Dysuria is the medical term for the uncomfortable sensation of pain, burning, or stinging during urination. This common symptom can affect people of any age or gender, though it occurs more frequently in women. The discomfort arises when urine passes over an irritated or inflamed lining of the urethra or bladder. While the experience is distressing, dysuria is a symptom of an underlying condition rather than a diagnosis in itself. Understanding the potential sources of this irritation can help determine the next appropriate steps.
Understanding the Most Common Causes of Dysuria
The most frequent origin of painful urination is a bacterial infection. A Urinary Tract Infection (UTI) occurs when bacteria, such as Escherichia coli, ascend the urethra and colonize the bladder. Due to the shorter urethral length, bacteria have less distance to travel in women, making them more susceptible to this type of infection. In men, dysuria is often associated with urethritis or issues concerning the prostate gland.
Another cause of urethral inflammation is a Sexually Transmitted Infection (STI). Organisms like Chlamydia trachomatis and Neisseria gonorrhoeae can infect the urethra, leading to urethritis. For men, STIs are the most common infectious cause of urethritis. A fungal overgrowth, such as a yeast infection, can also cause irritation and burning, especially in women.
Dysuria can also be triggered by kidney stones. These stones form within the kidney and cause pain as they travel through the narrow ureter toward the bladder. The irritation occurs when a stone passes near the bladder entrance or into the urethra. Inflammation can also arise from non-infectious sources, often due to chemical exposure.
This non-infectious irritation results from contact with external irritants. Products can irritate the area around the urethra, including:
- Scented soaps
- Bubble baths
- Certain laundry detergents
- Douches
- Spermicidal gels
For women, inflammation of the external genital skin, or vulvovaginitis, can cause pain when urine comes into contact with the irritated area. Avoiding these potential chemical triggers can resolve the discomfort without further intervention.
Analyzing Associated Symptoms to Narrow the Cause
The timing and nature of the pain, along with other symptoms, can provide clues about the underlying cause. Pain felt mostly at the beginning of the urine stream often suggests inflammation or irritation localized to the urethra. Conversely, discomfort that occurs as the bladder empties or immediately after urination points more toward irritation or a spasm within the bladder wall. This end-of-stream pain is a characteristic sign of cystitis.
The presence of discharge often indicates an infection. A thin, clear, or milky penile discharge in men, or a change in vaginal discharge for women, raises suspicion for a sexually transmitted infection. Symptoms of increased urinary frequency or an urgent need to urinate often accompany dysuria in cases of a UTI. This urgency occurs because inflammation makes the bladder hypersensitive to filling.
Fever, chills, or pain in the flank or lower back suggest that the infection has progressed to the upper urinary tract. Pyelonephritis requires immediate medical attention. Visible blood in the urine, even if only a pink or brown tint, can be associated with kidney stones, infection, or other complications. Kidney stones typically cause intense, shifting pain in the side or back, along with nausea and vomiting.
Diagnosis and Treatment Options
A healthcare provider will begin the evaluation by obtaining a history of the symptoms and conducting a physical examination. The initial diagnostic step is a urinalysis, where a clean-catch urine sample is tested for the presence of white blood cells, red blood cells, and bacteria. The detection of white blood cells confirms inflammation in the urinary tract, but does not identify the specific cause.
If the urinalysis suggests an infection, a urine culture may be performed to identify the bacteria and determine which antibiotics will be most effective. For sexually active patients, particularly those with urethral discharge, testing for STIs like gonorrhea and chlamydia is often necessary. If the symptoms are recurrent or do not respond to initial treatment, the provider may consider additional tests, such as imaging or cystoscopy, to rule out stones or structural issues.
Treatment is based on the confirmed cause of the dysuria. Bacterial UTIs are treated with a short course of oral antibiotics, selected based on local resistance patterns. For pain relief during the first few days of an infection, a urinary analgesic medication like phenazopyridine may be prescribed to soothe the irritated lining. Dysuria caused by chemical irritants is managed by identifying and eliminating the irritant.
While awaiting a diagnosis, increasing fluid intake can help by diluting the urine, making it less concentrated and less irritating as it passes. Over-the-counter pain relievers, such as ibuprofen, can help reduce discomfort and inflammation. Patients should seek prompt medical care if the pain is severe or persistent, or if it is accompanied by fever, back pain, or the inability to urinate.