Dysuria

What is it?

Dysuria is the medical term for pain or discomfort when urinating. Often described as a burning sensation, dysuria most commonly is caused by bacterial infections of the urinary tract.

Lower urinary tract infection (cystitis or bladder infection) — Dysuria is a common symptom of a bladder infection (cystitis). Cystitis is very common in women aged 20 to 50.

An infection often starts when bacteria enter the opening where urine comes out (urethra) during sexual intercourse. Bacteria also can enter the urethra in women and girls who wipe with toilet tissue from back to front. Once bacteria enter a woman's urethra, it only has to travel a short distance to the bladder.

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

Upper urinary tract infection (pyelonephritis or kidney infection) — A kidney usually becomes infected because bacteria have traveled 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 (called vesicoureteral reflux) or an obstruction related to abnormal development of the urinary tract.

Pyelonephritis is more common in women than in men.

Urethritis — Urethritis is an inflammation of the urethra. It is usually caused by sexually transmitted diseases (such as chlamydia and gonorrhea). Urethritis also can be caused by contact with an irritating chemical (such as antiseptics, bubble bath or some spermicides) or by irritation from an object, such as a tube (catheter) inserted to drain urine.

Vaginitis — Vaginitis is an inflammation of the vagina. It can be caused by an allergic reaction to an irritating chemical (spermicide, douche, bath soap), a low level of estrogen after menopause, or an object such as a tampon that was not removed. It can also be caused by infection. Common infections include:

• bacterial vaginosis, a condition linked to changes in the normal bacteria that live in the vagina
• candidiasis, also called a yeast infection
• trichomoniasis, a sexually transmitted disease caused by the microscopic one-celled organism Trichomonas vaginalis.

Symptoms

Depending on the cause of dysuria, there may be other symptoms in addition to pain when urinating. Symptoms can include:

• 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 odor, bloody urine
• Upper urinary tract infection (pyelonephritis) — Pain in the upper back, high fever with shaking chills, nausea and vomiting, cloudy urine, frequent urination, an intense urge to urinate
• Urethritis — A discharge from the urethra, redness around the opening of the urethra, frequent urination, vaginal discharge. Partners of people with urethritis that comes from a sexually transmitted disease often will not have any symptoms.
• Vaginitis — Pain, soreness or itching in the vagina, an abnormal or foul-smelling vaginal discharge or odor, pain or discomfort during sexual intercourse.

Diagnosis

Many people have occasional episodes of brief discomfort when they start urinating. Usually this is caused by irritation, and does not need to be treated. However, you should see your health care professional if pain while urinating lasts longer, is severe or if it continues to happen.

Your doctor will ask about your symptoms and personal and sexual habits. During a physical examination, the doctor will check for tenderness over the kidneys and examine your genitals. For women, this may include a pelvic exam. Men with suspected prostate problems may have a digital rectal exam.

If your doctor thinks you have a simple bladder infection, he or she usually can confirm this with a urine test in the doctor's office.

To diagnose urethritis and vaginitis, a swab of the infected area may need to be taken and sent for testing.

If your doctor suspects you have a kidney infection, a urine sample will be sent to a laboratory to identify the species of bacteria. If you have a fever or appear ill, a blood sample may be tested in a laboratory to check for bacteria in the blood.

If you have dysuria and a have had unprotected sex with multiple partners, your doctor may order tests to look for various types of sexually transmitted diseases, including gonorrhea, chlamydia, trichomoniasis, syphilis and HIV.

Expected duration

How long dysuria lasts depends on its cause. Most people with infections of the urinary tract respond well to treatment within a few days. When the cause is more difficult to determine, symptoms may last longer.

Prevention

To help prevent dysuria caused by cystitis or pyelonephritis, you can drink several glasses of water each day to flush out your urinary tract. Women should wipe from front to back after having a bowel movement. Also they should urinate soon after sexual intercourse to flush bacteria away from the urethra. This helps prevent the bacteria from moving into the bladder.

To prevent dysuria caused by irritation, women should keep the genital area clean and dry, change tampons and sanitary napkins frequently, and 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 sand and be wary of extended play in wet swimsuits, all of which can lead to irritation and redness of the vulva (vulvitis).

To help prevent dysuria caused by sexually transmitted diseases, practice safe sex. This includes always using a condom unless you have only one steady sexual partner.

Treatment

Treatment of dysuria depends on its cause:

• Cystitis and pyelonephritis — These infections, usually caused by bacteria, can be cured with antibiotics taken by mouth. Antibiotics may be given into a vein (intravenously) for severe pyelonephritis with high fever, shaking chills and vomiting.
• Urethritis — Urethritis is treated with antibiotics. The type of antibiotic used depends on which infection causes the urethritis.
• Vaginitis — Trichomoniasis and bacterial vaginosis are treated with antibiotics. Yeast infections are treated with antifungal drugs, either as a pill by mouth or as a suppository or cream inserted into the vagina.

If you are sexually active and are being treated for dysuria caused by a sexually transmitted disease, your sex partners must be treated, too.

When to call a professional

Call your doctor or seek urgent care if you have painful urination or blood in the urine and any these other symptoms:

• fever
• frequent urination and an urgent need to urinate
• abdominal pain
• back pain
• an abnormal vaginal or urethral discharge.

Prognosis

A single episode of infection in the bladder, urethra, vagina or kidney usually goes away completely after treatment with antibiotics if treated promptly. In most cases, there is very little risk of long-term damage. However, women with certain sexually transmitted diseases can lead to scarring of the reproductive tract and fertility problems if not diagnosed and treated.

Additional info

Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/

American College of Obstetricians and Gynecologists
https://www.acog.org/

American Urological Association
https://www.urologyhealth.org/