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Obstetrics and Gynaecology

Nonmenstrual Bleeding
The Mustahada

The mustahada is the woman who has bleeding per vaginam other than  her menstruation. Usually a woman knows about her menstruation, how it looks like and feels like, the date it is expected and the duration it lasts. As a matter of fact one of the terms referring to menstruation in the Arabic language is "aada", which literally means habit or custom, and is known by ongoing observation time after time. Istihada, that we might for convenience call pseudomenstruation, is bleeding other than a woman's menstruation and outside her personal pattern she is chronically accustomed to although "lstihada" might sometimes belie structural or functional disease, jurisprudence treats it as a different entity from menstruation. The mustahada should not refrain from prayer provided she performs a local wash, puts a pad (or tampon) and peforms a separate wodou (ablution) for each of the five prayer times every day. She is not subject to the total bath (ghusl or tuhr) as is the case with menstruation. She also does not abstain from fasting. She can carry out the tawaf around the Kaaba.

Whether the case is one of recurrence of bleeding after the end of menstruation, or a continuation of menstruation beyond the limit she is used to as her normal, the condition is "istihada', or pseudomenstruation from the religious point of view. Um-Salama, the wife of the prophet consulted him about a woman with prolonged bleeding and he said:
"Let her wait for the number of days and nights her period used to last without prayer, and then take her (ritual) bath, pad herself, and resume her prayers. " (Malik, Al Shafeai)

Another pattern of the "mustahada" is the woman who lacks the existance or the knowledge of a definite personal menstrual pattern to use as a reference. Examples of this are the menarche (first period ever in the life of the female) or the woman forgetful of her normal pattern. When Amna bint Jahsh, the sister in law of the prophet, sought his counsel whether to pray while she had a lengthy episode of bleeding and could not recognize her menstrual span, he gave her advice including:

"Menstruate like other women menstruate for the same time they menstruate and cease bleeding and do that every month". (Ahmad, Termizi, Abu Dawood)

The average duration of menstruation prevailing among other women was acknowledged as a suitable standard to go by in her case. The quality of the bleeding can also be considered. The woman might lack normal menstruation but have knowledge of the features of menstrual blood and is therefore able to tell whether her current bleeding has the features of menstrual blood, and if not, it would be regarded as "istihada". Such was the case of Fatima Um Habeesh when the prophet told her:

"If it is menstrual blood it is blackish and can be identified, in which case you should refrain from prayer. But if it is a different blood then do "wodou" and pray". (Abu Dawood, Nissa'i, Darokotni, Ibn Habban)

Certain other conditions are treated on the same lines as "istihada". The first is the passage of discharge from the vagina apart from blood ( leucorrhoea). Vaginal discharge of a yellowish or white turbid character occurring at the tailing off of menstruation is considered part of menstruation. Women used to introduce a cotton pledge into the opening to know whether menstruation has gone or not, and used to send the cotton bearing this discharge to Aisha, wife of the prophet (and his direct student and therefore reliable authority) and she would say: "Don't hurry, wait until the cotton comes out white." (Malik, Mohammad ibn al Hassan}

But when the period was over and the ritual bath taken, vaginal discharge would not be given heed according to Um-Atiyya who was an equally reliable authority She said "We did not use to pay any heed to a yellowish or turbid discharge once we have taken the bath."(Abu Dawood)

The same applies to the medical condition called stress incontinence of urine, which entails the involuntary passage of some urine even at a slight effort. It might affect men as well as women. Medical treatment should be sought, but from the point of view of worship, local wash and a "wodou" for each of the five prayer times, and the patient is allowed to resume prayer fasting and tawaf around the Kaabat and need not worry for they have their excuse even if urine dribbles during worship.