Painful Urination: Causes and Treatment
Painful urination is a common problem in men and women. Urologists at New York Urology Specialists have extensive experience evaluating and treating men and women with symptoms of painful urination.
A thorough evaluation is performed to fully evaluate each patient and to detect potentially dangerous causes of painful urination. While often dysuria or painful urination is a sign of infection, a number of more serious conditions can present with urinary pain.
Common causes of painful urination in men and women
- UTI – Pyelonephritis, Cystitis, Urethritis
- Bladder Stones or Kidney Stones
- Urethral stricture
- Sexually transmitted disease
- Chemical irritants – soaps, tampons, toilet paper
- Bladder cancer
- Common Causes of Painful Urination in men
- Prostate cancer
- Common Causes of Painful Urination in women
- Interstitial Cystitis / pelvic pain syndrome
Painful urination or dysuria is commonly associated with an inflammatory condition of the lower urinary tract. Inflammation of other pelvic organs may also result in pain during urination. The pain is commonly referred to the tip of the urethral opening though it may also be felt over the bladder region which lies just above the pubic bone. The pain may be acute and sharp or dull and diffuse.
Another interesting feature of this pain is its relation to the urination. Pain that occurs at the beginning of urination is often due to urethral inflammation whereas pain at the end of urination is often but not always related to bladder problems. This pain is usually accompanied with increased urinary frequency and urgency.
Painful urination, also known as dysuria, is a common condition associated with a number of diseases.
Symptoms of painful urination:
Painful urination or dysuria is basically a painful condition that is associated with urination. Usually there is no pain, but only happens while passing urine. This pain can range from a dull ache and heaviness, to a stinging or burning sensation. This makes passage of urine very difficult. The pain usually is felt around the urinary outlet.
Causes of painful urination:
Dysuria or painful urination is caused by a number of conditions. The most important cause of painful urination is infection of the urinary tract, better known as a urinary tract infection. It is a very common condition that almost 8 out of every 10 persons experience at least once in their life time.
Urinary tract infections are 50 times more common in women due to their anatomical difference from men. The infection can be in any part of the urinary tract. Most common is infection in the urethra and the bladder. The urethra is the part of urinary tract, a tube, which carries urine from the bladder to the urinary outlet. The bladder stores urine. The infection can spread upwards to involve the kidney which is a serious condition and is known as the pyelonephritis. These infections of the urinary tract are usually bacterial infections, but other pathogens may also be involved.
Urinary tract infections are not without a cause. They are usually secondary to some disease or cause. These include kidney stones, poor hygiene, and many kidney diseases. It can also be sexually transmitted.
Another important cause of painful urination in men is prostatitis, or inflammation of the prostate gland. It can happen due to a number of reasons, from age related enlargement of the prostate gland, called benign hyperplasia of prostate (BPH), to infections. Infection of the prostate is usually bacterial and can cause a lot of pain.
Cystitis or inflammation of the bladder is yet another possible cause of painful urination. It can occur secondary to infections, or renal tract stones. Or, it can be due to inflammation of the bladder walls, called interstitial cystitis, but whose cause is still unknown. It can lead to massive bladder pain and painful urination.
Other reasons for painful urination include prostate carcinoma in males, sexually transmitted diseases like gonorrhea, and local irritation of the skin including balanitis. Passage of urine causes burning and stinging on this inflamed skin.
Treatment of Painful Urination (Dysuria):
For infective conditions such as urinary tract infections, antibiotics are usually prescribed by the treating physician; with an increase in fluid intake recommended as well i.e. the patient is asked to drink excessive amounts of water to wash out any infective organism or the colonies.
The antibiotics used for this purpose are those which are excreted in large amounts by the kidneys, so that after filtration from the blood they can accumulate in the renal tract and kill the pathogenic or disease causing organism. Commonantibiotics in this regard include ciprofloxacin, levofloxacin, nitrofurantoin and sulfamethoxazole with trimethoprim. The selection of the most suitable antibiotic is done after a culture of urine sample.
In old days when the field of medicine was in its premature phase, physicians used to treat urinary tract infections by modifying the pH of urine i.e. by modification of the environment of bacteria or any pathogen causing the infection. Most of the bacteria survive at a specific level of acidity or basicity. First they used to make the urine more basic or less acidic so as to kill organisms capable of surviving in acidic environments, and then they used to make urine acidic so as to kill those organisms that grow in a basic environment. How did they achieve this? It is very simple. The kidneys regulate the environment of the body by excreting excess acids and bases in urine. If the diet is more acidic, the kidneys excretes this excess acid and vice versa. In modern day this technique is also used, and is effective in killing some microorganisms.
The treatment of sexually transmitted diseases and the inflammatory conditions also consists of antibiotics and anti-inflammatory medicines. Carcinoma of the bladder or prostate has to be surgically removed. And kidney stones have to be treated depending on their size, location and associated symptoms. Large stones may require surgical fragmentation and removal. Lithotripsy with ultrasound waves might also be beneficial.
Prevention involves some lifestyle modifications. For example, the use of condoms during sexual intercourse prevents sexually transmitted diseases. Similarly, maintaining good hygiene is also essential in preventing a number of urinary tract infections. Adequate water intake also helps to reduce the incidence of kidney stones and urinary tract infections.
- Pyelonephritis is an acute or chronic inflammation of kidney usually causes by bacterial infection. The acute condition presents with fever, flank pain and nausea or vomiting. Recurrent infections may result in progressive deterioration of kidney function especially in children.
- Cystitis is inflammation of urinary bladder commonly due to E. coli. Other bacteria and fungi may also be involved. The pain is burning is nature. The urine may appear turbid or blood stained. This condition is more common in women due to short urethra and proximity of urethral opening to the vagina and anus. In young women, sexual activity and use of spermicides also increase the risk of such infections and is called as ‘Honeymoon cystitis’. Catheterization of the urinary bladder increases chances of cystitis. Other risk factors include diabetes mellitus and bladder outflow obstruction leading to stagnation and bacterial infection.
- Interstitial cystitis is a chronic inflammatory condition of the bladder wall, not related to any infection. In this condition, the pain is aggravated on filling of bladder and relieved on passing urine. It is associated with increased frequency and urgency.
- Urethritis is inflammation of urethra. It is very painful condition and the pain is tearing or burning in character. It is maximal at the beginning of the act and reduces slightly after a good flow. It is broadly divided into gonococcal urethritis caused by N. gonorrhoea and non-gonococcal urethritis due to chlamydia trachomatis. Other organisms that cause urethritis include E. coli and trichomonas vaginalis. A yellowish or white discharge is seen at the tip of the urethra that is tender on palpation.
- Stone disease results in formation of stones of various composition and size in different parts of the urinary tract. They form in kidney, ureter, bladder and prostate. Presence of stones or their passage during urination causes severe pain that radiates downwards. It may also be associated with microscopic or macroscopic haematuria or blood in urine. Many people notice the passage of small stones in urine. An obstruction caused by stone results in infection and aggravation of pain.
- Urethral stricture is a localized narrowing in the lumen of urethra. It occurs due to fibrosis after an infection of urethral trauma due to catheterization. It causes urinary obstruction, pain, poor urinary stream and terminal dribbling.
- Sexually transmitted diseases are infections usually caused by chlamydia trachomatis, herpes simplex virus, human papilloma virus, Gonorrhea, Syphilis, Trichomoniasis and HIV.
- Schistosomiasis is a parasitic disease caused by Schistosoma haematobium which is responsible for involvement of urinary tract. Urinary schistosomiasis usually results in cystitis and urethritis and causes painful urination. It may progress to bladder cancer. It is uncommon in the US and occurs most commonly in visitors from Egypt.
- Chemical irritants – soaps, tampons and toilet paper may cause non-bacterial inflammation of the urethra and painful urination.
- Bladder cancer may present with dysuria in the early stages. It may be suspected in a person who is a chronic smoker and develops painful urination. Often but not always the urine is culture negative for bacteria and shows presence of red blood cells.
- Prostatitis is an inflammation of prostate in men. It is acute or chronic and bacterial or non-bacterial. The inflammation causes pain in the rectum or the perineum and is also aggravated during urination.
- BPH or benign prostatic hyperplasia causes bladder outflow obstruction. Straining is a feature in these cases and due to stasis; they are prone to infection of lower urinary tract that is associated with painful urination.
- In prostate cancer, pain either occurs due to similar reasons as in BPH. Pain can also occur if the cancer spreads to adjacent organs such as pelvic bones.
- Endometriosis is a condition in which islands of endometrium are present outside the uterine cavity. These ectopic sites of endometrium include ovaries, broad ligament bladder wall and peritoneum. These areas undergo similar cyclical changes during menses due to hormonal effects. Endometriosis can cause pain on urination, dysmenorrhea, pelvic pain and dyspareunia.
- Vaginitis is vaginal inflammation caused by bacteria, candida and trichomoniasis. It presents with vaginal discharge, itching and pain on urination. The discharge is foul smelling and is associated with inflammation of vaginal opening including labia majora and minora. It is more commonly seen in women with diabetes.