Pain on Urination (Dysuria)
What is it?A feeling of pain, burning, stinging, or discomfort during urination is called dysuria in medical language. Broadly speaking, pain during urination can occur because of irritation or inflammation anywhere along your urinary tract. At times, conditions affecting the genital organs can also cause pain during urination.
Causes of Pain on UrinationHere are the common reasons because of which passing urine may hurt.
- Urinary Tract Infection (UTI) — UTIs are the most common cause of painful urination in women. They are a possible reason in men as well. But it is not wise to attribute all episodes of painful or burning urination to an infection, or to treat it with common antibiotics unless some additional evidence of infection is present.
- Sexually-transmitted diseases (STDs) — Urethritis caused by a sexually-transmitted organism is a very common cause of painful urination in men whose sexual history puts them at risk of STDs. Common STDs such as gonorrhea, chlamydia, genital herpes and several others can cause painful urination.
- Chemical irritation — Soaps, bubble-baths, spermicides, scented toilet paper, personal hygiene products can all irritate the urethra and cause pain during urination.
- Trauma — Sexual intercourse, horseback riding, cycling, insertion of urinary catheter or any other instrument in the urethra, can cause trauma leading to pain during urination.
- Obstructions to urine flow — Obstruction to urine flow because of an enlarged prostate squeezing the urethra, or a stricture (narrowing) in the urethra can make urination painful.
- Hormonal conditions — Postmenopausal women with low levels of estrogen may have painful urination because of excessive dryness of the urinary and genital organs.
- Stones — A stone in the ureter, bladder or urethra can cause pain on urination.
- Interstitial cystitis (IC) —IC is a condition in which chronic bladder irritation or inflammation leading to pain on urination is present without any detectable reason. IC is also known as painful bladder syndrome (PBS).
- Cancers — About one third patients with bladder cancer have pain on urination. Advanced prostate cancer can cause pain on urination.
- Drugs and herbal remedies — Some drugs such as penicillin G and Cytoxan and some herbal remedies are known to cause pain on urination.
- Spondyloarthropathies — Syndromes associated with inflammation in multiple organs can cause pain on urination. For e.g. people with Reiter’s syndrome have joint pains, pain on urination and eye symptoms such as burning and pain.
- Psychogenic conditions — Major depression, stress and anxiety can cause problems associated with urination, including pain on passing urine.
Associated SymptomsThe nature of the pain and other symptoms that you might be experiencing can give a clue to the likely cause of dysuria. The symptoms associated with some common conditions causing pain on urination are discussed here.
- Frequent urge to urinate: Dysuria along with frequent urge to urinate is the classical symptom of a UTI, particularly acute bladder infection (cystitis). A stone or tumor irritating the bladder can also cause similar symptoms. They can also occur in interstitial cystitis. Acute cystitis is rather uncommon in men <50 years of age, hence these symptoms should be investigated thoroughly if you are a young man.
- Weak urine stream or straining to urinate: Painful urination with an unusually thin urine stream or difficulty in starting to urinate is a sign of obstruction in the urethra. In middle aged men the most common reason is an enlarged prostate. Or it could be because of a urethral stricture. Past history of a STD or urethral trauma makes strictures more likely.
- Internal vs external pain: If you are a woman, a burning sensation felt as the urine passes over the vulva and vagina is most likely due to trauma, chemical irritation, or infection of the genital organs and not the urinary tract. Most patients describe the pain and burning caused by a UTI to be occurring within the body. Pain just above the pubic bone particularly occurs with a bladder infection.
- Sudden vs. gradual onset: If the pain came suddenly, it’s more likely to be because of an UTI than an STD. Symptoms of STDS such as Chlamydia typically develop gradually over few weeks.
- Discharge from penis or vagina: If your sexual history raises any doubt of a STD, you should always consider it as a possible cause for pain on urination. It’s quite likely that you will also have a discharge from the penis or the vagina. Absence of discharge however does not rule out a STD. Vaginal yeast infection in women could cause burning or pain during urination, often with a curdy discharge from the vagina.
- Pain during intercourse: Many conditions causing pain on urination could also make sex painful, but STDs, atrophic vaginitis in postmenopausal women, trauma, and chemical irritants are more likely to cause these symptoms concomitantly.
- Pain in rectum: If you are a male and have also felt pain or pressure in the rectum along with pain in passing urine, an infection of the prostate gland could explain your symptoms.
Exams and Tests for Pain on UrinationA work-up for pain on urination may include one or more of the following tests:
- Urinalysis: It’s the most common initial urine test done in people complaining of painful urination. Presence of pus cells and bacteria in urine nearly confirms the presence of an UTI and nothing more may be needed. Presence of blood in urine often necessitates detailed testing for stones, cancers, or mechanical obstructions in the urinary tract.
- Urine Culture: It is done to find the cause of UTI and prescribe the most appropriate antibiotics for testing.
- Vaginal or urethral smear: Fluid sample from your urethra or vagina maybe taken for microscopic examination if a STD is suspected.
- Ligase chain reaction and Polymerase chain reaction tests: These are tests done to identify STDs such as gonorrhea and chlamydia.
- KOH microscopy and Yeast culture: Women with chronic or recurrent pain on urination may need these tests to check for yeast infection.
- Imaging studies: Ultrasound, X-ray, CT scans etc are ordered if the above tests do not bring forth the cause of dysuria.
- Cystoscopy and biopsy: Direct visualization of the bladder and examination of a tissue sample may be needed in some cases.
Treatment for Pain on UrinationDo consult your doctor if pain on urination is severe or it persists beyond a couple of days. Treatment for pain on urination depends on the cause. Minor trauma or inflammation caused by sensitivity to some chemicals heals on its own in a few days if you avoid further injury or irritation. UTIs and STDs can be successfully treated with a course of the right antibiotics. Women with atrophic vaginitis may be prescribed lubricants or hormone therapy if symptoms persist. Your urologist can decide the right therapy for other conditions such as interstitial cystitis, enlarged prostate, stones, or tumors.