Painful Urination - When urination is painful

When Urination is Painful

Dysuria is the medical term for uncomfortable, burning or painful urination. It is a common symptom and a frequent reason for a consultation with a urologist. There are many underlying causes including infections, inflammatory conditions, trauma, injury, and pelvic floor dysfunction.


Painful urination often occurs due to infections of the lower urinary tract or genital structures (urethra, bladder, prostate and vagina). The most common reason for painful urination is a bladder infection, cystitis. Prostatitis, an infection of the prostate gland can be a cause in males and the parallel process in females, para-urethral gland infection (Skenitis) can also give rise to burning. Because of the close proximity of the female urethra to the vagina, yeast infections and other forms of bacterial vaginitis can secondarily involve the urethra and cause painful urination. Urethritis, an infection of the urethra, is a frequent cause of painful urination, most often on the basis of sexual transmitted infections (STI), particularly those caused by chlamydia, gonorrhea, and herpes.

Types of urinary infections


There are also numerous non-infectious causes of painful urination. Urine contains waste products and if the urine concentration is too high because of insufficient hydration, one may experience burning. This happens particularly with the first urination of the day, when the urine is most concentrated because of the relative dehydration from the hours spent sleeping without consuming liquids. During the process of prostate radiation therapy as treatment for prostate cancer, radiation-induced inflammatory changes of the prostate may occur, resulting in irritative lower urinary tract symptoms and painful urination. On occasion, a long-term consequence of pelvic radiation therapy is radiation cystitis, that can manifest with bleeding, irritative lower urinary tract symptoms and painful urination. Interstitial cystitis, a painful inflammatory condition of the bladder that may severely impact one’s quality of life, causes painful urination, pelvic pain and urinary frequency.

Conditions that directly impacts the anatomy or function of the urethra can give rise to painful and difficult urination. These include the following: urethral stricture (scar tissue within the urethra), a urethral stone (lodged within the urethral channel), urethral diverticulum (an out-pouching from the urethra), atrophic urethritis (changes of the urethra that accompany menopause), and urethral trauma (following sexual intercourse, childbirth, straddle injuries and commonly from urinary catheters and following transurethral surgery). Pelvic floor dysfunction with hyper-tensioning of the pelvic floor muscles can cause painful urination as well as many other urinary, bowel, sexual and pelvic symptoms.


Examination of the urethra, penis, testes and prostate in males and a pelvic exam in females, along with urinalysis and urine culture are imperative. If there is urethral discharge accompanying the painful urination and/or a history of unprotected sex, a STI screen is appropriate. Urinalysis and culture will rule out urinary infection. Depending on associated urinary symptoms, cystoscopy (visual inspection of the urethra and bladder with a tiny fiberoptic telescope) and imaging tests may be indicated.


If the urine is hyper-concentrated, increasing fluid intake will improve the situation. Urinary infections are usually easily managed with a course of antibiotics. Urinary tract analgesics/antispasmodics are helpful for temporary relief of painful urination associated with infections. Prostatitis and Skenitis will generally require a more prolonged course of antibiotics. STIs are typically easily treated with the appropriate antibiotic or antiviral. Yeast infections are readily treated with anti-fungal medications. At times, a prostate relaxant medication can be helpful for the urinary difficulties associated with prostatitis, whether infectious or radiation induced. Anti-inflammatories are often useful as well. Interstitial cystitis is a complex situation with multiple potential treatment options. Atrophic urethritis can be addressed with topical estrogen. If a stone, stricture or diverticulum is found within the urethra, surgery is often indicated. For pelvic floor dysfunction, pelvic floor physical therapy can be extremely helpful to foster relaxation and “down-training” of the spastic pelvic muscles.

Painful urination treatment options

* Your urologist will determine the best course of treatment based on an individual diagnosis.

At times, despite substantial effort and testing, no source for the burning urination is found, a frustrating situation for patient and physician alike. This is often times labeled chronic urethritis and management may include including hot baths, anti-inflammatory analgesics, and the application of topical lidocaine jelly. However, in the vast majority of cases of painful urination, the diagnosis and treatment are straightforward.


Written by Dr. Andrew Siegel


Bladder Infections in Women: 12 Ways to Keep Cystitis at Bay

Bladder infections (a.k.a., cystitis) are common among women. Acute cystitis is a bladder infection that typically causes the following symptoms:

  • Pain/burning
  • Frequent urination
  • Urinary urgency (“gotta go”)

Additional symptoms that may occur include: urinating small volumes, bleeding, and urinary incontinence (leakage).

Microscopic inspection of urine usually shows bacteria, white blood cells and red blood cells.  80-90% of cystitis is caused by Escherichia coli, 5-15% by Staphylococcus and the remainder by less common bacteria including KlebsiellaProteus, and Enterococcus.

The occasional occurrence of cystitis is a nuisance and often uncomfortable, but it is usually easily treated with a short course of oral antibiotics. When bladder infections recur time and again, it becomes important to fully investigate the source of the recurrence.

Bladder infections occur when bacteria gain access to the urinary bladder, which normally does not have bacteria present. The short female urethra and the proximity of the urethra to the vagina and anus are factors that predispose to cystitis.

For an infection to develop, the vagina and urethra usually have to be colonized with the type of bacteria that can cause an infection (not the normal healthy bacteria that reside in the vagina). These bacteria must ascend into the bladder and latch onto bladder cells.

Bladder Infections in Young Women

Women aged 18-24 years old have the greatest prevalence of bladder infections and sex is usually a key factor. The most common risk factors include:

  • A new sexual partner.
  • Recent sexual intercourse.
  • Frequent sexual intercourse.
  • Spermicides, diaphragms and spermicide-coated condoms (which can increase vaginal and urethral colonization with E. Coli).

Bladder Infections in Older Women

Cystitis is common after menopause, based upon the following factors:

  • Female hormone (estrogen) deficiency, which causes a change in the bacterial flora of the vagina such that EColi replaces Lactobacilli.
  • Age-related decline in immunity.
  • Incomplete bladder emptying.
  • Urinary and fecal leakage (incontinence), often managed with pads, which remain moist and contaminated and can promote movement of bacteria from the anal area towards the urethra.
  • Diabetes (particularly when poorly controlled, with high levels of glucose in the urine that can be thought of as “fertilizer” for bacteria).
  • Neurological diseases that impair emptying or cause incontinence.
  • Pelvic organ prolapse.
  • Obesity.
  • Poor hygiene.

12 Ways to Help Keep Cystitis at Bay:

  1. Stay well hydrated to keep the urine diluted.
  2. Wipe in a top-to-bottom motion after urination or bowel movementsAt minimum, urinate every four hours while awake to avoid an over-distended bladder.
  3. Maintain a healthy weight.
  4. Urinate after sex.
  5. If infections are clearly sexual-related, an antibiotic taken before or right after sex can usually preempt the cystitis.
  6. If you are diabetic, maintain the best glucose control possible.
  7. Seek urological consultation for recurrent infections to check for an underlying and correctable structural cause.
  8. Cranberry extract. Cranberries contain proanthocyanidins that inhibit bacteria from adhering to the bladder cells. There are formulations of cranberry extract available to avoid the high carbohydrate load of cranberry juice.
  9. Probiotics such as lactobacillus. These bacteria promote healthy colonization of the vagina, production of hydrogen peroxide that is toxic to bacteria, maintenance of acidic urine, induction of an anti-inflammatory response in bladder cells, and inhibition of attachment between bacteria and the bladder cells.
  10. D-MannoseThis sugar can inhibit bacteria from adhering to the bladder cells.
  11. Estrogen creamApplied vaginally, this can help restore the normal vaginal flora as well as uro-genital tissue integrity and suppleness.
  12. Vaccination. Currently in the research phase, the concept is an oral vaccine or vaginal suppository capable of providing immunity against the typical strains of bacteria that cause infections.

Written by Dr. Andrew Siegel


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