 20 to 50 years.
Diabetes mellitus
Advanced age
Enlarged prostate
Kidney stones
Pregnancy
Having a urinary catheter in place
People who are sexually active.

Symptoms of UTI

Painful urination
Fever
Foul or stronger smelling urine
Cloudy or bloody urine
Increased frequency or urgency to urinate.

Note:
Sometimes painful urination can be related to a vaginal infection such as a yeast infection.
With vaginal infections, changes in vaginal discharges and odour can be expected.

Sexually transmitted infections or Sexually transmitted diseases (STD) –
Genital herpes, Chlamydia, Gonorrhoea

Symptoms of STD infections:

• Painful urination
• Itching
• Burning sensation
• Blisters or sores in genital herpes
• Abnormal discharges

Inflammation and irritation:
Many problems can lead to inflammation or irritation of the urinary tract or genital area. This will lead to painful urination. The reasons responsible for irritation and inflammation of the urinary tract (other than infection) are:

• Calculi – Stones in the urinary tract
• Coitus – Irritation of the urethra from sexual activity
• Interstitial cystitis – Inflammation of urinary bladder
• Menopause – vaginal changes due to menopause
• Activities – Like horse riding, bicycle riding etc
• Irritation or sensitivity of vagina – It is caused due to use of scented soaps or bubble bath, toilet papers, products such as douches or spermicides etc
• Medicines – Side effects from certain medicines, supplements or treatments
• Tumours – Tumours occurring in the urinary tract.

Other causes of dysuria

Other causes of dysuria: (pain while passing urine)

• Trauma – Local injury or irritation due to catheter placement or sexual contact
• Anatomic obstructions / malformations : obstruction due to enlarged prostate or urethral stricture
• Pain due to external lesions of the genitalia – Urine touching the lesion causes pain
• Frequent douching or application of irritating allergenic products
• Hormonal – Post-menopausal effects, such as vaginal dryness
• Neurological conditions : Any nerve conditions that cause difficulty with bladder emptying
• Cancer: Cancer affecting urethra, urinary bladder, prostate, vagina/vulva or penis
• Medical conditions: Diabetes mellitus, other chronic conditions that suppress the immune system
• Vaginitis : It is an inflammation of the vagina. It is caused due to an allergic reaction to an irritating chemical, a low level of estrogen after menopause or an object such as a tampon that was not removed. It can also be caused by an infection. Common infections of the vagina are:

Bacterial vaginosis – A condition linked to changes in the normal bacteria that live in the vagina
Candidiasis – It is also called a yeast infection
Trichomoniasis – A sexually transmitted disease caused by a microscopic one-celled organism named Trichomonas vaginalis.

Dysuria symptoms

Symptoms of dysuria – difficulty to pass urine
Symptoms usually depend on the cause of dysuria. There may be other symptoms in addition to pain when urinating.

Lower UTI symptoms

Symptoms of Lower urinary tract infection (cystitis):

• Frequent urination – an intense urge to urinate
• Loss of bladder control
• Pain in the lower front portion of the abdomen (near the bladder)
• Cloudy urine that may have a strong odour, bloody urine

Upper UTI symptoms

Symptoms of Upper urinary tract infection (pyelonephritis):

• Pain in the upper back
• High fever with chills
• Nausea and vomiting
• Cloudy urine
• Frequent urination
• Intense urge to urinate (frequency)

Urethritis symptoms

• Discharges from urethra
• Redness around the opening of the urethra
• Frequent urination
• Vaginal discharge

Vaginitis symptoms

• Pain
• Soreness or itching in the vagina
• Abnormal or foul-smelling vaginal discharge or odour
• Pain or discomfort during sexual intercourse

Diagnosis

The doctor will take a thorough history and conduct a physical examination to begin with.

The examination will include:
Abdominal examination
Examination of external genitalia
Gynaecological examination for women
Digital rectal examination (in case of suspected prostate problems in men)

• The symptoms you narrate might give a clue towards a diagnosis.
• Your doctor may suggest certain lab tests to diagnose the causes of your dysuria and its symptoms which includes

A thorough urine test and
A culture and sensitivity test for urine (to confirm a bacterial infection and also to identify the exact bacteria causing the infection) – This will help in the effective treatment of dysuria.

Tests for sexually transmitted diseases (if you have dysuria and have had unprotected sex with multiple partners) – including gonorrhoea, Chlamydia, trichomoniasis, syphilis and HIV.

What else does your doctor want to know?
Your doctor may ask you for the following details regarding painful urination to determine the cause:

• Whether dysuria started suddenly or gradually
• If dysuria has occurred once or many times
• Whether dysuria is felt at the onset of urination

He may ask for accompanying (associated) symptoms like –

• Fever
• Abnormal discharges from the urethra

He will also be interested to know about the changes in the urine flow if any –

• Dribbling of urine
• Difficulty in initiating the flow
• Increased frequency or need (urgency) to urinate

Questions regarding changes in urine character may be asked like changes in urine such as:

• Colour of the urine
• Quantity of the urine
• Blood in the urine
• Pus in the urine
• Cloudiness of the urine

Information about:

• Sexual history
• Social history

When your doctor documents all the answers given by you and summarizes them, he may be arriving at the possible cause of your painful urination. You will still need to go for a urine test or other tests to confirm the diagnosis.

Differential diagnosis

Categories of Dysuria (Classification of causes or Differential Diagnosis):
Urinary tract:

• Kidney stones
• Urethral stricture
• Cystitis
• Prostatic enlargement i.e. prostatic cancer and benign prostatic hyperplasia (BPH) in males
• Prostatitis (in males)
• Urinary tract infection (UTI) caused by a bacterial infection
• Sexually transmitted disease
• Chlamydia
• Urethritis
• Urinary schistosomiasis
• Malignancy – bladder cancer, prostatic cancer, urethral cancer
• Pyelonephritis
• Haemorrhagic cystitis
• Trichomoniasis

Genital:

• Endometriosis (female)
• Vaginitis (female)
• Prostatic cancer (male)
• Benign prostatic hyperplasia (male)
• Prostatitis (male)
• Drugs:
• Chemical irritants e.g. soaps, tampons, toilet papers
• Drugs ex. NSAID’s, anticholinergics etc

Others:

• Reactive arthritis
• Diverticulitis
• Hypotension
• Mass in the abdomen

When to call for a doctor?
Call for a doctor or seek urgent care if you have painful urination or blood in the urine and any of the below said symptoms:

• Fever
• Frequent urination and an urgent need to urinate
• Abdominal pain
• Back pain
• An abnormal vaginal or urethral discharge

Ayurvedic aspect of dysuria

Dysuria – Ayurvedic Concepts and Treatment
In Ayurveda, Dysuria is explained under the context of Mutrakrichra. The term seems to fit the comparison as Mutrakrichra is a word composed of 2 words,

• Mutra – meaning Urine,
• Krichra – meaning difficulty.

Thus Mutrakrichra means difficulty in passing urine.
Mutrakrichra denotes:

• The predominant symptom of the disease and
• The disease itself – unlike Dysuria which is a symptom (presentation) of various conditions

There are other contexts also in which pain and difficulty in passing urine is a symptom. In these, Mutrakrichra or dysuria appears as a symptom of other diseases. They may be considered as differential diagnosis of Mutrakrichra vis-à-vis dysuria with an Ayurvedic perspective. These conditions are –

• Mutraghata (Obstruction to the passage of urine)
• Mutrashmari (Urinary calculi – stone in urinary tract including kidney, ureter, urinary bladder or urethra)

Causes of Dysuria according to Ayurveda

• The above said conditions i.e. Mutrakrichra (as a disease), Mutraghata and Mutrashmari can themselves be considered as causes of Mutrakrichra vis-à-vis dysuria
• Though we have another set of diseases, in fact, 20 of them called Prameha in which different clinical presentations of urine w.r.t its colour, consistency, flow, quantity etc has been explained. But we cannot find the word mutrakrichra in any of these 20 conditions. Thus dysuria is not a feature of Prameha. Prameha has famously been correlated with Diabetes Mellitus, but Diabetes can only be a later manifestation of untreated or neglected Prameha.

All the causes of Mutrakrichra, Mutraghata and Mutrashmari can be considered under the causes of Dysuria.

Mutrakrichra – Causes and pathogenesis

• Vyaayaama – Excessive exercise, physical exertion
• Teekshna aushada – strong and intense medication
• Ruksha – dry food substances
• Madhya – Excessive addiction to alcohol
• Prasanga – excessive and unprotected sex
• Nitya druta prishta yanat – Riding on the back of animals like horse etc (daily)
• Anupa mamsa – Excessive consumption of meat / flesh of animals living in marshy areas
• Adhyashana – eating in excess or eating even before the food taken previously has not yet been digested
• Ajeerna – indigestion

Pathogenesis:
When the Dosha’s i.e. Vata, Pitta and Kapha vitiated by their own causative factors enter the Vasti (urinary bladder) either individually or together and cause constriction, obstruction, pressure or irritation in the mutramarga’s (urinary passages/tracts) they cause difficulty in the passage of urination. This condition is called Mutrakrichra.

Mutraghata – Causes and pathogenesis

The Dosha’s, especially Vayu on getting vitiated due to the consumption of dry foods and withholding the natural reflexes of the body etc, on getting lodged in the urinary bladder causes 13 types of Mutraghata (obstructive disease of the urine).

Mutra Ashmari – Causes, types, pathogenesis

Ashmari (stones / calculi) is of 4 types:

• Vataja Ashmari
• Pittaja Ashmari
• Kaphaja Ashmari
• Shukraja Ashmari / Shukrashmari

Kapha is invariably involved in the formation of all types of Ashmari’s. If Ashmari is not treated in proper time they will become dreadful like the God of death.

Pathogenesis:

When the vitiated Vayu dries up the semen, urine, pitta and kapha in the urinary bladder, Ashmari’s (stones) are formed.

The stones resemble the dried and calcified bile (gorochana) found in the gall bladder of the cow.

All the ashmari’s (stones) are formed due to the vitiation of all the 3 Dosha’s.

Mutrakrichra vis-à-vis dysuria as a symptom is not only found in the above said conditions, it is also present as one of the symptoms in the below said diseases. These diseases too can be considered under the aetiology (causative factors) of Dysuria. They are as enlisted below:

• Pakvashaya sthita Vayu
• Vasti vidradhi
• Rajayakshma
• Gulma
• Kaphaja Arshas
• Mutra nigrahaja Udavarta
• Visuchika

Mutra vega Dharana
When the body wants to eliminate something, we just need to co-operate. Mutra Vega or urge to urinate or urination reflex is one among the many urges which the body produces on a daily basis. An urge or reflex is a call from our system to attend to it immediately.

When the body wants to eliminate something, we just need to co-operate. Mutra Vega or urge to urinate or urination reflex is one among the many urges which the body produces on a daily basis. An urge or reflex is a call from our system to attend to it immediately.

If we get habituated to holding the reflex due to our busy schedules, the urinary system will be trained to withhold the urine and cause many diseases especially those related to the uro-genital system. Dysuria is also one of the symptoms which occur due to withholding or suppressing the natural call to urinate. Therefore, to keep our urinary system healthy we need to follow the body basics by developing a habit of healthy and timely toileting.

Diseases presenting with Dysuria as a symptom:
Since we can find Dysuria as a presenting complaint in 3 main diseases i.e. Mutrakrichra, Mutraghata and Mutra Ashmari, we shall discuss these diseases, types and their symptoms in detail:

Mutrakrichra Types

Mutrakrichra is of 8 types. They are:

Vataja Mutrakrichra

Presents with –

• Teevrarti – Severe pain
• Ruk vankshana – Pain in groins and flank
• Ruk vasti – Pain in urinary bladder
• Ruk medra – Pain in the penis
• Svalpam – muhurmutrayati – Urination in small quantity, with frequent urination.

Pittaja Mutrakrichra

Presents with –

• Peetam mutram – Yellow coloured urination
• Saraktam mutram – Urine with blood (Haematuria) or reddish coloured urination
• Sarujam mutram – painful urination
• Sadaham mutram – Burning urination
• Krichram murmutrayati – Frequent and difficult urination

Kaphaja Mutrakrichra

Presents with –

• Vasti linga gurutva – heaviness in the urinary bladder and penis
• Vasti linga shota – swelling in the urinary bladder and penis
• Pichchila mutra – sticky urine

Sannipataja Mutrakrichra

This is manifested when all the 3 morbid Dosha’s get involved in the disease pathology. The symptoms too will be of mixed type i.e. the symptoms in all the above said Doshic Mutrakrichra’s will be present in mixed proportions.

Shalyabhighatajam Mutrakrichram

When the passages of urinary tract get injured by a Shalya (foreign body) either internally or externally, they will cause severe pain during urination. This is called Shalyabhighataja Mutrakrichra. Its symptoms are similar to those of Vataja Mutrakrichra.

Shakrut vighaataja Mutrakrichra

On withholding the urge / reflex for defecation and having habituated to it, the Vata gets aggravated and moves in a reverse direction (upwards) and causes –

• Adhmana – Distension of the abdomen
• Shula – Pain in the abdomen (region of the bladder)
• Mutrasanga – Obstruction to the passage of urine

Ashmari janya mutrakrichra

Formation of stones and gravel in the urinary passages leads to the manifestation of Ashmari (calculi / stone) janya mutrakrichra or dysuria due to stone.

Shukraja mutrakrichra

When the shukra or semen which has been displaced from its site of formation (ejaculated but not come out of the urethra) gets obstructed by the vitiated Dosha’s in the urinary passages, the following symptoms are manifested:

• Sashukra krichra mutra – Urine mixed with semen is eliminated with difficulty
• Vasti shula – Pain in the urinary bladder
• Mehana Shula – Pain in the penis

Mutraghata

It means urinary obstruction. So, dysuria caused by urinary obstruction due to physical injury, structural deformities etc are explained here. Types of Mutraghata and their symptoms are explained here

Mutrashmari

Urinary calculi can also lead to dysuria.
Read related: Urinary calculi: Home Remedies, Ayurvedic Treatment, Diet, Recipes

Ayurvedic treatment principles

The best way of treating any disease according to Ayurveda is to avoid or keep away from the causative factors, this principle holds good with Dysuria too.

Avoid the causes of:

• Mutrakrichra
• Mutraghata
• Mutrashmari

Avoid: Withholding the natural impending reflexes / urge for urination and defecation.

Ayurvedic Treatment of Dysuria:
Dysuria should be treated on the lines of treatment principles and medicines described in the context of:

• Mutrakrichra
• Mutraghata
• Mutrashmari

Since dysuria vis-à-vis mutrakrichra manifests secondarily to the below said diseases, they too should be treated. When the primary disease is treated, the patient will be relieved of Mutrakrichra. The diseases (already mentioned above in causes) are –

• Pakvashaya sthita Vayu
• Vasti vidradhi
• Rajayakshma
• Gulma
• Kaphaja Arshas
• Mutra nigrahaja Udavarta
• Visuchika

Treatment of Mutrakrichra

Vataja Mutrakrichra Chikitsa

• Abhyanga – massage
• Snehana – intake of medicated oils and ghee
• Niruha vasti – Decoction enemas
• Svedana –Steaming / Fomentation / Sudation
• Upanaha – herbal poultices
• Uttaravasti – Enemas given through urethral or vaginal route
• Seka – Stream pouring of herbal decoctions or processed milk or oils
• Mamsarasa – Meat soup prepared from Vata alleviating drugs like Sthiradi group of medicines

Medicines:
Amritadi kwatha:
Decoction prepared from –

• Guduchi – Tinospora cordifolia
• Shunti – Zingiber officinale
• Amalaki – Emblica officinalis
• Ashwagandha – Withania somnifera
• Gokshura – Tribulus terrestris

Paittika Mutrakrichra chikitsa

• Seka – Stream pouring of herbal decoctions or processed milk or oils
• Avagahana – Making the patient seated dipped in a river or lake
• Shishira pradeha – Application of pastes made up of drugs which are cold in potency like Chandana (sandal) etc, all over the body, especially over the lower abdomen
• Vasti – Enemas, especially with milk processed with pitta alleviating drugs (ksheera vasti) and enemas with medicated ghee (anuvasana / matra)
• Paya pana – drinking of milk
• Virechana – Therapeutic purgation
• Medicated ghee for intake – Ghee processed with Draksha (Vitis vinifera), Vidarikanda (Pueraria tuberosa) and Sugar cane juice.

Medicines:

• Trinapanchamoola kashaya / Ghrita / dugdha (Decoction or ghee or milk prepared from the Trinapanchamula group of drugs)
• Shatavaryadi Ghrita
• Draksha kalka – Paste of Vitis vinifera mixed with sugar should be taken with Mastu (curd water).
• GudaKsheera – Jaggery mixed in hot milk should be taken many times.
• Narikela Jalam – Coconut water mixed with jaggery and coriander powder.

Kaphaja Mutrakrichra Treatment

• Kshara – Alkalis
• Ushna aushadha & annapana – medicines, food and drinks with a hot potency
• Teekshna aushadha & annapana – Medicines, food and drinks which have an intense and deep penetrating nature
• Svedana – Sudation / Fomentation / Sweating therapy
• Yavanna – Food predominantly prepared using Yava (Barley – Hordeum vulgare)
• Vamana – Therapeutic emesis
• Niruha vasti – Decoction enemas
• Takra – buttermilk
• Tikta padartha – Things and food that have bitter taste
• Maricha taila – intake and enema with oil processed with Piper nigrum (black pepper).

Medicines:

• Ela churna (Elettaria cardamomum) – should be administered with Gomutra (cow’s urine) or kadali svarasa (juice of stem of plantain tree)
• Pravala bhasma (ash of coral) with rice water.

Sannipataja Mutrakrichra Treatment

Treatment should be done according to the predominance of Dosha’s.

In Sannipata,

• If Kapha is predominant – Vamana (therapeutic emesis) should be given
• If Pitta is predominant – Virechana (therapeutic purgation) is the best option
• If Vata is predominant – Vasti (enemas) should be preferred.

Medicines:
Shatavari mula kwatha – Decoction prepared from the roots of Asparagus racemosa

Abhighataja Mutrakrichra Treatment

Treatment on the lines of treatment of Vataja Mutrakrichra

Lepa –
Paste made out of: Panchavalkala (5) bark, i.e. Barks of –

• Vata – Ficus bengalensis
• Ashwatha – Ficus religiosa
• Udumbara – Ficus glomerata
• Plaksha – Ficus lacor
• Parisha – Thespesia populenea

The powders of the above said Panchavalkala drugs are made into a paste and mixed with mud. This paste is made warm and applied on the abdomen.

Medicines: Amalaki (Emblica officinalis) juice should be mixed with sugarcane juice and honey and given for intake.

Shukravibandhaja Mutrakrichra Chikitsa

• Shilajatvadi yoga – Shilajit (Mineral pitch, Mineral wax – Asphaltum punjabianum), honey, milk, sugar and ghee should be mixed together and consumed
• Pramadaam shrayate – Sex with a healthy and excited partner
• Trinapanchamula ghrita
• Shilajit with honey
• Bala kwatha – Decoction of Sida cordifolia mixed with asafoetida, milk and ghee.

Shakrudvighataja Mutrakrichra Chikitsa

Also called Vidvighataja mutrakrichra.

• Swedana – Sudation / Fomentation / Steaming / Sweating therapy
• Abhyanga – Massage with herbal oils
• Vasti – Enemas.

Medicines:
Gokshuradi kwatha: Decoction prepared with – Gokshura beeja – Seeds of Tribulus terestris mixed with Yava Kshara (alkali of Hordeum vulgare – barley).

Ashmarijanya Mutrakrichra Chikitsa

• Swedana – Sudation / Fomentation / Steaming / Sweating therapy
• Vata shamaka – All treatments and medications that will alleviate Vata.

Medicines: Pashanabheda kwatha – Decoction of Bergenia ligulata

Classical formulations

Other effective classical medicines/formulations for Mutrakrichra:

Eladi Churna –
Powder prepared from

• Ela – Elettaria cardamomum (Cardamom)
• Pashanabheda – Bergenia ligulata
• Shilajit – (Mineral pitch, Mineral wax – Asphaltum punjabianum),
• Pippali – Piper longum

This powder should be taken with rice water or with honey.

Yavakshara –
Alkali of Hordeum vulgare should be taken with

• Sugar
• Buttermilk
• Kushmanda rasa (juice of Benincasa hispida) and sugar
• Gokshura kwatha (Decoction of Tribulus terrestris).

Nidagdhika Kwatha – Decoction of Solanum xanthocarpum with honey.

Dadimadi yoga –

• Juice of Dadima (pomegranate – Punica granatum)
• Jeeraka churna – cumin powder
• Saindhava lavana – Rock salt

The above said should be mixed in Arjunarishta and consumed.

Triphaladi Yoga –
Paste of the powders of:

• Haritaki – Terminalia chebula
• Bibhitaki – Terminalia bellirica
• Amalaki – Emblica officinalis
• Badara – Ziziphus jujube (Indian jujube)

The paste of the above said should be mixed with Saindhava lavana (rock salt) and consumed.

Eladi Kashayam – The decoction prepared with the roots of the drugs mentioned in Eladi Yoga (above) can be used to treat Mutrakrichra.

Loha Bhasma – Ash of Iron- Loha Bhasma should be taken with honey

Trikantakadi Ghritam

Shatavaryadi Ghritam

Chandrakala Rasa

Yogas for Mutrakricchra from Sahasra Yoga Text Book
Mutrakricchrahara Kashaya
Mutrakricchrahara Phanita
Tiktaka Ghrita
Maha Tiktaka ghrita
Vastyamayantaka Ghrita
Trikantaka Ghrita
Satavaryadi Ghrita
Mahakusmada Ghrita
Kusmandorvaru Bijadi Choorna
Hinguvachadi Choorna
Narasimha Choorna
Dasamoolarishta
Devadarvarishta
Satavari Guda
Chandabhaskara Rasa
Neelakantha Rasa
Varinellu Tippalyadi Kashaya
Kallurvanjyadin Kashaya
Haritakyadi Kashaya
Swadamshtradi Ghrita

Mutraghata Chikitsa

Principle of treatment

• Snehana – Intake of medicated ghee / oils / both
• Swedana – Sudation / Sweating therapy / Fomentation
• Sneha Virechana – Therapeutic purgation using medicated ghee and oil, should be administered after Snehana and Swedana
• Uttaravasti – Enemas given through urethra and / or vagina – Should be preferred in presence of severe pain
• Mutrakrichra & Mutra Ashmari roga chikitsa – all the treatments and formulations mentioned in Mutrakrichra and Mutra Ashmari contexts should be administered for effective treatment of Mutraghata.

Medications:
Shilajit – (Mineral pitch, Mineral wax – Asphaltum punjabianum)

• Shilajit should be taken mixed in Veeratarvadi Gana Sidda Kashayam (decoction prepared using Veeratarvadi group of drugs)
• Shilajit mixed with sugar cures:

Mutrajathara
Mutraateeta

Dashamula Kwatha – Decoction of Dashamula (10 roots) mixed with Shilajit and sugar is useful in Mutraghata (obstruction to urination)

It is especially prescribed in the effective treatment of:

• Vatakundalika
• Vatavasti
• Mutraghata

Gokshuradi Kwatha –

• Decoction of Tribulus terrestris
• Shuddha Shilajit (purified Shilajit)
• Shuddha Guggulu (Purified Commiphora mukul)

All the above said should be mixed together and consumed

Useful in

• Mutraghata
• Mutrakrichra
• Mutrashukra
• Mutraroga – All urinary diseases

Trikantakadi Yoga –

Milk processed with:

• Trikantaka – Tribulus terrestris
• Eranda mula – Root of Ricinus communis (castor plant)
• Shatavari – Asparagus racemosus

Added with – Jaggery and ghee

Useful in all types of

• Mutraghata
• Mutrakrichra
• Vata type of pains

Nidagdhika Kashayam: Decoction of Soalnum xanthocarpum or its juice mixed in buttermilk is useful in

Mutraghata (all types)

Ushnavata associated with bleeding from urinary tract

Chandrakala Rasa – Useful in all types of Mutraghata

Yogas for Mutraghata From Sahasra Yoga Text Book
Dhanvantara Taila
Kalyana Kshara
KAllurvanjyadi Kashay
Haritakyadi Kashaya
Puvankuruntaladi Eranda Taila

Recommended diet and lifestyle

Useful diet and lifestyle changes in Mutraghata:

• Purana lohita shali – old red rice
• Dhanva mamsa – Flesh of animals living in desert areas
• Mudga yusha (green gram soup)
• Takra – buttermilk
• Ksheera – milk
• Dadhi – Curds
• Sarpi (ghee)
• Masha yusha – Soup prepared from black grams
• Purana Kushmanda – Old ash gourd
• Patola – Pointed gourd
• Kharjura – dates
• Narikela – tender coconut
• Sita (sugar candy)
• Kushmanda (ash gourd)
• Urvaru (cucumber)
• Tanduliyaka (red spinach)
• Amalaki (Indian gooseberry)
• Narikela (coconut water)

Contraindicated diet and lifestyle

Unwholesome things in Mutraghata:

• Viruddha bhojana – Incompatible foods
• Vyayama – Excessive exercises
• Maargasheelanam – Excessive walking
• Ruksham – Dry foods
• Vidahi annam – foods causing a burning sensation
• Vishtambha ahara – Constipating foods
• Vegadharanam – Suppressing or holding on to the impending natural urges / reflexes
• Vamanam – Emesis

Pathya – apathya according to Yogaratnakara

Wholesome herbs, diet and habits

Old red variety of rice, flesh of animals living in desert areas, green gram juice, sugar, cow milk, butter milk & curd prepared out of cow milk, old pumpkin, pointed gourd, cucumber, dates, coconut, amaranth, Indian gooseberry, ghee, river water, camphor etc.

Wholesome herbs, diet and habits

Alcohol, sternous work, sexual intercourse, riding on elephant & horse, diet which interrupts tissue metabolism, incompatible food, betel, fish, salt, ginger, oil fried foods, oil-cake, asafetida, sesame, mustard, urge of urination, black gram, caper, foods that are having penetrating quality, foods that cause burning sensation, dry & sour food etc.

Mutra Ashmari Chikitsa

Principles of treatment: Ashmari indicators

The below said symptoms indicate the presence of Ashmari or stones in the urinary tract:

• Abdominal pain and Low back pain at the beginning of the disease
• The pain gets masked
• Hot urine is eliminated

By seeing the above-said symptoms, we need to infer the presence of stones and start the treatment accordingly.

Vataja Ashmari treatment

Snehapana:
When the premonitory symptoms or Ashmari indicators are diagnosed, the patient of Vataja Ashmari should be given Snehapana (medicated / herbal ghee or oils)

The below said are beneficial:

• Kshara – Alkalis
• Yavagu – Gruels
• Peya – Gruel
• Kashaya – Herbal decoctions
• Veeratarvadi Kwatha – Decoction prepared from Veratarvadi group of drugs
• Ksheera – Milk

Medicines:
Varuna Kwatha –
Varuna Twak – Bark of Crataeva nurvala
Shunti – Zingiber officinale
Gokshura – Tribulus terrestris
The decoction prepared from the above-said drugs should be consumed by mixing Yava Kshara (Alkali prepared from Hordeum vulgare plant – Barley) and Jaggery

Pittaja Ashmari Treatment

Pashanabheda Kwatha:
Decoction of Pashanabheda (Bergenia ligulata) should be taken mixed with Shilajit and sugar.

Kaphaja Ashmari Treatment

ShigruVaruna Kwatha:

• Decoction of Shigru bark (Moringa oleifera) and Varuna bark (Crataeva nurvala) should be taken mixed with Yava Kshara (alkali of Hordeum vulgare).

Shukraja Ashmari treatment

Principle – General line of treatment of treating Ashmari (stones) should be adopted.

Medicines:

Kushmanda Swarasa – Shweta Kushmanda Swarasa (Juice of Ash gourd) should be taken with Yava Kshara and Jaggery.

Classical formulations

Other useful classical formulations in Ashmari:

Shatavari Swarasa – Juice of Asparagus racemosus should be taken with milk.

Kutaja Kalka –

• Paste of Holarrhena antidysenterica mixed in the supernatant watery portion of curds prepared from cow’s milk.

Erandadi Kalka –
Paste of:

• Erandamula – root of castor plant
• Brihati – Solanum indicum
• Kantakari – Solanum xanthocarpum
• Gokshura – Tribulus terrestris
• Kokilaksha – Asteracantha longifolia / Hygrophila auriculata

The paste of the above said should be taken with sweet curds

Shigrumula Kwatha:

• Hot decoction prepared from the roots of Shigrumula (Moringa oleifera)
• Milk and rice should be consumed during its use

Apamarga mula –

• The root of Apamarga (Achyranthes aspera) should be taken with rice washed water.
• Milk and rice should be consumed during its use.

Shilajit:

• Shilajit should be taken mixed with honey
• It cures Ashmari and dysuria caused by Ashmari

Yava Kshara –

• Yava Kshara (Alkali prepared from the plant of Hordeum vulgare) should be taken mixed with Gokshura Churna (Powder of Tribulus terrestris).

Trikantakaadi Churnam – Powder of Trikantaka beeja churna (seeds of Tribulus terrestris) should be taken mixed in honey along with goat’s milk.

Trivikrama Rasa – Useful formulation for urinary disorders especially urinary calculi and dysuria

Good foods in Ashmari

• Kulattha – Horse gram
• Mudga – Green gram
• Godhuma – Wheat
• Jeerna Shali – Old rice
• Yava – Barley
• Dhanvamisham – Meat of animals living in desert regions
• Kushmanda phalam – Ash gourd
• Ardraka – Wet ginger

Note: Since the concept of Prameha also deals with Urinary disorders, the treatment of the same can also be considered in this context.

Since Prameha doesn’t involve the predominant and classical symptom of Dysuria i.e. ‘Pain during urination’ is not present in Prameha, I have not discussed the treatment of the same in detail. But the medicines explained in the above said contexts (most of them) can be used in Prameha also. Some formulations which I would put forth in the heading ‘Formulations for Dysuria’ following this, I would include some medicines which are common for all conditions.

Ayurvedic medicines for Dysuria

Kashaya (Herbal Decoctions)

• Brihatyadi Kashayam
• Drakshadi kashaya
• Varanadi Kashayam
• Trikantakadi Kashayam
• Nishakatakadi Kashayam
• Katakakhadiradi Kashayam
• Kokilaksham Kashayam
• Varadi Kashayam
• Tiktakam Kashayam
• Aragwadhadi Kashayam
• Pashanabhedi kashaya
• Punarnavashtaka kwatha
• Punarnavadi kashaya
  
• Shatavaryadi kashaya

Asava / Arishta

• Lodhrasavam
• Ayaskriti
• Devadarvarishtam
• Chandanasavam
• Kumaryasavam
• Dashamularishtam
• Punarnavarishtam
• Punarnavasavam

Churnam (Powders)

• Shaddharana Churnam
• Triphaladi Churnam
• Amritamehari Churnam
• Kharjooradi choorna

Vati and Gulika (Tablets and pills)

• Chandraprabha Gulika
• Gokshuradi guggulu
• Saptavimshati Guggulu
• Shukramatruka Vati
• Shilajitvadi Vati
• Mehamudgara Vati
• Chandrakala Vati
• Chandanadi Vati
• Vishamajwarantaka Lauha
• Amlapittantaka Lauha
• Nishamalaki
• Shveta Gunjadi Gulika
• Valiya Marma Gulika
• Niruryadi Gulika

Lehas and Rasayanam

• Shatavari Gulam – Shatavari rasayana
• Narayana Gulam,
• Chyavanaprasham
• Narasimha Rasayanam
• Drakshadya avaleha
• Trivrit Leham
• Amrasara Rasayanam
• Gandhakaraja Rasayanam
• Sukumara Leham

Parpati preparations and Satva

• Shweta Parpati
• Giloy Satva

Ghrita / Tailam

• Trikantakadi Ghrita
• Traikantaka Ghritam
• Shatavaryadi Ghritam
• Dhanwantaram Ghritam
• Shalmali Ghritam
• Virataradi Ghritam
• Varahyadi Ghritam
• Vastyamayantaka ghrita
• Varanadi Ghritam
• Dhanwantaram Tailam 101
• Ksheerabala Tailam 101

Bhasma

• Vanga Bhasma
• Abhraka Bhasma
• Loha Bhasma
• Naga Bhasma
• Shilajit Bhasma / Kanmada Bhasmam
• Svarna Bhasma
• Shringa Bhasma
• Rajata Bhasma
• Spatika Bhasma
• RoupyaMakshika Rasa
• Trivanga Bhasma

Rasa aushadhas

• Rasa Sinduram
• Hemanatha Rasa
• Somanatha Rasa
• Vangeshwara Rasa
• Vasantakusumakara Rasa
• Pravala Panchamrita Rasa
• Chandrakala rasa
• Kamadhenu Rasa
• Suvarna Raja Vangeshvara (Svarna Vanga)
• Siddha Makaradhwaja

Single herbs useful in dysuria

• Narikela – Coconut – Cocus nucifera Linn.
• Gokshura – Tribulus terrestris
• Amalaki – Amla – Emblica officinalis Gaertn.
• Draksha – Raisin – Vitis vinifera Linn.
• Sukshma Ela – Cardamom – Elettaria cardamomum Matom.
• Usheera – Vetiveria zizanoides
• Pashanabheda – Bergenia ligulata
• Varuna – Crataeva nurvala
• Ikshu – Saccharum officinarum
• Amalaki – Emblica officinalis
• Shatavari – Asparagus racemosus
• Durva – Cynodon dactylon (Linn.) Pers.
• Draksha – Vitis vinifera
• Ela – Elettaria cardamomum
• Punarnava – Boerhavia diffusa
• Vidari – Pueraria tuberosa
• Kushmanda – Benincasa hispida
• Yava – Hordeum vulgare
• Kumari – Aloe vera
• Urvaru – Cucumis sativus Linn.

Effective Decoctions For Dysuria From Sahasrayogam

Mutrakricchra means difficulty in passing urine or painful urination. Decoctions are the simple Ayurvedic dosage form known as kashayas. It is prepared by boiling coarsely powdered herbs in water.
Read – Kashayam (Kwath) – Herbal Teas Preparation [Video], Benefits, Usage

1. Mutrakricchrahara Kashayas

a. Dasamooladi Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 39

b. Vyaghryadi Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 39c

Read – Amla Home Remedy For Dysuria [Video]

c. Pathyadi Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 43d

Read – Should Kashayams Be Given Necessarily Before Food?

d. Varyadi Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 39e

Read – Effects Of Constant Holding Urine: Ayurvedic Treatment

e. Brihatyadi Kashayam (Read more here)

2. Varinellu Tippalyadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 52

Read – Ayurvedic Home Remedy For Urine Infection And Painful Urination

3. Kallurvanjyadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 53

4. Haritakyadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 54

Allopathic Treatment of Dysuria

Antibiotics: Since the most common cause of dysuria is UTI, infections are treated with antibiotics. Based on the current pattern of UTI in your community, your doctor will choose the optimal medication. If your urine sample had been sent to the lab for Culture and sensitivity (C&S) test and if the culture indicates that bacteria are present in the urine, the antibiotic course will be started. The sensitivity test in C&S will also specify the particular organism causing your dysuria.

The report will also suggest the range of antibiotic choice for the type of infection you have. The doctor will evaluate so as to which antibiotic fits you and will administer a schedule for it.

If you have already started an antibiotic before you get the C&S report and if the culture shows that the bacteria in it are resistant to the initial antibiotic, your doctor might change the medication after seeing the report and prescribe a suitable antibiotic.

If the C&S report fails to show bacteria then your dysuria is not infectious. In this case, your doctor or health-care professional might recommend further tests and treatments.

The antibiotics should be taken for a full course though you start feeling better after popping a few pills

Analgesic: Medication for pain in the form of a general analgesic or a specific medicine that will numb the pain in the urinary tract may be required.

Follow up:
If your UTI is uncomplicated, it doesn’t need a follow-up
If the UTI’s are frequent, a further evaluation must be done, including –

• Referral to urologist
• Ultrasound tests
• Cystoscopy

Prognosis:

• Most UTI’s will improve with appropriate antibiotics and should have no long-term consequences.
• Women with certain STD’s can lead to scarring of the reproductive tract and fertility problems if not diagnosed and treated at proper time

References:
https://en.wikipedia.org/wiki/Dysuria
http://www.emedicinehealth.com/dysuria/article_em.htm
http://www.webmd.com/women/dysuria-causes-symptoms
http://www.drugs.com/health-guide/dysuria.html

You have the best remedies for Dysuria in Ayurveda. Ayurvedic medicines are not symptomatic. Rather they have a gross impact on general health and well being too. Thus while you get relieved from your dysuria, you may also get relieved from the systemic diseases in its backdrop. They not only remove the disease from the root level but also provide you with long-standing immunity.

But don’t forget to consult an Expert Ayurveda Doctor for an opinion before starting on with anything because self-medication might be harmful.
– By Dr MS Krishnamurthy and Dr Raghuram Y.S.
Consult Dr Raghuram Y.S