Dysuria (Painful Urination): Key Causes, Symptoms, and Effective Treatments

Dysuria is a pain or burning sensation when peeing. It occurs in males and females at least once in their lifetime, but females tend to develop dysuria frequently. The most common cause of dysuria is urinary tract infection, but it can also be due to non-infectious causes. Dysuria is a symptom but not a health condition seen in many diseases.  

Causes:

Dysuria causes can be broadly classified into two types. They are  

• Infectious causes: urinary tract infections (UTIs), infections of the urethra, vagina, prostate glands, and sexually transmitted infections.  
• Non-infectious causes: Skin conditions, stones or foreign bodies in the urinary tract, trauma, benign hypertrophy of the prostate, and tumors.  
• Other conditions: Medications, structural abnormalities, menopause, reactive arthritis, atrophy of the vagina, and reactive arthritis.  

Dysuria causes differ in females and males. In this blog, we explain why there is a difference in dysuria between males and females.  

• Dysuria causes in women is mainly due to bladder infection, infections from the vagina, urinary tract infection, conditions such as diverticulosis and diverticulitis, and urethral inflammation. Due to the positioning and the close location of the three openings, such as the urethral, vaginal, and anal, in females, it is easy for the bacteria to contaminate other areas.  
• Bacteria from the vagina and anal areas can quickly move to the urethral area leading to urinary tract infections. Incorrect wiping of the urethral area can transmit the infection, leading to urinary tract infection. Recurrent UTIs can also cause dysuria in women.  
• Use of douches, bubble baths, and contraceptive gels can also lead to dysuria.        
• Dysuria caused in men is mainly due to urinary tract infections, prostate disease, gonorrheal infections, Escherichia coli infections, and cancer.  

Risk factors for dysuria:

The following factors increase the risk of dysuria.  

• Pregnancy  
• Diabetes  
• Bladder diseases in either gender

How does dysuria occur

When urine comes in contact with the inflamed or irritated tissue lining, bladder muscle contractions, and peristalsis start that stimulate submucosal pain and sensor receptors. These muscle contractions stimulate pain and the fine sensory receptors, resulting in pain, itching, and burning sensations.  

Dysuria symptoms:

Dysuria is one of the most common urinary symptoms. Dysuria symptoms vary between men and women. Some of the dysuria symptoms include the following:

• Burning, stinging, and itching are some of the commonly associated symptoms.
• Pain at the beginning of urination may suggest urethral infection  
• Pain at the end of urination may suggest bladder or prostate infection  
• In males, pain can be seen before and after urination  
• In females, pain outside the vaginal area is primarily due to inflammation or irritation of the sensitive skin
• Pain inside the vaginal or urethral area is due to a urinary tract infection
• Acute dysuria is the main symptom of UTIs.  

Urethral pain syndrome:

• Dysuria symptoms associated with frequent suprapubic pain without any infection, inflammation, or any other cause are diagnosed as urethral pain syndrome. Incomplete voiding, discontinuous flow of urine, and worsened symptoms during daytime rather than night are some of its features.  
• Dysuria diagnosis:
• Dysuria diagnosis depends on history evaluation, physical examination, and diagnostic tests.  
• Dysuria diagnosis by history evaluation includes the following:
• Presence of vaginal or urethra irritation  
• Screening for pregnancy, kidney stones, trauma, tumors, recent urologic procedures, and obstructions
• Along with dysuria, additional symptoms such as fever, chills, flank pain, nausea, vomiting, joint pain, blood in urine, pus in urine, and incontinence are evaluated.  
• Recent sexual activity  
• Dysuria evaluation in women should include menstrual history, vaginal discharge examination, and use of contraceptives.
• Dysuria evaluation in men includes obstructive urinary symptoms, urethral discharge, and redness around the urethra. The inner side of the underwear should be evaluated for urethral discharge, and milking of the urethra should be carried out to detect it.  
• Mental confusion in old age can be associated with dysuria caused by UTIs.  
• Dysuria associated with pus-like discharge from the urethra indicates gonorrhea. Blood dysuria in men indicates urethral cancer. This blood discharge is different from blood in urine.  
• Dysuria associated with fever, increased pulse rate, and decreased blood pressure may be due to infection in the body.  
• Dysuria associated with flank pain, blood in urine, decreased urination, and bladder spasms are related to urological obstructions such as tumors or stones.  

Dysuria diagnosis by tests includes the following:

• Urinalysis is one of the important and initial tests for dysuria diagnosis. Nitrates in urinalysis increase positive urine culture. Dysuria symptoms with positive leukocyte esterase in urinalysis indicate urethra infections
• Dysuria symptoms associated with gram-negative diplococci in microscope examination indicate gonorrheal infections.  
• Screening tests for sexually transmitted infections are also recommended if dysuria symptoms are associated with vaginal discharge in younger and sexually transmitted infections.  
• Dysruria with a lack of response to initial treatment is indicative of complicated UTIs. Further UTI tests are recommended in such cases.  
• In males, prostatic secretions should also be assessed along with urine culture for dysuria due to prostatitis.  
• Dysuria symptoms associated with blood in urine should also be suspected for bladder cancer by cytology tests and urine cystoscopy.  
• Imaging tests like ultrasound or computed tomography diagnose when dysuria is associated with stones or urinary obstruction.  

Dysuria treatment:

Dysuria treatment depends on the cause of the infection or inflammation. The following treatments are prescribed for dysuria treatment.  

• Antibiotics are the mainstay of treatment for UTIs that cause dysuria. They are prescribed based on the type of pathogens, antibiotic resistance pattern, and dysuria symptoms.  
• Dysuria caused by urinary stones is treated by hydration for smaller ones or other surgical procedures for larger ones.  
• Intravenous antibiotics should manage dysuria diagnosed with abscess.
• Dysuria symptoms due to prostate hypertrophy are managed by alpha blockers or prostatectomy in severe cases.  
• Urethral dilation can be considered in women who have dysuria diagnosis due to urethral narrowing.
• Phenazopyridine is a commonly prescribed pain medication for dysuria treatment that temporarily subsides the symptoms and gives symptomatic relief. Due to its orange color, it can give the urine an orange tint.  
• Calcium Glycerophosphate is another medication that reduces urine acidity and relieves dysuria.  
• Doxycycline is an antibiotic that helps reduce dysuria symptoms caused due to unusual organisms.  
• Hydration helps in dysuria treatment by reducing the burning sensation due to regular voiding of urine.  
• Dietary modifications also help individuals in dysuria treatment.  
• Foods such as alcoholic beverages, chilies, condiments, cranberry juice, peppers, and sauces can cause dysuria and should be avoided.  

Dysuria prevention:

Dysuria can be prevented by following some simple precautions such as:

• Drinking at least 2-3 liters of water  
• Changing the urinary incontinence pad or tampons regularly to avoid infections
• Following the correct steps of wiping and cleaning the perineal area. Wipe from front to back and uses tissues to dry off the vaginal tissues.  

Conclusion:

Dysuria is a common symptom seen in both men and women at least once in their lifetime. Dysuria symptoms include burning and pain while urinating. Dysuria diagnosis is made through examination and diagnostic tests. Antibiotics and dietary modifications play a vital role in dysuria treatment.