Urinary Tract Infection: Mutrakruccha Notes

 

Urinary Tract Infection:

           Table of content

1. Definition of UTI
2. Types of UTI
3. Causative Factors:
4. Predisposing factor
5. Complications
6. Signs and Symptoms
7. Pathophysiology
8. Pathological investigations
9. Differential Diagnosis
10. Mutrakriccha
11. Nidana
12. Samprapti
13. Samprapti Ghatak
14. Types
15. Lakshan
16. Commonly used medications

Definition:

Urinary Tract Infection (UTI) refers to infection caused by microbs in any part of the urinary system which is commonly sterile— kidneys, ureters, bladder, or urethra.

Most commonly caused by- Bacteria, particularly Escherichia coli.

Types of UTI:

1. Based on Location:

1) Upper UTI: Involves kidneys and ureters.

    Pyelonephritis (infection of kidney parenchyma and renal pelvis)

2) Lower UTI: Involves bladder and urethra.

   Cystitis (bladder infection)

   Urethritis (urethral infection)

 

2. Based on Clinical Course:

Uncomplicated UTI: Occurs in healthy individuals with a “normal urinary tract”.

Complicated UTI: Occurs in individuals with structural/functional urinary tract abnormalities.

 

3. Other Classifications:

Recurrent UTI: ≥2 infections in 6 months or ≥3 in 12 months.

Asymptomatic Bacteriuria: Presence of bacteria in urine without symptoms.

 

Causative Factors:

(Uncomplicated UTI)

Bacterial Pathogens:

Microbes: Escherichia coli (most common, >80%), Klebsiella pneumonia, Proteus mirabilis, Staphylococcus saprophyticus, Enterococcus faecalis, Pseudomonas aeruginosa (hospital-acquired) etc.

Long use of Anti-microbials- Develops resistance leading towards secondary infection.

Unprotected/ Unhygienic sexual intercourse.

Ageing: Post-menopausal oestrogen depletion and immunodepression. (Oja-Kshaya)

Some medications like Benadryl, muscle relaxant, antihistaminics etc.

 

(Complicated UTI)

Outflow obstruction:   Stricture,

Prostatomegaly,

Bladder-neck obstruction,

Stone/Tumor,

Renal cyst,

Neuropathic Bladder.

Renal disorders: Reduced glomerular filtration rate (GFR), aplastic kidneys.

Foreign body: Catheter, stone, ureteric stent.

Metabolic disorders:    Immunosuppresent,       

                                    Kidney Failure,

                                    Diabetes mellitus,

                                    Chrinic alcoholism,

                                    Pregnancy.

Other: Enterocycstoplasty

            Bladder diverticulitis

            Instrumentation: Cystoscopy, ureteroscopy, catheterization, Biopsy needle etc.

 

Predisposing Factors:

• Female anatomy- short urethra (4cm).
• Sexual activity: Unprotected sexual practices.
• Urinary catheterization- becomes ground for microbial breeding)
• Diabetes mellitus: High glucose content in urine 2x microbial growth.
• Pregnancy: immuno-compromised state.
• Urinary obstruction (e.g., BPH, stones)
• Immunosuppression: Chemotherapy etc.
• Poor hygiene.
• Congenital abnormalities (e.g., vesico-ureteral reflux)

 

Complications:

• Pyelonephritis
• Urosepsis
• Renal abscess
• Chronic kidney disease (in recurrent/chronic cases)
• Pregnancy complications: Preterm labor, low birth weight
• Strictures (in urethritis)
• Bladder fibrosis/scarring

 

Signs and Symptoms:

 

Lower UTI (Cystitis/Urethritis):

• Dysuria (painful urination)
• Increased urinary frequency
• Urgency
• Suprapubic pain
• Hematuria (blood in urine)
• Foul-smelling urine
• Cloudy urine

Upper UTI (Pyelonephritis):

• Fever with chills
• Flank or loin pain
• Nausea and vomiting
• Costovertebral angle tenderness
• Malaise
• In Elderly/Immunocompromised: Confusion, Falls, Non-specific weakness

Pathophysiology:

1. Entry of Pathogen: Typically, via ascending route from urethra to bladder (and possibly kidneys).

 

2. Colonization: Adherence of bacteria to uroepithelial cells via fimbriae (e.g., Type 1 pili in E. coli).

 

3. Inflammatory Response: Release of cytokines and immune cells leads to inflammation, causing symptoms like dysuria and frequency.

 

4. Spread: In severe cases, infection can ascend to kidneys (pyelonephritis) or enter bloodstream (urosepsis).

Pathological investigations

Dipstick method: To detect the presence of Nitrites. Normally, nitrates are found in urine in smaller quantities but due to microbial activity, these nitrates convert to nitrites which gets detected in this test.

Urine microscopy: to rule out presence of microbes.

Urine Culture: To identify the microbe and specifically start intervention.

CT scan/ Contrast CT: To clearly visualise abscess, etc.

USG: To detect post voidal volume, Kidney structure, Obstruction, bladder wall, protatomegaly etc.

Complete blood count: to rule out haemorrhage, leucocyte count increased in response to infection.

 

Differential Diagnosis:

Condition	Distinguishing Features
Vaginitis	Vaginal discharge, irritation, itching.
Pelvic Inflammatory Disease (PID)	Lower abdominal pain, cervical motion tenderness.
Urethritis (e.g., STI-related)	Associated with urethral discharge, sexually transmitted pathogens.
Interstitial Cystitis	Chronic pelvic pain, urgency without infection.
Renal Calculi	Flank pain, hematuria, no fever unless secondary infection.
Prostatitis (in men)	Perineal pain, fever, tender prostate on DR.

 

Ayurvedic perspective

Urinary tract infection is usually correlated with Mutrakruccha in Ayurveda.

Mutrakriccha is a state of difficult or painful micturition.

 

Causes/ Nidan:

1. Causes of Mutrakruccha may include:
2. Excess physical exercise (Vyayam)
3. Excess Alcohol (Ruksha Madya)
4. Drying and Tikshna medication
5. Travelling (maarga-gaman)
6. Aanup Mams sevan
7. Adhyashan (Eating when not hungry)
8. Ajirna (Indigestion)
9. Abhighat (Trauma)

 

Samprapti/ Pathophysiology:

1. Nidana Sevan.
2. Vatadi Dosha Prakopa
3. Mutravaha Strotas me Sthaan Samshray
4. Mutrakruccha

Samprapti Ghatak

1.  Dosha- Vata Pradhan Tridosha
2. Dushya- Mutra, Jala
3. Strotas – Mutravaha Strotas
4. Adhisthaan- Basti, Mutramarga
5. Strotodushti- Sanga
6. Swabhava- Ashukari
7. Sadhyasadhyata- Sadhya

Types of Mutrakruccha:

1. Vataj Mutrakruccha.
2. Pittaj Mutrakruccha.
3. Kaphaj Mutrakruccha.
4. Sannipataja Mutrakruccha.
5. Abhighataja Mutrakruccha.
6. Shakritaja Mutrakruccha.
7. Ashmarija Mutrakruccha.
8. Sharkaraja Mutrakruccha.

Symptoms

(Vataja)

1. Acute pain in lower abdomen (Basti, Vankshan, Medhra)
2. Frequent micturition
3. Frequent touching and pressing of Vankshan & Medhra.

(Pittaja)

1. Mutrendriya evam Basti- Daha (Burning in bladder and penis)
2. Peeta, Rakta, Harita Mutra (Discoloured and decresed quantity of urine)
3. Ruja (Painful micturition).
4. 🔥 Daha (Burning micturition).

(Kaphaj)

1. Basti, andakosha, mutrendriya -Guruta & shotha (Heaviness & swelling in bladder, testis and penis.)
2. Picchil, snigdha, Shukla, sheeta mutra (Oily, sticky,whitish discoloured urine).
3. Romaharsha (Horripilation)
4. Painful micturition.

(Sannipataj)

1. Sarvanga Daha (Burning sensation in whole body).
2. Sheeta (Rigor)
3.  Vedana (Pain in lower abdomen)
4. Tamah pravesh (Blackout)
5. Vividh-varni Mutra (Multi-coloured urine)
6. Painful micturition.

(Abhighataja)

1. Acute pain in bladder
2. Distension of bladder
3. Heaviness in bladder

(Shakritaja)

1. Flatulence
2. Abdominal pain
3. Obstruction of urine

(Ashmarija)

1. Chest pain
2. Pain in lumbar and hypogastric region
3. Tremors in hands and feet.
4. Indigestion

(Shukraja)

1. Urine mixed with semen
2. Painful micturition
3. Pain in bladder and penis
4. Stiffness in testis
5. Oedema around testis

Commonly Used medications

1. Chandrakala Rasa – 125- 250mg BD
2. Shweta Parpati- 125- 250mg BD
3. Tarakeshwara Ras- 125- 250mg BD
4. Gokshuradi Guggul- 250-500mg BD
5. ChandraprabhaVati- 250-500mg BD
6. Gokshuradi Kwath – 20 ml on BD empty stomach
7. Punarnavadi Kwath- 20 ml on BD empty stomach
8. Guduchyadi Kwath- 20 ml on BD empty stomach
9. Pattharchoor Swaras- 20 ml on BD empty stomach
10. Chandanasav- 20ml + 20 ml lukewarm water after meal Bd
11. Ushirasav- 20ml + 20 ml lukewarm water after meal Bd
12. Shatavari Ghrita- 2-3 tsf with lukewarm milk HS.

(Correlate clinically before using medication)