What Causes Painful Urination (Dysuria)?

 Key takeaway

• Dysuria is a symptom, not a confirmation of a medical condition. It is a medical term used to describe painful urination.
• Causes of painful urination include urinary tract infections, kidney stones, chronic pelvic pain conditions, and vaginal infection. Certain medications and allergic reactions can also cause painful urination.
• The treatment for painful urination depends on the cause. Your doctor will recommend the right treatment for you.

Painful urination (dysuria) is a medical term that describes a feeling of pain or a burning sensation while urinating. This pain is usually felt in the bladder, the tube that carries urine out of your bladder (urethra), or the area between the genitals and the anus (perineum).

Dysuria is not a disease but an indication of an underlying health problem. It usually occurs when urine comes into contact with the irritated or inflamed mucosal lining of the urethra. The causes can be infectious (usually bacterial infections) or non-infectious. If you have dysuria, you may feel pain, a burning or stinging sensation, and discomfort at the start of peeing, when peeing, or immediately after peeing.

The causes of painful urination include:

 1. Urinary tract infection (UTI)

If you have a urinary tract infection, you may experience painful urination and frequent urination. UTI occurs when bacteria enter the urinary system and cause an infection in any part of the urinary tract—the urethra, bladder, ureters, or kidneys. These bacteria are often from the skin or rectum. UTIs are one of the leading causes of dysuria.

Having sex with an infected partner or cleaning the anus in the wrong direction can increase the risk of a UTI. Also, the risk of getting a UTI is higher in females. This is because females' urinary tracts are shorter, and the urethral opening is closer to the anus, which is the source of the bacteria.

Symptoms of urinary tract infections depend on the part of the urinary tract that is affected, but severe UTIs can also cause blood in urine, flank pain, and fever. If you have up to three episodes of this infection in a year, it indicates recurrent urinary tract infections.

 2. Sexually transmitted infections (STIs)

Sexually transmitted infections, like genital herpes, are common causes of painful urination. Sometimes, these medical conditions may not present any physical symptoms and may go unnoticed until a sex partner is diagnosed or complications occur. So a person can infect others without realizing that they are infected. Other times, affected individuals may notice symptoms like warts or bumps in their pelvic region.

Painful urination is a common symptom of many sexually transmitted infections in both men and women. Most sexually transmitted diseases, like gonorrhea, chlamydia, and trichomoniasis, can cause irritation and inflammation of the urinary tract and result in pain when you pee.

Sexually transmitted infections can also cause urethral stricture (narrowing of the urethra), which can also cause painful urination and chronic bacterial prostatitis. Other symptoms of sexually transmitted diseases depend on the infectious organism.

To reduce the risk of contracting a sexually transmitted infection during sexual activity, it is best to use condoms, especially if you have multiple sex partners.

 3. Prostate inflammation

Prostate inflammation is also known as prostatitis and is often characterized by swelling of the prostate gland, which is one of the male reproductive organs. Anyone with a prostate can have prostatitis. It can be caused by a bacterial infection, which occurs when bacteria in the urinary tract get into the prostate. Other times, the cause is unknown.

Prostatitis can be painful.  The pain can spread to the genitals and bladder. Sometimes, painful urination is one of the symptoms of this medical condition. It can also cause difficulty urinating, a frequent urge to urinate, and pelvic pain.

You can treat painful urination caused by prostatitis by seeing a urologist, who will prescribe medications to treat your prostate disease first. A prostatic massage may also help ease pressure and eliminate some of the prostate swelling.

 4. Interstitial cystitis (IC)

IC is a common cause of painful urination. Also known as painful bladder syndrome (PBS) or bladder pain syndrome (BPS), interstitial cystitis is a bladder condition that is characterized by bladder inflammation. It typically causes pain in the bladder and pelvic areas.

The exact cause of IC is unknown. Different factors can trigger this condition, causing painful urination, difficulty urinating, and increased urinary frequency.

 5. Vaginitis

Also known as vaginosis, vaginitis means vaginal inflammation. It occurs when the vaginal tissues are infected. Vaginitis is usually caused by fungi (e.g., candidiasis), bacterial infections (e.g., bacterial vaginosis), and protozoa (e.g., trichomoniasis). This infection is also commonly triggered by an imbalance in the yeast and bacteria ratio in the vagina.

In rare cases, menopause, poor hygiene, and STIs like gonorrhea, chlamydia, and herpes may also cause vaginitis. Symptoms of vaginitis include painful urination, abnormal and foul-smelling vaginal discharge. 

Pregnancy is one of the risk factors for vaginosis, as pregnant women are prone to developing this condition. If you are pregnant and feel pain when urinating, among other symptoms, let your doctor know so you can get proper treatment.

Depending on the type of vaginitis you have, you may need to take medications like antifungal medication and topical or oral antibiotics to treat the condition and relieve dysuria symptoms.

 6. Kidney stones

The kidney is part of the urinary system. In people with kidney stones, solid masses form in their kidneys from the accumulation and hardening of minerals or salt. The size of these stones varies from as small as sand grains to the size of a golf ball. These stones may remain in the kidney or travel down to the bladder and be passed out with urine. 

Sometimes the stones can get stuck in the urinary tract, e.g., in the tube that carries urine out. This can block the flow of urine and cause pain on the side or lower back and pain while urinating.

 7. Medication

Some medications, including those prescribed by a doctor, may cause side effects that include irritation and inflammation of the bladder tissues. These can often lead to pain while urinating.

If you just started a new medication and notice you also start having painful urination, go to the hospital for a differential diagnosis and speak to your doctor about getting appropriate medical treatment. Also, do not stop the medication without consulting your doctor.

 8. Allergic reactions to products

Just like in people with sensitive skin, your genital area can be sensitive and sometimes react to the chemicals in some of the products we use or apply to it. Products such as:

• Soaps
• Shaving creams
• Douches
• Scented toilet paper
• Vaginal lubricants
• Tampons, sanitary pads, and pantyliners
• Contraceptive foams
•  Spermicide cream

They can cause irritation or inflammation, resulting in dysuria.

Discontinue and monitor your symptoms if you notice painful urination that started with the use of a new hygiene product. If the painful urination stops, then it is likely caused by chemical sensitivity or a reaction to the product, and if it doesn't, you need to consult your doctor.

 Symptoms of dysuria

The symptoms of dysuria may not be the same for people with uteruses and those with penises. But the most common symptom reported by both genders is pain or a burning sensation when urinating. This pain can either be at the beginning or/and at the end of urination.

Most often, having pain at the beginning of urination is a symptom of a urinary tract infection (UTI). Pain at the end of urinating can be a symptom of prostate or bladder problems. Men may experience pain in their penis both before and after urinating.

In women, the symptoms may be internal or external. The external pain may be a result of irritation and inflammation of the sensitive vulva skin. Internal pain can be an indication of a urinary tract infection.

 Who has a higher risk of experiencing painful urination?

Anyone can experience painful urination, but people with vaginas are more commonly affected. Others who are at a higher risk of experiencing painful urination are:

• Pregnant people
• People who have diabetes
• People with enlarged prostates
• Those who have kidney stones
• People with bladder disease
• Those using a urinary catheter
• Older adults
• People who have multiple sex partners and are not using protection during sex

 Treatment for painful urination

There is no specific standard treatment for dysuria. Keep in mind that dysuria is not a health condition but a symptom of a problem. 

So, the treatment depends on the cause. For instance, if yours is caused by a bacterial infection, your doctor may prescribe antibiotics for you. For painful urination caused by an allergic reaction, treatment will involve avoiding the irritant or allergen causing the reaction. You may also consider dietary factors when treating some underlying causes of painful urination, such as kidney stones. Eating foods that contain less salt can help prevent kidney stones.

In all, treatment for painful urination focuses on treating the underlying cause, and the first step to doing that will involve determining if the cause is an infection, inflammation, diet-related, or a problem with your bladder or prostate.

 Tips for preventing painful urination

The following lifestyle changes can help you prevent painful urination and reduce pain:

1. People with vaginas should wipe from front to back after urinating or after every bowel movement. This can help prevent bacteria from getting into the vagina.
2. Stay hydrated. Taking enough water can help flush most bacteria from the urinary tract as you pee more often.
3. Practice safe sex. Use condoms when having sexual intercourse.
4. Eat fruits and vegetables. They are a source of vitamin C, which can help boost your immune system and fight infections.
5. Avoid using douches, scented toiletries, soaps, or any other product that can irritate the groin area.
6. Urinate after sex to help prevent UTIs.
7. Avoid foods and drinks that can irritate the bladder, such as acidic foods, caffeine, alcohol, and artificial sweeteners.
8. Keep the genital area clean and dry.
9. During menstruation, you should change your tampons or sanitary napkins frequently.

 When to seek medical attention

Seek medical attention for painful urination if:

• The pain is severe and persistent and lasts for more than 24 hours.
• Urinary pain is accompanied by a fever.
• You have had unprotected sexual intercourse recently.
• You have received a diagnosis of a sexually transmitted infection
• You notice an unusual discharge from the penis or vagina.
• Your urine is cloudy or smelly. 
• You have a lower urinary tract infection
• There is blood in your urine.
• You have a frequent urge to urinate. 
• You are vomiting, or you feel nauseous. 
• You experience abdominal pain.
• Your groin/ genital area is itchy.
• You pass out a kidney stone while urinating. 
• Your side or back aches.
• You are pregnant.

 Wrap up

Painful urination is a symptom of many health conditions, especially urological-related conditions. Its treatment depends on the cause.

When seeking medical care for painful urination, it is important to inform your doctor of any other symptoms you may be experiencing. This will help the doctor make a quick diagnosis and recommend the right treatment for you if those symptoms are related to your dysuria.