What causes dysuria: Dysuria: Evaluation and Differential Diagnosis in Adults
8 Causes of Burning & Pain While Peeing
Dysuria is a symptom of pain, discomfort, or burning when urinating. It is more common in women than in men. In men, it is more common in older men than younger men.
These are some of the more common causes of painful urination:
Infections. Urinary tract infections (UTIs) are one of the leading causes of painful urination. Infections can occur in any part of the urinary tract, including:
- Ureters (tubes that carry urine from the kidneys to the bladder)
- Urethra (tube from the bladder that carries urine out of the body)
Urinary tract infections are most often caused by bacteria that get into the urinary tract through the urethra.
Factors that can increase your chance of developing a UTI include:
- Being a woman
- Advanced age
- Enlarged prostate
- Kidney stones
- Having a urinary catheter in place
Besides painful urination, other symptoms of UTI include:
- Foul or stronger-smelling urine
- Cloudy or bloody urine
- Increased urinary frequency or urge to urinate
- Flank pain
Sometimes painful urination can be related to a vaginal infection, such as a yeast infection. With vaginal infections, you may also expect changes in vaginal discharge and odor.
Sexually transmitted infections can also cause painful urination. These include:
Besides painful urination, these sexually transmitted infections can also cause symptoms such as:
Inflammation and irritation. A range of problems can lead to inflammation or irritation of the urinary tract or genital area, leading to the symptom of painful urination. Besides infections, other reasons that area may be irritated or inflamed include:
- Stones in the urinary tract
- Irritation of the urethra from sexual activity
- Interstitial cystitis, a condition caused by bladder inflammation
- Vaginal changes related to menopause
- Activities such as horseback riding or bicycling
- Vaginal sensitivity or irritation related to use of scented soaps or bubble bath, toilet paper, or other products such as douches or spermicides
- Side effects from certain medications, supplements, and treatments
- Tumor in the urinary tract
Seeing a Doctor for Dysuria
After a history and physical exam, your doctor may request lab tests to help diagnose the cause of your dysuria symptoms. Then you can begin targeted treatment.
To help determine the cause, the doctor may ask whether your painful urination:
- Started suddenly or gradually
- Occurred once or many times
- Is felt at the onset of urination
The doctor may also ask if your painful urination is accompanied by symptoms such as:
- Abnormal discharge
- Flank pain
The doctor may also want to know if the painful urination is accompanied by changes in urine flow, such as:
- Difficulty initiating flow
- Increased frequency or need to urinate
And you may also be asked by your doctor if there are changes in urine character along with painful urination. These include changes in urine such as:
Answers to these questions will give your doctor clues to the cause. You will likely need a urine test or other tests to confirm a diagnosis.
Dysuria (Painful Urination): Treatment, Causes & Symptoms
What is dysuria (painful urination)?
Dysuria is pain or discomfort when you urinate (pee). It burns! Dysuria isn’t about how often you go (urinary frequency), though urinary frequency often happens together with dysuria. Dysuria is not a diagnosis. It’s a sign or symptom of an underlying health problem.
Who gets dysuria (painful urination)?
Men and women of any age can experience painful urination. It’s more common in women. Urinary tract infections (UTIs) are commonly associated with dysuria. UTIs occur in more women than men.
Other people at a higher risk of dysuria include:
- Pregnant women.
- Men and women with diabetes.
- Men and women with any type of disease of the bladder.
What are the symptoms of dysuria (painful urination)?
Symptoms of painful urination can vary between men and women, but both genders usually describe it as a burning, stinging or itching. Burning is the most commonly reported symptom.
Pain can occur at the start of urination or after urination. Pain at the start of your urination is often a symptom of a urinary tract infection. Pain after your urination can be a sign of a problem with the bladder or prostate. In men, pain can remain in your penis before and after urination too.
Symptoms in women can be internal or external. Pain outside your vaginal area may be caused by inflammation or irritation of this sensitive skin. Internal pain can be a symptom of a urinary tract infection.
How is dysuria (painful urination) diagnosed?
See your healthcare provider if you feel pain or burning when you pee. Dysuria can be a symptom of medical condition that may need to be treated. To diagnose your pain, first your healthcare provider will review your complete medical history, including asking you questions about your current and past medical conditions, such as diabetes mellitus or immunodeficiency disorders. He or she may also ask about your sexual history to determine if an STI could be the cause of the pain. Tests to screen for STIs may also be needed, especially if men have a discharge from their penis or women have discharge from their vagina. If you are a woman of childbearing age, a pregnancy test may be done.
Your provider will also ask about your current prescriptions and over-the-counter medication use and any tried “home remedies” to manage the dysuria.
Your healthcare provider will also ask you about your current symptoms and obtain a clean catch sample of your urine. Your urine sample will be analyzed for white blood cells, red blood cells or foreign chemicals. The presence of white blood cells tells your provider you have inflammation in your urinary tract. A urine culture reveals if you have a urinary tract infection and if so, the bacteria that are causing it. This information allows your provider to select the antibiotic that will work best in treating the bacteria.
If no sign of infection is found in your urine sample, your healthcare providers may suggest additional tests to look at your bladder or prostate (in men). Your provider may also take a swab sample of the lining of your vagina or the urethra to check for signs of infection (in women).
What are the causes of dysuria (painful urination)?
There are many causes of dysuria. Also know that doctors can’t always identify the cause.
WOMEN: Painful urination for women can be the result of:
- Bladder infection (cystitis).
- Vaginal infection.
- Urinary tract infection.
- Endometritis and other causes outside the urinary tract, including diverticulosis and diverticulitis.
- Inflammation of the bladder or urethra (urethritis) (Your urethra is the tube that begins at the lower opening of your bladder and exits out of your body). Inflammation is usually caused by an infection.
The inflammation may also be caused by sexual intercourse, douches, soaps, scented toilet paper, contraceptive sponges or spermicides.
Normal female anatomy
MEN: Painful urination for men may be the result of:
- Urinary tract infection and other infections outside the urinary tract, including diverticulosis and diverticulitis.
- Prostate disease.
Normal male anatomy
Painful urination for men and women may be the result of a sexually transmitted infections (STIs) or the side effect of medications. Chemotherapy cancer drugs or radiation treatments to the pelvic area may inflame the bladder and cause painful urination.
Care and Treatment
How is dysuria (painful urination) treated?
Treatment for dysuria depends on the cause of your pain/burning sensation. The first step in your treatment is to determine if your painful urination is caused by infection, inflammation, dietary factors, or a problem with your bladder or prostate.
- Urinary tract infections are most commonly treated with antibiotics. If your pain is severe, you may be prescribed phenazopyridine. Note: this medication turns you urine red-orange and stains undergarments.
- Inflammation caused by irritation to the skin is usually treated by avoiding the cause of the irritant.
- Dysuria caused by an underlying bladder or prostate condition is treated by addressing the underlying condition.
There are several steps you can take to reduce the discomfort of painful urination, including drinking more water or taking an over-the-counter aid (such as Uristat® or AZO®) to treat painful urination. Other treatments need prescription medications.
If you have frequent urinary tract infections, your provider can help find the cause.
Can anything be done to prevent dysuria?
- Drink more water. Drink two to three liters of water a day.
- If you wear a urinary incontinence pad, change it as soon as it gets soiled.
- After you (a woman) urinates, take some additional new tissue and wipe away any urine from the inside of your vaginal lips.
When to Call the Doctor
When should I call my healthcare provider?
Dysuria is a symptom. It causes a burning sensation, pain and/or discomfort. You will likely choose to contact your healthcare provider because this symptom is uncomfortable. It’s important to see your provider to determine if your symptom is related to a urinary tract infection or another medical cause. In any case, the sooner you see your provider, the sooner a diagnosis can be made and treatment can be started.
What Causes Burning or Painful Urination (Dysuria)?
A common cause of painful urination is a lower urinary tract infection or inflammation in the urinary tract. Infection occurs when bacteria enter the urethra and travel to the bladder.
Women ages 20 to 50 are more likely to experience bladder infections (cystitis) and therefore painful urination. (5) Pregnant women, people with diabetes, postmenopausal women, and people with bladder diseases are also at higher risk of bladder infections and dysuria. (2)
Upper urinary tract infections, or kidney infections, can also cause dysuria. Kidneys become infected when bacteria travel to the kidney from the bladder. Pregnant women, people with diabetes, people with a history of kidney stones, and men with an enlarged prostate are more likely to experience upper urinary tract infections. (5)
Vaginitis, or inflammation of the vagina, can also cause painful urination. Vaginitis can be caused by an allergic reaction to chemicals (such as spermicides, soap, or bubble bath), low levels of estrogen, yeast infections, bacterial vaginosis, or the sexually transmitted infection trichomoniasis. (5)
Urethritis, or inflammation of the urethra, can also cause painful urination. Causes typically include sexually transmitted infections, like gonorrhea and chlamydia, a reaction to irritating chemicals, or irritation from the insertion of a catheter. (5)
Causes of dysuria can also vary by gender. Women often experience dysuria with: (4)
- Irritation of vaginal tissue
- Atrophic vaginitis during menopause
- Herpes infection in genitals
- Dietary factors
- Sexual intercourse
Men may experience burning with urination if they have prostate disease (an inflamed or infected prostate) or cancer. (3) Men over age 50 are more likely to experience bladder infections due to prostate issues. (5)
Additional causes of painful urination for both men and women can include: (4)
Dysuria – StatPearls – NCBI Bookshelf
Continuing Education Activity
Dysuria is a symptom of pain and/or burning, stinging, or itching of the urethra or urethral meatus with urination. It is a very common urinary symptom experienced by most people at least once over their lifetimes. Causes of dysuria can be divided broadly into two categories, infectious and non-infectious. Treatment varies depending on the etiology. This activity describes the evaluation and treatment of dysuria and explains the role of the healthcare team in improving care for patients with this condition.
Identify the various pathophysiologies of dysuria.
Summarize the history and physical exam of a patient presenting with dysuria.
Review the management options available for dysuria.
Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients with dysuria.
Access free multiple choice questions on this topic.
Dysuria is defined as the sensation of pain and/or burning, stinging, or itching of the urethra or urethral meatus associated with urination. It is a very common urinary symptom experienced by most people at least once over their lifetime. Dysuria typically occurs when urine comes in contact with the inflamed or irritated urethral mucosal lining. This is exacerbated by and associated with detrusor muscle contraction and urethral peristalsis, which then stimulates the submucosal pain receptors resulting in pain or a burning sensation during urination. Several conditions can cause dysuria via different mechanisms. True dysuria requires differentiation from other symptoms, which can also occur due to pelvic discomfort from various bladder conditions such as interstitial cystitis, prostatitis, and suprapubic or retropubic pain.
The causes of dysuria can be divided broadly into two categories, infectious and non-infectious. Infectious causes include urinary tract infections or urethritis, pyelonephritis, prostatitis, vaginitis, and sexually transmitted diseases. Non-infectious causes include skin conditions, foreign body or stone in the urinary tract, trauma, benign prostatic hypertrophy, and tumors. Also, interstitial cystitis, certain medications, specific anatomic abnormalities, menopause, reactive arthritis (Reiter’s syndrome), and atrophic vaginitis can all cause dysuria.
One of the most common causes of dysuria is urinary tract infection (UTI) which occurs in both males and females. Urinary tract infections are much more common in females than males due to anatomical considerations. In females, bacteria can reach the bladder more easily due to a shorter and straighter urethra compared to males, as the bacterial organisms have far less distance to travel to reach the bladder from the urethral meatus. Females who use the wrong wiping technique, from back to front instead of the preferred front to back, take baths instead of showers, or do not use washcloths to clean their vaginal area first when bathing, can predispose themselves to more frequent urinary tract infections due to repeated contamination of the urethral meatus to peri-rectal and other bacteria. Because of their higher likelihood of recurrent urinary tract infections, females also tend to experience dysuria more frequently than males. Most urinary tract infections are uncomplicated and relatively simple to treat. However, persistent dysuria may be associated with complicated urinary tract infections which are found in men with UTIs, incompletely treated simple UTIs, prostatitis, pregnancy, immunocompromised status, catheters, nephrolithiasis, renal failure, dialysis, neurogenic bladder, anatomical or functional abnormalities of the urinary tract, pelvic floor dysfunction, and overactive bladder.
The most common cause of male urethritis is infectious from sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium. Chlamydia is the most commonly identified cause of non-gonococcal urethritis (found in about 50%), followed by Mycoplasma genitalium. Less commonly, other organisms will be found, such as Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Gardnerella vaginalis, and Ureaplasma urealyticum.  Refractory cases should have testing for Trichomonas vaginalis. When testing patients suspected or at risk for sexually transmitted infections, consider screening for HIV and syphilis as well.
Gonorrhea is found in about 22% of symptomatic men, with an overall incidence of 213 cases per 100,000 males in 2018, and the incidence is increasing. Rates are significantly higher in non-Hispanic African Americans compared with the general population. Rates are also higher in the geographic South compared to other regions in the US. Other parts of the world have even higher rates, such as a reported 62% incidence of gonorrhea in symptomatic men in South Africa.
Urethritis associated with bacterial prostatitis is most often caused by gram-negative organisms such as E. coli. Dysuria together with epididymitis is most often caused by Chlamydia trachomatis in men less than 35 years and by E. coli, Pseudomonas, and other gram-negative coliforms in older men.
Dysuria associated with frequency and suprapubic pain without any objective evidence of infection, inflammation, or any other identifiable cause is sometimes called urethral pain syndrome (formerly urethral syndrome). This is very similar to a mild form of interstitial cystitis, which is possibly just a different variety of the same disorder. Both lack positive urine findings of infection. The main clinical differences are:
Urethral syndrome has more continuous but somewhat milder dysuria, usually described as a constant irritation. It is possibly related to urethral stenosis and/or hormonal imbalances, although the exact cause is still unknown. Painful spasms of the pelvic musculature are common. Suprapubic discomfort and urinary frequency may be present but are usually not the primary urinary symptoms and are generally not as severe as with interstitial cystitis. Urinary frequency is much more severe during the daytime when it can often require voiding every 30 to 60 minutes with little or no nocturia. Urethral syndrome patients are typically female from 13 to 70 years of age.
Interstitial cystitis typically has more bladder discomfort, frequency, urgency, and pain when the bladder is full and is relieved somewhat upon voiding.
Various foods can increase bladder and urethral irritation, of which caffeine is the most prevalent. High potassium and hot, spicy foods are also considered irritating to the bladder and urethra. A complete, detailed list is available at: http://my.clevelandclinic.org/disorders.overactive_bladder/hic_bladder_irritating_foods.aspx.
Uncommon causes of dysuria would include endometriosis, atrophic vaginitis, urethral strictures, diverticula, inflammation or infection of the paraurethral/Skene’s glands, syphilis, mycobacterium, herpes genitalis, and infected urachal cysts.
Other causes would include the presence of a double J urinary stent, recent urethral instrumentation or Foley catheterization, bladder calculi, prostatitis, traumatic sexual intercourse, pelvic floor dysfunction, herpes zoster, and lichen sclerosis.
Topically applied products, such as douches, bubble baths, and contraceptive gels, are also potentially irritating to the urethra. A clinical trial of avoiding any and all topical agents is reasonably warranted.
Overactive bladder will present with urgency and frequency as the primary symptoms. There may also be intermittent suprapubic pain or discomfort.
Dysuria typically affects about 3% of all adults over 40 years of age at any given time, making it one of the most common of all urinary symptoms. Acute cystitis is the most common cause of dysuria. It accounts for about 7 million outpatient visits yearly in the United States, with one-fifth of these occurring in Emergency Departments.
Dysuria typically occurs when urine comes in contact with the inflamed or irritated urethral mucosal lining. This is exacerbated by and associated with detrusor muscle contractions and urethral peristalsis, which then stimulates the submucosal pain and sensory receptors resulting in pain, itching, or a burning sensation during urination. Various inflammatory or neuropathic processes can increase the sensitivity of these receptors. Occasionally, inflammation from surrounding organs, such as the colon, can result in dysuria.
Non-infectious causes of dysuria, such as urinary calculi, tumors, trauma, strictures or foreign bodies, and atrophic vaginitis, can result from irritation of the urethral or bladder mucosa. Decreased capacity and elasticity of the detrusor can cause urinary urgency or incontinence along with dysuria.
History and Physical
Detailed history taking is essential when someone presents with dysuria. The clinician must try to determine the timing, severity, duration, and persistence of the symptoms. For example, pain at the beginning of urination suggests a urethral problem such as urethritis. Pain at the end of urination may be from the bladder or prostate. Initial history should include features of a possible local cause that may be causing dysuria, like vaginal or urethral irritation. Any history regarding risk factors like pregnancy, the possibility of a kidney stone, trauma, tumor, recent urologic procedures, and the possibility of urologic obstruction merit consideration. Patient history should include information regarding associated symptoms like fever, chills, flank pain, low back pain, nausea, vomiting, joint pains, hematuria, nocturia, urgency, frequency, and incontinence. In elderly patients, history regarding changes in mental status is necessary, as many times the most common symptom of a urinary tract infection in older adults is confusion. History regarding recurrence of symptoms is also necessary, and a thorough physical examination should be performed.
A purulent urethral discharge is suggestive of gonorrhea. Isolated dysuria without other symptoms is most likely from chlamydia. Dysuria with genital ulcers suggests possible herpes simplex virus, and balanoposthitis is sometimes associated with Mycobacterium genitalium.
The clinician should also look for physical findings of fever, rash, direct tenderness over the bladder area, and joint pain. Physical findings of increased temperature, rapid pulse, or low blood pressure in the presence of dysuria can indicate systemic infection. Regional lymph nodes should be palpated. Urological obstruction due to a stone or tumor can result in findings of flank pain, hematuria, decreased urination, and bladder spasms. All these physical findings should be looked for carefully. History regarding recent sexual activity is crucial. In women, it is essential to note menstrual history, complaints of vaginal discharge, and whether the patient is using contraception. Males can present with different symptoms than females and may have perineal pain or obstructive urinary symptoms and dysuria, which could be caused by prostatitis. Males patients require inspection for a urethral discharge, and the urethral meatus should be checked for redness, crusting, and exudate. Check the inside lining of the underwear for signs of a discharge. If urethritis or a discharge is suspected, the urethra can be milked to elicit a specimen for testing. This is done by placing a gloved finger at the base of the penis on the ventral surface and pressing inwards. Then, slowly move the entire hand forward towards the glans. Any discharge should be collected for culture.
Evaluation of dysuria starts with detailed history taking and a thorough physical examination. Associated signs and symptoms of hematuria, suprapubic tenderness, urinary frequency, urgency, fever, chills, nausea, vomiting, low back pain, flank pain, joint pain, rash, etc., require close follow-up.
Urinalysis is the most useful test to start the work up in a patient with dysuria. Urinalyses positive for nitrites carries a high predictive value of a positive urine culture (75% to 95%). Positive leukocytes (anything more than a trace positive) is also highly predictive but slightly less than nitrites (65% to 85%). The presence of both positive nitrites and leukocytes on a dipstick is extremely predictive. Dysuria in a patient with only positive leukocyte esterase or pyuria in the urine suggests urethritis. 
Gram stain microscopy showing Gram-negative diplococci is diagnostic for gonorrhea. Typically, microscopic examination of urethral secretions demonstrating 5 WBC or more per oil immersion microscopic field was diagnostic for urethritis, but some have suggested this cutoff be lowered to just 2 WBC. The most sensitive test for male gonorrhea or chlamydia is urinary nucleic acid amplification testing (NAAT). The sample should be obtained at least 20 minutes after the most recent void and optimally at least an hour afterward.
Patients who do not respond to initial treatment and those with risk factors for a possible complicated urinary tract infection should have a full urine culture and sensitivity analysis performed.
It is important to check a complete blood count and a metabolic panel, including serum creatinine, if a systemic infection is suspected, especially if the patient is having nausea, vomiting, fever, or chills. Blood cultures need to be done if there is a suspicion of systemic spread of infection. In severe cases, hospitalization should be considered.
If sexually transmitted infections are suspected, such as in younger, sexually active patients, then a urethral or vaginal probe should be performed. Samples should be obtained to diagnose Neisseria gonorrhoeae and Chlamydia trachomatis. Women who have vaginal symptoms should have a wet mount examination or a vaginal DNA probe. In male patients where chronic prostatitis is suspected, gentle prostatic massage can help obtain a sample of the expressed prostatic secretions for a urine culture. If the patient has hematuria and bladder cancer is suspected, then urine cytology can be helpful in addition to the usual cystoscopy. Imaging tests like ultrasonography or CT scan may be in order in cases of dysuria where patients show signs of having a complicated urinary tract infection, obstruction, unexplained fevers, flank pain, hydronephrosis, abscess, stones, or tumors. However, imaging is not necessary in most cases of simple dysuria. In selected cases, cystoscopy can be performed to evaluate symptoms of chronic or intractable dysuria resistant to standard therapies, which can be associated with bladder cancer, vesicle stones, prostatitis, or hematuria.
Urethral pain syndrome, formerly urethral syndrome, typically presents with dysuria as one of the key symptoms. Other symptoms of urethral pain syndrome include urinary frequency and suprapubic discomfort. The bladder pain is relieved somewhat by voiding. There may also be hesitancy, slowing of the urinary stream, and a feeling of incomplete bladder emptying. Urine cultures are negative, and the urinary symptoms are usually worse during the day compared to nighttime. The original description of urethral syndrome was urinary frequency and dysuria without evidence of infection. It was thought to be primarily due to urethral stenosis treatable with serial urethral dilations. It is now thought that urethral dilations are only appropriate in a very small minority of patients. Urethral pain syndrome is found predominantly in women aged thirty to fifty years. In this group of women, vaginal pathology (vaginal infections, atrophic vaginitis, and similar pathology) should be carefully excluded. It is thought that up to one-quarter of all patients, especially women, with lower urinary tract symptoms without a documented infection might actually have urethral pain syndrome. The diagnosis is primarily one of exclusion. There is clearly an overlap between urethral pain syndrome, interstitial cystitis, and urethral pain syndrome, as there is a definite lack of consensus on specific criteria between these disorders, and they may not be mutually exclusive. The exact cause of urethral pain syndrome is unknown.
Reactive arthritis, formerly called Reiter’s syndrome, was historically used to describe the combination of urethritis, conjunctivitis, and arthritis. Arthritis is usually a post-infectious, autoimmune response. Reiter’s syndrome reflects only a portion of all patients with reactive arthritis. It is defined as arthritis which follows an infection that cannot be cultured from the affected joint. When triggered by a sexually transmitted organism, the condition is called sexually acquired reactive arthritis. It usually presents in younger adults, with gastrointestinal and genitourinary infections being the most common triggering events. The most common causative genitourinary organism is Chlamydia trachomatis, followed by Chlamydia pneumoniae, Escherichia coli, Ureaplasma urealyticum, and Mycoplasma genitalium. Intravesical Bacillus Calmette-Guerin (BCG), used as an immunotherapy for bladder cancer, has also been identified as a rare cause, affecting about 1% – 2% of treated patients.
Recently, reactive arthritis cases have been reported following COVID-19 infections. The arthritis produced is usually acute, non-symmetrical, and typically affects the lower extremities (knees), although it may occur in almost any joint. This arthritis typically follows the original infection by 1-4 weeks.  Ocular effects are present in about 20% of all cases of reactive arthritis. The diagnosis is made by clinical suspicion where there is a history of urethritis preceding arthritis and the lack of any evidence for other types of arthritis. Urinary Nucleic Acid Amplification Testing (NAAT) can help identify Chlamydia and Gonococcus in suspected cases. Human Leukocyte Antigen (HLA-B27) testing will be positive in 30% to 50% of patients with reactive arthritis, but a negative test does not rule it out. Appropriate antibiotic treatment is usually recommended for Chlamydia based reactive arthritis if an active infection is present. Antibiotics for chronic infection-related arthritis are more controversial as most randomized trials of long-term antibiotic therapy show little or no improvement. Treatment of arthritis includes NSAIDs, intra-articular and systemic glucocorticoids, and other disease-modifying agents such as sulfasalazine and methotrexate. Prognosis is usually good as reactive arthritis typically lasts only 3 to 5 months, and most patients enjoy a complete remission.
Treatment / Management
Treatment of dysuria depends on the underlying etiology whenever possible. The most common cause of dysuria is a urinary tract infection. Empiric antibiotic therapy based on a patient’s history and symptoms is usually the most cost-effective therapy. No further evaluation is necessary in those cases where dysuria from uncomplicated urinary tract infection is suspected. When the clinician suspects a complicated urinary tract infection, as in the presence of associated symptoms like nausea, vomiting, fever, or chills, then along with starting antibiotics, additional testing like blood cultures, a metabolic panel, or a complete blood count are all viable options. In the case of suspected pyelonephritis, stones, or urinary obstruction, imaging with ultrasonography or CT scan can be diagnostic.
Antibiotic therapy for urethritis depends on the underlying organism, which is most likely to be sexually transmitted. Gonorrhea is treated with ceftriaxone, cefixime, ceftizoxime, cefoxitin, or azithromycin. Quinolones are no longer recommended due to increasing resistance. Non-gonococcal urethritis is usually treated with single-dose azithromycin (1 gram) or doxycycline (100 mg BID for 7 days). This regimen generally has about an 80% overall cure rate. Doxycycline is generally preferred for chlamydia. Mycoplasma, a relatively common cause of persistent urethritis, demonstrates resistance to standard therapy with doxycycline, which now has a high failure rate. Azithromycin appears to be more effective than doxycycline and is currently recommended for Mycoplasma genitalium and Ureaplasma urealyticum. An extended azithromycin regimen, which tends to avoid induced macrolide resistance, is also available (500 mg orally to start, then 250 mg daily for the next four days). This is appropriate for those who fail initial doxycycline therapy. If this regimen fails (azithromycin failures), ten days of moxifloxacin 400 mg daily is recommended. Prolonged erythromycin therapy does not appear to be effective and is not recommended. Recurrent symptoms tend to be related to non-compliance, repeat exposure, chronic prostatitis, or infections with Trichomonas vaginalis or Mycoplasma genitalium.
Trichomonas is present in only about 2.5% of male urethritis cases. When present, treatment is with metronidazole 2 grams for the patient and his/her partner.
Infrequent causes of urethritis include Treponema pallidum (syphilis) and Haemophilus influenzae which can be transmitted during oral sex.
Physicians should be mindful of the possibility of anti-microbial resistance, and optimal antibiotics should be started based on likely pathogens, local resistance patterns, and costs (or insurance coverage) associated with the treatment. When dysuria occurs due to chronic prostatitis in males, appropriate oral antibiotics are recommended after obtaining a urine culture. If the cause of dysuria is renal stones, then various treatment options can be considered depending on the size and location of the calculi. Stones smaller than 5 mm typically pass on their own. Patients should be asked to hydrate themselves and strain the urine to document the evidence of a passed stone. Stones larger than 5 mm are treatable through various modalities, including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy (PCNL), and very rarely open surgery.
When the patient presents with dysuria and a perinephric abscess is suspected, it should first undergo evaluation with an imaging study like ultrasonography or a CT scan. Once it is confirmed to be an abscess, the patient should be hospitalized, and intravenous antibiotics should be initiated, followed by open surgical drainage or percutaneous catheter drainage, or both. If the cause of dysuria is benign prostatic hypertrophy, then medical treatment with alpha-blockers or 5-alpha reductase inhibitors should be considered. If the patient has no symptomatic improvement after trying the medical therapy, then the surgical option of transurethral resection of the prostate should be considered, but this is typically done for other urinary symptoms rather than for isolated dysuria.
Historically, female urethral dilation has been used for many urological complaints in women, including dysuria, but this practice is rarely used today. Nevertheless, there may be the occasional female patient with actual urethral stenosis who would benefit from dilation.
There will inevitably be cases where no specific cause of dysuria can be found. In such cases, treatment tends to be symptomatic or holistic. Various generic dysuria treatments include:
Dietary modification. A large variety of foods and beverages have been reported to contribute to dysuria symptoms. These include alcoholic beverages, highly acidic and spicy foods, hot sauces, condiments, high potassium fruits like bananas, lemons, and tomatoes, fruit juices including cranberry, salad dressings, peppers, chillis, tomato sauces, and ketchup. As mentioned earlier, a more complete list is available on the Cleveland Clinic website.
Phenazopyridine. This medication can often relieve the irritation and stinging of dysuria and sometimes the urinary frequency that accompanies it. For best results, it must be taken three times a day. It has an intense orange color when it passes into the urine and will permanently stain anything it touches, so it is best to warn patients of this. The most common side effects are dizziness, headache, and nausea. It is not an antibiotic but a topical analgesic. Since it only provides symptomatic relief and can build up in the body, it is not usually recommended for more than three days continuously. The medication should not be used in patients with known glucose-6-phosphate dehydrogenase deficiency as it can lead to hemolysis.
Calcium glycerophosphate is an OTC medication that purports to reduce urinary acidity to help relieve dysuria. While it appears to help with dysuria in at least some patients, there are no published randomized studies on its efficacy, so evidence on the product is purely anecdotal. It is officially classified as a “medical food” and was originally designed to treat interstitial cystitis. It can be sprinkled over food or taken as a tablet at mealtime. The dietary recommendations are essentially the same as for interstitial cystitis.
Hydration. Many patients with dysuria will tend to drink less, so they will have to void less often. However, this tends to increase urinary concentrations and ultimately leads to worse burning. Patients should be encouraged to drink more, not less.
Trial of doxycycline, if not used previously. Doxycycline is a tetracycline-based antibiotic with a unique spectrum of activity that includes many unusual and uncommon organisms. A trial of this antibiotic may cure some patients of otherwise intractable dysuria from an unusual organism.
Trial of azithromycin as Mycoplasma genitalium is a common cause of persistent or intractable urethritis.
A clinical trial of estrogen cream in postmenopausal women is a reasonable therapy to try as at least some patients will benefit.
Other treatments of dysuria to consider include topical anesthetics, tricyclic antidepressants (such as imipramine or amitriptyline), muscle relaxants, alpha-blockers, urothelial barrier protection enhancement drugs (such as pentosan polysulfate), local steroids, and antibiotics.
Some success has also been reported with behavioral therapy such as biofeedback, meditation, hypnosis, dietary therapy (to increase urinary pH and avoid high urinary potassium as well as other known bladder irritants), acupuncture, botox injections, gabapentin (300 to 600 mg daily) and sertraline (50 – 200 mg daily) therapy. Intravesical gentamicin plus betamethasone has also been reported to be of benefit in some dysuria patients. Tolterodine can act as both a bladder antispasmodic and anesthetic. A combination of atropine, hyoscyamine methenamine, methylene blue, phenyl salicylate, and benzoic acid is another option; it has both mildly anesthetic and antispasmodic effects. It also will inhibit bacterial growth. It gives the urine a blue-green color.
There is generally no specific surgical treatment for dysuria, but Nd:Yag laser ablation has shown some promise in carefully selected female patients with symptoms refractory to medical therapy. Laser ablation of squamous metaplasia of the trigone and bladder neck areas has shown success in some patients with trigonitis. The initial necrotic tissue coagulation immediately after laser ablation is followed by regrowth of normal urothelium.
Summary of Dysuria Treatments
Antibiotics as appropriate for UTIs, urethritis, and/or prostatitis)
Dietary therapy (avoidance of alcohol, caffeine, hot spices, processed and high potassium foods)
Second-line antibiotics (doxycycline, azithromycin)
Third line antibiotics (moxifloxacin)
Vaginitis therapy (metronidazole, miconazole, fluconazole, etc.)
Estrogen for atrophic vaginitis
Alpha-blockers and overactive bladder medications (tolterodine)
Symptomatic therapy (phenazopyridine, calcium glycerophosphate, and similar)
Oral or intravesical elmiron
Female urethral dilation
Differential diagnoses broadly divide into two categories. Inflammatory and non-inflammatory.
Infectious causes – Cystitis, urethritis, pyelonephritis, sexually transmitted infections. In females, vulvovaginitis and cervicitis can be the causes of dysuria, while in males, it can result from prostatitis and epididymo-orchitis.
Dermatologic – Contact dermatitis, psoriasis, Behcet syndrome, lichen sclerosis, lichen planus, Stevens-Johnson syndrome
Noninfectious causes – Stone, a urethral or ureteral stent
Trauma – Foreign body, surgery, urinary tract instrumentation, pelvic radiation.
Endocrine – Atrophic vaginitis, endometriosis
Drugs – Cyclophosphamide, Ketamine
Anatomic – Benign prostatic hypertrophy, urethral stricture.
Neoplastic – Renal cell cancer, bladder cancer, lymphoma, vaginal cancer, vulvar cancer, prostate cancer, penile cancer, metastatic cancer.
Idiopathic – Interstitial cystitis, urethral pain syndrome
The prognosis for dysuria depends upon the cause of dysuria. Most of the etiologies of dysuria, including inflammatory and non-inflammatory, demonstrate a good long-term prognosis, but early detection and treatment of the underlying causes of the dysuria are essential. Sepsis occurring due to urinary tract infections can lead to higher morbidity and mortality than systemic infections of other organs or systems although urosepsis still has a better overall prognosis. Long-term complications can occur due to stones, chronic infections, or benign prostatic hypertrophy, potentially leading to renal failure and, in severe cases, end-stage renal disease. During pregnancy, both maternal and fetal complications can arise if urinary tract infections do not receive treatment timely and adequately. Prognosis of dysuria occurring from neoplastic causes like renal cancers or bladder cancers depends upon the stage and type of cancer when it gets diagnosed. Early diagnosis and quick follow-up with adequate treatment carry a good prognosis, while a delayed diagnosis is associated with higher recurrence and poor prognosis.
Depending on the cause of dysuria, short-term complications can include acute renal failure, development of systemic infection and sepsis, acute anemia from hematuria, urethral strictures with urinary retention, and emergent hospitalizations. Long-term complications consist of developing end-stage renal disease, infertility, long-term disability from recurrent infections, strictures or urinary tract cancers, and even death from severe systemic infections or advanced urinary tract cancers. Patients with complicated urinary tract infections can develop recurrences with greater antibiotic resistance, leading to higher rates of hospitalizations and increased morbidity and mortality.
Deterrence and Patient Education
Patient education is crucial in preventing recurrent cases of dysuria. If women have dysuria due to recurrent urinary tract infections or vaginitis, they should be educated not to use douches, maintaining perineal hygiene, and using correct wiping techniques. Patients who are experiencing recurrent sexually transmitted infections should be educated about safe sex practices, the use of condoms, and urinating right after sex. Patients who get recurrent urinary tract infections due to uncontrolled diabetes should be educated about the importance of controlling their blood sugars. Patients with dysuria from atrophic vaginitis can benefit from education and the use of hormone replacement therapy. Male patients suspected of having dysuria from benign prostatic hypertrophy should be educated about routine prostate exams and taking medications to control the related urinary symptoms. All patients should understand the importance of early detection and treatment of infections, which can present with dysuria as the earliest sign, and should be encouraged to seek proper follow-up and treatment.
Enhancing Healthcare Team Outcomes
Using these recommendations, the interprofessional health care team can modify their approach to diagnose and treat patients with dysuria. It will also benefit in terms of increasing efficiency and reducing unnecessary testing. It will improve patient outcomes by educating them about the importance of early detection, adequate follow-up, and timely treatment.
Given the broad spectrum of possible etiologies for dysuria, all healthcare team members must collaborate and function as a unit. The clinician who first encounters the complaint must order appropriate testing, which will often form the basis for referrals. Diagnosis and management can include specialists from several different disciplines. Nursing can serve as a primary contact point for patient questions and offer counsel, while pharmacists can help with medication recommendations, check for interactions, and counsel the patient on proper dosing and administration. Prompt interprofessional care will help discover the underlying cause, allowing earlier, proper treatment, leading to better patient outcomes. [Level 5]
- Dysuria: What You Should Know About Burning or Stinging with Urination. Am Fam Physician. 2015 Nov 01;92(9):Online. [PubMed: 26554482]
- Michels TC, Sands JE. Dysuria: Evaluation and Differential Diagnosis in Adults. Am Fam Physician. 2015 Nov 01;92(9):778-86. [PubMed: 26554471]
- Geerlings SE. Clinical Presentations and Epidemiology of Urinary Tract Infections. Microbiol Spectr. 2016 Oct;4(5) [PubMed: 27780014]
- Stamm WE. Chlamydia trachomatis infections: progress and problems. J Infect Dis. 1999 Mar;179 Suppl 2:S380-3. [PubMed: 10081511]
- Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC. Mycoplasma genitalium compared to chlamydia, gonorrhoea and trichomonas as an aetiological agent of urethritis in men attending STD clinics. Sex Transm Infect. 2009 Oct;85(6):438-40. [PMC free article: PMC2761964] [PubMed: 19383597]
- Horner P, Blee K, O’Mahony C, Muir P, Evans C, Radcliffe K., Clinical Effectiveness Group of the British Association for Sexual Health and HIV. 2015 UK National Guideline on the management of non-gonococcal urethritis. Int J STD AIDS. 2016 Feb;27(2):85-96. [PubMed: 26002319]
- Black V, Magooa P, Radebe F, Myers M, Pillay C, Lewis DA. The detection of urethritis pathogens among patients with the male urethritis syndrome, genital ulcer syndrome and HIV voluntary counselling and testing clients: should South Africa’s syndromic management approach be revised? Sex Transm Infect. 2008 Aug;84(4):254-8. [PubMed: 18192290]
- Miklovic T, Davis P. Dysuria, Rebound Tenderness, and a Palpable Mass-A Ticking Time Bomb. Mil Med. 2021 Apr 30; [PubMed: 33929544]
- Wrenn K. Dysuria, Frequency, and Urgency. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths; Boston: 1990. [PubMed: 21250134]
- Horner PJ, Taylor-Robinson D. Association of Mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis. Sex Transm Infect. 2011 Feb;87(1):38-40. [PubMed: 20852310]
- Sinnott JD, Howlett DC. Urinary frequency and dysuria in an older woman. BMJ. 2016 Sep 13;354:i4587. [PubMed: 27625371]
- Rees J, Abrahams M, Doble A, Cooper A., Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015 Oct;116(4):509-25. [PMC free article: PMC5008168] [PubMed: 25711488]
- Little P, Turner S, Rumsby K, Jones R, Warner G, Moore M, Lowes JA, Smith H, Hawke C, Leydon G, Mullee M. Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women. Br J Gen Pract. 2010 Jul;60(576):495-500. [PMC free article: PMC2894378] [PubMed: 20594439]
- Bellazreg F, Abid M, Lasfar NB, Hattab Z, Hachfi W, Letaief A. Diagnostic value of dipstick test in adult symptomatic urinary tract infections: results of a cross-sectional Tunisian study. Pan Afr Med J. 2019;33:131. [PMC free article: PMC6754830] [PubMed: 31558930]
- Orellana MA, Gómez-Lus ML, Lora D. Sensitivity of Gram stain in the diagnosis of urethritis in men. Sex Transm Infect. 2012 Jun;88(4):284-7. [PubMed: 22308534]
- Rietmeijer CA, Mettenbrink CJ. Recalibrating the Gram stain diagnosis of male urethritis in the era of nucleic acid amplification testing. Sex Transm Dis. 2012 Jan;39(1):18-20. [PubMed: 22183839]
- Kwan B, Ryder N, Knight V, Kenigsberg A, McNulty A, Read P, Bourne C. Sensitivity of 20-minute voiding intervals in men testing for Chlamydia trachomatis. Sex Transm Dis. 2012 May;39(5):405-6. [PubMed: 22504609]
- Artero A, Esparcia A, Eiros JM, Madrazo M, Alberola J, Nogueira JM. Effect of Bacteremia in Elderly Patients With Urinary Tract Infection. Am J Med Sci. 2016 Sep;352(3):267-71. [PubMed: 27650231]
- Wagenlehner FM, Brockmeyer NH, Discher T, Friese K, Wichelhaus TA. The Presentation, Diagnosis, and Treatment of Sexually Transmitted Infections. Dtsch Arztebl Int. 2016 Jan 11;113(1-02):11-22. [PMC free article: PMC4746407] [PubMed: 26931526]
- Ateya A, Fayez A, Hani R, Zohdy W, Gabbar MA, Shamloul R. Evaluation of prostatic massage in treatment of chronic prostatitis. Urology. 2006 Apr;67(4):674-8. [PubMed: 16566972]
- Comploj E, Trenti E, Palermo S, Pycha A, Mian C. Urinary cytology in bladder cancer: why is it still relevant? Urologia. 2015 Oct-Dec;82(4):203-5. [PubMed: 26219472]
- Brisbane W, Bailey MR, Sorensen MD. An overview of kidney stone imaging techniques. Nat Rev Urol. 2016 Nov;13(11):654-662. [PMC free article: PMC5443345] [PubMed: 27578040]
- DeGeorge KC, Holt HR, Hodges SC. Bladder Cancer: Diagnosis and Treatment. Am Fam Physician. 2017 Oct 15;96(8):507-514. [PubMed: 29094888]
- Bremnor JD, Sadovsky R. Evaluation of dysuria in adults. Am Fam Physician. 2002 Apr 15;65(8):1589-96. [PubMed: 11989635]
- Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A., Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003 Jan;61(1):37-49. [PubMed: 12559262]
- Taniguchi Y, Nishikawa H, Karashima T, Yoshinaga Y, Fujimoto S, Terada Y. Frequency of reactive arthritis, uveitis, and conjunctivitis in Japanese patients with bladder cancer following intravesical BCG therapy: A 20-year, two-centre retrospective study. Joint Bone Spine. 2017 Oct;84(5):637-638. [PubMed: 27825571]
- Saricaoglu EM, Hasanoglu I, Guner R. The first reactive arthritis case associated with COVID-19. J Med Virol. 2021 Jan;93(1):192-193. [PMC free article: PMC7405389] [PubMed: 32652541]
- Yokogawa N, Minematsu N, Katano H, Suzuki T. Case of acute arthritis following SARS-CoV-2 infection. Ann Rheum Dis. 2020 Jun 26; [PubMed: 32591356]
- Ono K, Kishimoto M, Shimasaki T, Uchida H, Kurai D, Deshpande GA, Komagata Y, Kaname S. Reactive arthritis after COVID-19 infection. RMD Open. 2020 Aug;6(2) [PMC free article: PMC7722270] [PubMed: 32763956]
- Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Rheum Dis Clin North Am. 2009 Feb;35(1):21-44. [PubMed: 19480995]
- Kvien TK, Gaston JS, Bardin T, Butrimiene I, Dijkmans BA, Leirisalo-Repo M, Solakov P, Altwegg M, Mowinckel P, Plan PA, Vischer T., EULAR. Three month treatment of reactive arthritis with azithromycin: a EULAR double blind, placebo controlled study. Ann Rheum Dis. 2004 Sep;63(9):1113-9. [PMC free article: PMC1755135] [PubMed: 15308521]
- Bardin T, Enel C, Cornelis F, Salski C, Jorgensen C, Ward R, Lathrop GM. Antibiotic treatment of venereal disease and Reiter’s syndrome in a Greenland population. Arthritis Rheum. 1992 Feb;35(2):190-4. [PubMed: 1734908]
- Laasila K, Laasonen L, Leirisalo-Repo M. Antibiotic treatment and long term prognosis of reactive arthritis. Ann Rheum Dis. 2003 Jul;62(7):655-8. [PMC free article: PMC1754599] [PubMed: 12810429]
- Putschky N, Pott HG, Kuipers JG, Zeidler H, Hammer M, Wollenhaupt J. Comparing 10-day and 4-month doxycycline courses for treatment of Chlamydia trachomatis-reactive arthritis: a prospective, double-blind trial. Ann Rheum Dis. 2006 Nov;65(11):1521-4. [PMC free article: PMC1798345] [PubMed: 17038453]
- Barry HC, Ebell MH, Hickner J. Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies. J Fam Pract. 1997 Jan;44(1):49-60. [PubMed: 9010371]
- Workowski KA, Bolan GA., Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 05;64(RR-03):1-137. [PMC free article: PMC5885289] [PubMed: 26042815]
- Garcia MR, Wray AA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 15, 2021. Sexually Transmitted Infections. [PubMed: 32809643]
- Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, Colombara DV, Golden MR, Hakhu NR, Thomas KK, Hughes JP, Jensen NL, Totten PA. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013 Apr;56(7):934-42. [PMC free article: PMC3588116] [PubMed: 23223595]
- Seña AC, Lensing S, Rompalo A, Taylor SN, Martin DH, Lopez LM, Lee JY, Schwebke JR. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis. 2012 Aug 01;206(3):357-65. [PMC free article: PMC3490700] [PubMed: 22615318]
- Wikström A, Jensen JS. Mycoplasma genitalium: a common cause of persistent urethritis among men treated with doxycycline. Sex Transm Infect. 2006 Aug;82(4):276-9. [PMC free article: PMC2564707] [PubMed: 16877573]
- Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis. 2009 Jun 15;48(12):1649-54. [PubMed: 19438399]
- Weinstein SA, Stiles BG. Recent perspectives in the diagnosis and evidence-based treatment of Mycoplasma genitalium. Expert Rev Anti Infect Ther. 2012 Apr;10(4):487-99. [PubMed: 22512757]
- Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis. 2011 Dec;53 Suppl 3:S129-42. [PMC free article: PMC3213402] [PubMed: 22080266]
- Wetmore CM, Manhart LE, Lowens MS, Golden MR, Whittington WL, Xet-Mull AM, Astete SG, McFarland NL, McDougal SJ, Totten PA. Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study. Sex Transm Dis. 2011 Mar;38(3):180-6. [PMC free article: PMC4024216] [PubMed: 21285914]
- Ito S, Hatazaki K, Shimuta K, Kondo H, Mizutani K, Yasuda M, Nakane K, Tsuchiya T, Yokoi S, Nakano M, Ohinishi M, Deguchi T. Haemophilus influenzae Isolated From Men With Acute Urethritis: Its Pathogenic Roles, Responses to Antimicrobial Chemotherapies, and Antimicrobial Susceptibilities. Sex Transm Dis. 2017 Apr;44(4):205-210. [PubMed: 28282645]
- Bader MS, Hawboldt J, Brooks A. Management of complicated urinary tract infections in the era of antimicrobial resistance. Postgrad Med. 2010 Nov;122(6):7-15. [PubMed: 21084776]
- Coker TJ, Dierfeldt DM. Acute Bacterial Prostatitis: Diagnosis and Management. Am Fam Physician. 2016 Jan 15;93(2):114-20. [PubMed: 26926407]
- Shafi H, Moazzami B, Pourghasem M, Kasaeian A. An overview of treatment options for urinary stones. Caspian J Intern Med. 2016 Winter;7(1):1-6. [PMC free article: PMC4761115] [PubMed: 26958325]
- Leslie SW, Sajjad H, Murphy PB. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 1, 2021. Renal Calculi. [PubMed: 28723043]
- Patti L, Leslie SW. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr 17, 2021. Acute Renal Colic. [PubMed: 28613743]
- Edelstein H, McCabe RE. Perinephric abscess. Modern diagnosis and treatment in 47 cases. Medicine (Baltimore). 1988 Mar;67(2):118-31. [PubMed: 3352513]
- Tanguay S, Awde M, Brock G, Casey R, Kozak J, Lee J, Nickel JC, Saad F. Diagnosis and management of benign prostatic hyperplasia in primary care. Can Urol Assoc J. 2009 Jun;3(3 Suppl 2):S92-S100. [PMC free article: PMC2698785] [PubMed: 19543429]
- Frank JE. Diagnosis and management of G6PD deficiency. Am Fam Physician. 2005 Oct 01;72(7):1277-82. [PubMed: 16225031]
- Phillip H, Okewole I, Chilaka V. Enigma of urethral pain syndrome: why are there so many ascribed etiologies and therapeutic approaches? Int J Urol. 2014 Jun;21(6):544-8. [PubMed: 24447292]
- YOUNGBLOOD VH, TOMLIN EM, WILLIAMS JO. Senile urethritis in women. Gynaecologia. 1960;149(Suppl):76-9. [PubMed: 13846661]
- Cakici ÖU, Hamidi N, Ürer E, Okulu E, Kayigil O. Efficacy of sertraline and gabapentin in the treatment of urethral pain syndrome: retrospective results of a single institutional cohort. Cent European J Urol. 2018;71(1):78-83. [PMC free article: PMC5926640] [PubMed: 29732211]
- Palleschi G, Carbone A, Ripoli A, Silvestri L, Petrozza V, Zanello PP, Pastore AL. A prospective study to evaluate the efficacy of Cistiquer in improving lower urinary tract symptoms in females with urethral syndrome. Minerva Urol Nefrol. 2014 Dec;66(4):225-32. [PubMed: 25034330]
- Costantini E, Zucchi A, Del Zingaro M, Mearini L. Treatment of urethral syndrome: a prospective randomized study with Nd:YAG laser. Urol Int. 2006;76(2):134-8. [PubMed: 16493214]
- FERGUSON JD. The differential diagnosis of dysuria. Practitioner. 1952 Oct;169(1012):458-61. [PubMed: 13003775]
- Qiang XH, Yu TO, Li YN, Zhou LX. Prognosis Risk of Urosepsis in Critical Care Medicine: A Prospective Observational Study. Biomed Res Int. 2016;2016:9028924. [PMC free article: PMC4756185] [PubMed: 26955639]
- Yaxley JP. Urinary tract cancers: An overview for general practice. J Family Med Prim Care. 2016 Jul-Sep;5(3):533-538. [PMC free article: PMC5290755] [PubMed: 28217578]
- Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gágyor I. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. Ger Med Sci. 2016;14:Doc01. [PMC free article: PMC4749724] [PubMed: 26909012]
Dysuria, Uncertain Cause (Adult)
The urethra is the tube that allows urine to pass out of the body. In a woman, the urethra is the opening above the vagina. In men, the urethra is the opening on the tip of the penis. Dysuria is the feeling of pain or burning in the urethra when passing urine.
Dysuria can be caused by anything that irritates or inflames the urethra. An infection or chemical irritation can cause this reaction. A bladder infection is the most common cause of dysuria in adults. A urine test can diagnose this. A bladder infection needs antibiotic treatment.
Soaps, lotions, colognes, and feminine hygiene products can cause dysuria. So can birth control jellies, creams, and foams. It will go away 1 to 3 days after using these irritants.
Sexually transmitted infections (STIs) such as chlamydia or gonorrhea can cause dysuria. Your healthcare provider may take a culture sample. Your provider may start you on antibiotic medicine before the culture test returns.
In women who have gone through menopause, dysuria can be from dryness in the lining of the urethra. This can be treated with hormones. Dysuria becomes long-term (chronic) when it lasts for weeks or months. You may need to see a specialist (urologist) to diagnose and treat chronic dysuria.
These home care tips may help:
Don’t use any chemicals or products that you think may be causing your symptoms.
If you were given a prescription medicine, take as directed. Take it until it is all used up.
If a culture was taken, don’t have sex until you have been told that it is negative. A negative culture means you don’t have an infection. Then follow your healthcare provider’s advice to treat your condition.
If a culture was done and it is positive:
Both you and your sexual partner may need to be treated. This is true even if your partner has no symptoms.
Contact your healthcare provider or go to an urgent care clinic or the public health department to be looked at and treated.
Don’t have sex until both you and your partner have finished all antibiotics and your healthcare provider says you are no longer contagious.
Learn about and use safe sex practices. The safest sex is with a partner who has tested negative and only has sex with you. Condoms can prevent STIs from spreading, but they aren’t a guarantee.
Follow up with your healthcare provider, or as advised. If a culture was taken, you may call as directed for the results. If you have an STI, follow up with your provider or the public health department for a complete STI screening, including HIV testing. For more information, contact CDC-INFO at 800-232-4636.
When to get medical advice
Call your healthcare provider right away if any of these occur:
You aren’t better after 3 days of treatment
Fever of 100.4ºF (38ºC) or higher, or as directed by your provider
Back or belly pain that gets worse
You can’t urinate because of pain
New discharge from the urethra, vagina, or penis
Painful sores on the penis
Rash or joint pain
Painful lumps (lymph nodes) in the groin
Testicle pain or swelling of the scrotum
Dysuria (Painful Urination) Treatment – Newport Urgent Care
Painful urination is a common indication for a urinary tract infection, but may also indicate the presence of a sexually transmitted disease, kidney stones, tumors or a prostate condition. Most often a bacterial infection causes inflammation that triggers the pain. Bacteria can present from soaps, bubble baths, spermicides, douches and unclean wiping habits.
- Burning sensation or slowness during urination
- Blood in the urine or itchy vaginal discharge
- Upper back pain with fever and chills
Who is at risk?
Dysuria occurs mostly in the 24-55 age group. Physical activities such as cycling or horseback riding can trigger symptoms. Sexual intercourse may also introduce contaminates that may result in dysuria.
Physicians will prescribe antibiotics if infection is detected. In general, keep the area clean and dry. Women should change feminine products frequently and limit products used in the bathtub. Bubble baths should be avoided in children, as they are a frequent cause of burning with urination and urinary infections, especially in females.
Emergency Warning Signs: When should I see a doctor?
Dysuria should be evaluated by your physician to expedite treatment. Pain in the upper back accompanied by fever are signs of kidney infection and must be evaluated immediately to avoid severe illness.
Treatment for dysuria (painful urination) is available now at Newport Urgent Care in Newport Beach, CA.
For more information on dysuria, see the following websites:
WiseGeek on What Causes Dysuria?
EverydayHealth on Prevention of Dysuria
Dysuria in Pregnancy
Disclaimer: The links above are to sites independent of NewportUrgentCare.com. The pages will open in a new browser window. The information provided is for educational purposes only, and is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health problem, you should consult your doctor. Always follow your doctor’s recommendations regarding your specific medical questions, treatments, therapies, and other needs.
Dysuria (Painful Urination): Causes, Treatment, & More
One of the most mundane everyday activities is going to the bathroom. Everyone does it, every single day. At home, at work, while out shopping, it’s so commonplace, that it’s easy to overlook how great it is to do so without any issues. But, if you’ve suddenly started noticing a painful or burning sensation every time you urinate, you may be wondering what’s causing it. Why is it happening? What’s the best form of treatment? And, how do you know it’s time to go to an emergency room.
What is dysuria?
Dysuria is the medical term for painful urination. It is not a disease in itself, but a symptom of an underlying medical condition. Some individuals do not necessarily feel pain, but they are aware that something may be wrong, due to discomfort or a burning sensation every time they urinate. Symptoms of dysuria could vary in how long they last, depending on what’s causing it.
Causes of Dysuria
There are many reasons why a person may be experiencing painful or uncomfortable urination. Some are easier to diagnose than others. The most common ones include:
- Urinary tract infections (cystitis)
- Kidney infections (pyelonephritis)
- Kidney or bladder stones
- Yeast infections
- Sexually transmitted diseases — gonorrhea, herpes, or chlamydia
- Certain medications
- Certain personal care products
Symptoms of Dysuria
Painful, burning, or otherwise uncomfortable urination isn’t the only telltale sign of dysuria. Other symptoms depend on the condition that’s causing them. The most common ones include:
Cystitis (Urinary Tract Infection)
If this is the ailment that’s causing your dysuria, you’ll also typically experience a frequent and intense urge to urinate, abdominal pain, cloudy urine, strong-smelling urine, loss of bladder control, and sometimes, blood in the urine.
Pyelonephritis (Kidney Infection)
This is an infection of the upper urinary tract. Other symptoms include a high fever, chills, nausea, vomiting, a frequent and intense urge to urinate, and in some cases, back pain.
This is an inflammation of the vagina. Additional symptoms include pain, itching, light vaginal bleeding, and/or unusual vaginal discharge. The condition is more common in postmenopausal women.
This is an inflammation of the prostate — the gland that produces semen, located right below the bladder. Additional signs include flu-like symptoms, difficulty urinating, pain of the penis or testicles, and/or cloudy urine.
Also known as candidiasis, this is a fungal infection of the vagina that causes irritation and intense itching of the vulva. Another common sign is a thick, white vaginal discharge that looks like cottage cheese.
Sexually Transmitted Diseases
The symptoms of STDs can vary depending on the type of disease. However, in addition to painful or burning urination, you may experience pain or discomfort during sex, painful or swollen genitalia, unusual discharge, and/or bumps, rashes, or sores in the genitals, anus, thighs, or mouth.
Treatment for Dysuria
Treatment for dysuria will depend on the underlying condition that’s causing it. Typically, it includes staying hydrated throughout the day and taking antibiotics. It may also include topical ointments or over-the-counter medications. However, if you’ve never experienced this feeling before and you know it’s not a mild UTI or yeast infection — or whenever you’re in doubt — seek medical attention. Doing so will help prevent complications, such as urinary incontinence or erectile dysfunction.
When to go to the ER for Dysuria
Seek immediate emergency medical care if, in addition to a painful or burning urination, you are experiencing a fever, abdominal or back pain, or an abnormal discharge from the vagina or urethra. Failing to seek treatment could result in complications and sometimes death if the infection spreads.
How to Prevent Dysuria
There are several things you can do to prevent dysuria. These include:
- If you’re a woman, wipe front to back after bowel movements.
- Urinate as soon as possible after sexual intercourse.
- Keep the genital area clean and dry.
- Practice safe sex.
- Avoid irritating soaps, laundry detergents, and personal care products.
- Drink several glasses of water a day — this will flush bacteria out of your urinary tract.
24-Hour Emergency Room Services in Colorado Springs and Texas
If you or a loved one believe you may have dysuria, let us help you. If you have questions or need immediate treatment, your nearest Complete Care location is ready to help, no matter the time of day or night. We offer a variety of services to help you and your family in your time of need. No appointments are necessary.
90,000 Treatment of dysuria at the Klass Klinik medical center in Omsk
Dysuria is a pathological condition in which urination becomes difficult and painful. The disease occurs in men and women of different ages.
At the initial stage, the disease is not a cause for concern. You notice that you have frequent urination, but do not attach much importance to this problem. In the future, maintaining the old way of life becomes impossible. The urge to urinate becomes so frequent that you cannot go about your usual activities.In this case, severe pain appears. Home treatment is ineffective. Pain relievers and thermal treatments are only temporary.
Lack of timely treatment causes constant pain. The patient’s quality of life deteriorates markedly. The patient is constantly faced with infectious and inflammatory diseases of the genitourinary system. In severe cases, urination stops. Long-term retention of urine in the body leads to an increase in the concentration of toxic substances in the blood.This condition is life threatening.
Causes and symptoms
Among the main causes of the disease – inflammation of the bladder, stones in the ureter. Violation of urination can develop as a consequence of traumatic brain injury, endocrinological disease, hemorrhoids. In men, dysuria occurs with diseases of the prostate gland. In women, the disease is provoked by malignant neoplasms of the uterus, inflammatory diseases of the pelvic organs. Predisposing factors – psychogenic reactions, frequent stress, weakening of the immune system, hypothermia.
Dysuria is manifested by the following symptoms:
- painful urination
- decrease or increase in the volume of excreted urine
- Frequent or too infrequent urination
- Failure to empty the bladder
How to solve the problem?
Are you afraid that dysuria will cause constant pain or dangerous complications? You can avoid the severe consequences of the disease.Will help with the examination by an experienced specialist. Experienced urologists attend the Klass Klinik medical center. The doctor will conduct an examination. Based on its results, you will be prescribed treatment for dysuria, which will help in your case. All follow-up visits to the urologist are free of charge.
Do not try to fight urinary problems on your own. Get back to normal and protect yourself from complications. Make an appointment with your doctor now.
Do you want to see a urologist at a convenient time for you? Fill out the online registration form.
UROLOGISTS CLASS CLINICS
Prices for urology in Omsk
- Doctor’s consultation
- Ultrasound of the prostate
- ultrasound of the bladder
- Physical examination
- Digital rectal examination of the prostate
- Doppler ultrasound (study of blood flow in the vessels of the penis)
Cost when registering online
Repeated consultation of a urologist during the course of treatment
Repeated consultation of a urologist (within 6 months)
Before being examined by a urologist, you should not urinate for 2-4 hours before the appointment time (if possible).If your disease is accompanied by frequent urge to urinate, it is permissible to drink 0.5 liters of liquid 30 minutes before taking it and not urinate before taking it.
Do not drink alcoholic beverages, including beer, during the day before taking.
Attention! Compliance with the standard conditions for blood sampling for analysis significantly reduces the error at the preanalytical stage:
- Patient should not eat 12 hours prior to blood sampling.
- Before donating venous blood, it is necessary to exclude fatty foods and alcohol from the diet.
- Avoid physical activity 3 days before the study.
- Exclude X-ray exposure and instrumental examination.
- 15-30 minutes before blood sampling, the patient should be in a state of emotional rest.
- The amount of blood collected depends on the number of tests requested.
- Blood sampling for infections can be carried out at any time of the day for at least 4 hours on an empty stomach.
Preparation for other analyzes
Make an appointment online at a convenient time
|Only a few herbal remedies from the numerous list available today are reliable: the herbal origin of raw materials alone is not yet proof of sufficient efficacy and safety of the drug produced from it. Different extracts contain different components, have different pharmacological effects and are characterized by different bioavailability, therefore, each phytopreparation requires a comprehensive study to ensure a sufficient level of evidence of the results obtained.Not all companies manage to carry out the process of standardization at all stages of creating a phytopreparation – from growing to obtaining the final product; manufacturers. Thus, only phytopreparations with proven efficacy and safety – such world-famous brands as Kanephron ® N (“Bionorica”).|| According to the number of clinical studies and scientific publications, the complex herbal preparation Canephron ® N is considered one of the most studied. Its components have complex activity, manifested in anti-inflammatory action and elimination of urinary tract spasm, diuretic, antibacterial effects. It has been shown that its use at the stage of follow-up examination in patients with dysuria syndrome makes it possible to achieve a decrease in the activity of the pathological process without transitioning to a detailed clinical picture of exacerbation in 85.3% of cases (Dudar I.A. et al., 2015).
Of course, the data obtained in clinical studies of the phytopreparation Canephron ® N cannot be automatically extrapolated to other medicines and biologically active additives containing the same composition of medicinal plants as components – rosemary, lovage and centaury. Thus, it was found that the equivalent anti-inflammatory and antispasmodic effects of in vitro are achieved by 2 times lower concentrations of the drug Canephron ® N in comparison with the phytosimilar of a domestic manufacturer, containing components of the same botanical species (Zupanets I.A. et al., 2014).
| Sarah Bush Lincoln
Dysuria is when you experience pain while urinating. It is often described as a burning sensation. Learn more about this problem and how you can solve it.
What causes dysuria?
Possible causes of dysuria:
Bacterial or viral infection such as urinary tract infection (UTI) or sexually transmitted infection (STI)
Sensitivities or allergies to chemicals such as those found in lotions and other products
Prostate or bladder problems
Radiation therapy to the pelvic area
How is dysuria diagnosed?
Your doctor will examine you.He or she will ask about your symptoms and health. After talking with you and having a physical examination, your doctor will be able to find out what is causing the dysuria. Typically, you will need a urinalysis. Various urine tests will then be done. These may include:
examining a urine sample (visual inspection),
checking for certain substances (chemical analysis),
examining a small amount of urine under a microscope (microscopic examination).
Some parts of the urinalysis can be done in the doctor’s office and some in the laboratory. A urine sample can also be tested for bacteria and yeast (urine culture). Your healthcare provider will tell you more about these tests, if needed.
How is dysuria treated?
Treatment depends on the cause. If you have a bacterial infection, you may need antibiotics. You may be given medications to help ease urination and relieve pain.Your healthcare provider can tell you more about your treatment options. If left untreated, symptoms may worsen.
When to contact your healthcare professional
Call your healthcare professional immediately if any of the following symptoms occur:
Temperature 100.4 ° F (38 ° C) or higher or as directed by your healthcare professional,
No improvement after three days after starting treatment,
urinary problems due to pain,
new or enlarged vaginal or penile discharge,
rash or joint pain,
increased back or abdominal pain ,
enlarged and painful lymph nodes (swelling) in the groin.
Road Clinical Hospital
Pyelonephritis is a nonspecific infectious – inflammatory process that occurs mainly in the pelvic – calyx system of the kidney and its tubulointerstitial zone. Distinguish between primary and secondary pyelonephritis. Primary pyelonephritis – occurs as an independent disease, secondary – as a consequence of another disease.
The main clinical forms of the disease are: acute, chronic and recurrent pyelonephritis.Pyelonephritis can be caused by many types of microorganisms (E. coli, staphylococcus, streptococcus, leak and other infectious agents), both in an isolated and in a mixed state. The infection enters the kidney through the blood and lymphatic tracts, from the external genitalia and ureters. Predisposing factors are urinary retention, impaired blood supply and lymph circulation in the kidneys, decreased immunity, long-term chronic and infectious processes in the body.
Acute pyelonephritis can be suppurative, serous, or interstitial. This disease is characterized by an acute onset, increased body temperature, chills. The pain may be in the lumbar region with irradiation to the side of the kidney injury. Severe intoxication syndrome: headache, thirst, nausea, vomiting, excessive sweating. Dysuric phenomena: violation of urination, painful urination. A positive symptom of Pasternatsky is soreness when tapping in the area of the kidney projection.In the clinical analysis of urine: leukocytes, protein, possibly blood.
Chronic pyelonephritis is most often a consequence of an untreated acute process, a prolonged course of infectious and inflammatory processes in the organs of the urinary system. This course of the disease is characterized by dull pain in the area of the projection of the kidneys, dysuric phenomena. The rest of the symptoms are mild and may worsen with exacerbation of pathological processes in the kidneys. To clarify the diagnosis of chronic pyelonephritis, clinical and laboratory diagnostics is of great importance.In urine tests: leukocytes, bacteria, protein.
The treatment regimen is selected individually, taking into account the form and stage of the disease, the type of infection and its sensitivity, the characteristics of the patient’s body, the presence of complications. The acute process involves antibiotic therapy, symptomatic treatment, elimination of signs of intoxication, restoration of urodynamics. A chronic process may require prolonged treatment and dynamic monitoring of the patient’s condition.
Treatment is provided by: Nephrology Department
Dysuria | Uroweb.kz | Urological information portal of Kazakhstan
Dysuria – painful or accompanied by discomfort, usually with cutting or burning urination. Some conditions cause severe pain in the bladder or perineum.Dysuria is a very common symptom in women, but it can also occur in men and occurs at any age.
Irritation of the mucous membrane of the bladder triangle or urethra leads to dysuria. Inflammation or stricture of the urethra causes discomfort at the beginning of urination and burning during urination. Irritation of the bladder triangle causes contractions of the bladder, resulting in frequent or painful urge to urinate.Dysuria is most often due to an infection in the lower urinary tract, but it can also be associated with an infection of the upper tract. A decrease in the concentration of the kidneys is the main cause of frequent urination in upper urinary tract infections.
Dysuria is usually caused by inflammation of the urethra or bladder, although pathological processes in the perineum in women (for example, with vulvovaginitis or herpes simplex virus infections) can cause pain when urine enters the lesion.Most cases are associated with infection, but sometimes non-infectious inflammation can be the cause.
Overall The most common causes of 90,062 dysuria are:
- Cystitis, prostatitis
- Urethritis due to sexually transmitted diseases (STDs)
Some causes of dysuria
|Infectious diseases *|
|Cervicitis|| Often discharge from the cervical canal
History of unprotected intercourse
|Laboratory tests for STDs|
|Cystite|| Usually frequent urination and urge to urinate
Sometimes urine with blood or with a characteristic odor
Soreness in the projection of the bladder
|Clinical diagnosis with or without urinalysis if there are no warning signs †|
|Orchoepididymitis||Painful, enlarged appendage||Clinical evaluation|
|Prostatitis|| Enlarged, painful prostate gland
History of frequent obstructive symptoms
|Urethritis|| Usually visible discharge
History of unprotected intercourse
|Laboratory tests for STDs|
|Vulvovaginitis|| Vaginal discharge
Erythema in the labia and vaginal opening
| Clinical examination, urinalysis and urine culture to rule out UTI
Catheterization should be considered to reduce the risk of bacterial contamination of the sample
|Contact with irritant or allergen (e.g. spermicide, lubricant, latex condom), foreign bodies in the bladder, parasites, stones, chemotherapy (cyclophosphates) and radiation|| External inflammation
| Clinical Evaluation
Imaging of the genitourinary system and pelvic organs
|Interstitial cystitis|| Chronic symptoms
Absence of other, more frequent causes
|Spondyloarthropathies (eg, reactive arthritis, Behcet’s syndrome)|| History of gastrointestinal and / or joint symptoms
Sometimes lesions of the skin and mucous membranes
| Clinical Evaluation
Laboratory tests for STDs
|Atrophic vaginitis|| Postmenopausal (including estrogen deficiency due to medication, surgery, or radiation)
Atrophy or erythema in the area of the folds of the vaginal mucosa
|Tumors (usually cancer of the bladder, prostate or urethra)|| Prolonged symptoms
Usually hematuria without pyuria or inflammation
| Cystoscopy, cytological examination of urine
Possible prostate biopsy or bladder biopsy
|* The most common pathogens include bacteria that are not sexually transmitted (mainly Escherichia coli , Staphylococcus saphrophyticus , Enterococcus species Klebsiella and and Proteus species) Neisseria gonorrhoeae , Chlamydia trachomatis , Ureaplasma urealyticum , Trichomonas vaginalis , herpes simplex virus).|
|† Warning signs are fever, pain or tenderness on palpation in the lateral region of the abdomen, a history of recent instrumental intervention in the genitourinary tract, the patient’s immunodeficiency, recurrent episodes of dysfunction, known urologic abnormalities, and male gender.|
|STDs = sexually transmitted diseases.|
Taking a history of present illness should include obtaining information about the duration of symptoms and whether they have been observed in the past.Clinically significant concomitant symptoms include fever, back pain, discharge from the urethra or vagina, and irritative (frequent urination, urgency) and obstructive (interruption of the urine stream, undermining at the end of urination). In patients, it is necessary to clarify the presence of an impurity of blood in the urine, its turbidity or an unpleasant odor, as well as the nature of the discharge (liquid, watery or thick purulent). Clinicians should also ask whether patients have recently had unprotected sex, whether irritants have been applied to the perineal area, and whether urologic manipulations (eg, cystoscopy, catheterization, surgery) have been performed, and women should be asked about the possibility of pregnancy.
When examining organs and systems , an attempt should be made to identify possible causes, including back or joint pain and conjunctival irritation (connective tissue disorders) or gastrointestinal symptoms such as diarrhea (reactive arthritis).
The collection of life history data should be aimed at identifying previous infections of the genitourinary tract (including in childhood) and any known pathology of the urinary tract, including a history of urolithiasis.As with any disease with a potentially infectious etiology, it is important to identify a history of immunodeficiency (including HIV / AIDS) or a recent hospital stay.
The examination begins with an assessment of the main indicators of the body’s functioning, in particular with the determination of the presence of fever.
The skin, mucous membranes, and the joint area are examined for symptoms that may indicate reactive arthritis (eg, conjunctivitis, mouth ulcers, vesicular or cortical foci on the palms, soles and around the nails, joint tenderness).Percussion of the lumbar region and soreness in the projection of the kidneys. The abdomen is palpated for tenderness over the bladder region.
In women, it is also necessary to examine the pelvic area to detect inflammation, pathological formations and vaginal or cervical discharge (Cervicitis). At the same time, and not a second examination, it is necessary to obtain smears and scrapings for the diagnosis of STDs.
In men, it is necessary to examine the external genital organs to detect lesions of the penis and discharge from the urethra, it is necessary to examine the area under the foreskin.The testicle and epididymis are palpated for tenderness or swelling. Rectal examination is performed to palpate the prostate and determine its size, consistency, and tenderness.
The following symptoms are alarming:
- Pain or tenderness in the lumbar region
- Recent instrumental intervention
- Immunocompromised patient
- Recurrent episodes of infection (including frequent relapses in childhood)
- Known urological diseases
Interpretation of results
Some data may be highly pathognomonic.In young, healthy women with dysuria and severe symptoms of bladder irritation, cystitis is the most likely cause. Visible discharge from the urethra or cervix suggests an STD. Thick purulent discharge usually indicates gonococcal epitology; liquid or watery – about non-gonococcal. Colpitis and ulcerative lesions from herpes simplex virus infections are usually easy to spot on examination. In men, severe tenderness of the prostate gland suggests a prostate gland, and soreness and swelling of the epididymis may indicate epididymitis.Other findings may also be informative, but not diagnostically significant; for example, women with signs of vulvovaginitis may have a urinary tract infection or other cause of dysuria along the way. Symptom-based diagnosis of urinary tract infection is less accurate in older people.
Symptoms suggestive of infection are more severe in those with warning signs. Fever, lumbar pain, or a combination of both suggests concomitant pyelonephritis.A history of frequent recurrence of UTI should be suggestive of primary anatomical abnormalities or impaired immunity. Infections after hospitalization or instrumental examinations may indicate an atypical or resistant infectious agent.
There is no generally accepted approach. Many clinicians empirically use antibiotics for cystitis without any laboratory diagnosis (sometimes even without urinalysis) in young healthy women with a clinical picture of dysuria, pollakiuria, urgency and no warning signs.Other doctors examine everyone with a freshly collected midstream urine sample for CBC and culture. Some doctors postpone the culture if the dipstick test does not show white blood cells. A pregnancy test is done in women of childbearing age (UTIs during pregnancy are dangerous because they can increase the likelihood of premature birth or premature rupture of membranes). Vaginal discharge justifies taking a smear. Many clinicians in all patients produce a collection of cervical (in women) and urethral (in men) discharge for the diagnosis of STDs (culture for gonococci and chlamydia or PCR), because many infected patients do not have a typical clinical picture.
Detection of> 10 5 colony forming units (CFU) of bacteria per ml suggests infection. In symptomatic patients, sometimes even titers as low as 10 2 or 10 3 CFU / ml indicate a UTI. Leukocyturia, determined in the general analysis of urine in patients with sterile cultures, is a nonspecific finding and can be observed with STDs, vulvovaginitis, prostatitis, tuberculosis, tumor, interstitial nephritis, or other causative diseases.Erythrocyturia detected by urinalysis without leukocyturia and by sterile culture can be caused by cancer, urinary tract stones, foreign bodies, glomerular abnormalities, or recent instrumental manipulation of the urinary tract.
Cystoscopy and urinary tract imaging may be indicated for the diagnosis of obstruction, anatomical abnormalities, cancer, or other pathology in patients who do not respond to antibiotic therapy, and in patients with recurrent symptoms or non-inflammatory hematuria.The possibility of a rectovesical fistula should be considered in men with recurrent urinary tract (lower portion) infections or in patients with polymicrobial infections. Pregnant women, men, elderly patients, and patients with prolonged or recurrent dysuria require closer attention and more careful examination.
Treatment is focused on eliminating the cause of the disease. Many doctors do not treat dysuria in women without warning signs unless a cause is found on examination or urinalysis.If they decide to carry out treatment, according to the identified pathogen. Complicated urinary tract infections require treatment for 10-14 days with an antibiotic that is effective against gram-negative organisms, especially Escherichia coli .
90,000 Acute cystitis – causes, symptoms, treatment
The main cause of cystitis in women is the close location of the urethra to the vagina and anus.That is why the risk of the disease is higher in women than in men. 
From the point of view of microbiology, in 75-95% of cases, acute inflammation of the mucous membrane of the bladder is caused by Escherichia coli. It enters the bladder through the urethra and provokes inflammation. Among other causative agents of the inflammatory process, representatives of the Enterobacteriaceae family, such as Proteus mirabilis and Klebsiella pneumoniae, as well as Staphylococcus saprophyticus, are also distinguished.[20, 21]
Acute cystitis: symptoms, treatment of the disease
Clinical manifestations of the disease are urge to urinate, dysuric disorders. Also, the symptoms of cystitis are :
- Suprapubic or lumbosacral pain;
- increase in the level of leukocytes, erythrocytes in the urine;
- blood leukocytosis.
In acute cystitis, regardless of the cause, there may be an increase in subfebrile temperature up to 37-38 ° C within 1-3 days.An increase in temperature above 38 ° C often indicates the development of ascending acute pyelonephritis .
In older women, a nonspecific symptom such as urinary incontinence and noctauria (abnormal urge to urinate at night) may be present in the clinical picture. Patients also often have weakness, dysfunction of the urinary tract, muscle cramps, and fever. The infectious nature of inflammation of the mucous membrane of the bladder confirms a change in color, odor, and clouding of urine.[12, 20]
Diagnosis of urological diseases
The diagnosis of acute cystitis is usually straightforward. The doctor evaluates the clinical manifestations of the disease and prescribes a urinalysis, which is an additional way to confirm the diagnosis. First, a general urine test is performed, after which a sowing is done on the microflora, which allows you to choose the right drugs for the treatment of cystitis. 
But the diagnosis of the disease in women has some peculiarities.Therefore, in order to prescribe the correct treatment for acute cystitis, doctors carry out differential diagnostics.  Symptoms of dysuria, suprapubic pain, urge to urinate can cause a number of processes of non-infectious and infectious origin :
- Inflammatory diseases of the pelvic organs. They are accompanied by pain in the lower abdomen and in the pelvic region, mucopurulent endocervical discharge.
- Overactive bladder. The clinical picture includes nocturia, urge to urinate.Often accompanied by depression, sexual dysfunction, psychological disorders that lead to urinary incontinence.
- Urethritis. The disease occurs in sexually active women. It can be caused by the herpes simplex virus, Trichomonas, Chlamydia, Candida, gonococci. In some cases, urethritis occurs due to the use of a contraceptive gel.
- Interstitial cystitis (painful bladder syndrome). It is accompanied by a reduction in the volume of the bladder, imperative / frequent urination, dysuria.
In a number of clinical cases, in patients with dysuria and the presence of profuse vaginal discharge, which are accompanied by itching and odor, doctors consider the diagnosis of vaginitis. It is often caused by intestinal flora, Trichomonas, yeast-like fungi. 
Features of treatment of cystitis in women
In the absence of complications, the disease is treated with antibacterial drugs at home (on an outpatient basis). As an additional therapy, antispasmodics are prescribed, which eliminate spasms of the smooth muscles of the bladder.It is important to choose the right medicines that destroy the pathogens of cystitis. Otherwise, the wrong approach to treatment can provoke the transition of the disease into a chronic form. 
The effectiveness of treatment is assessed based on the number of relapses of the disease during the year. Relapse is usually taken as clinical manifestations of cystitis, which will occur during the period of observation of the patient. The main laboratory sign of repeated inflammation is bacteriuria – the detection of 10 3 and more microbial bodies in 1 ml of urine.
Hospital referral is usually required for patients with acute urinary retention and intractable pain. At the initial stage of treatment, bed rest is usually prescribed. Sexual intercourse before the end of therapy is not recommended. 
To eliminate the symptoms of acute cystitis, treatment is usually supplemented with thermal treatments. These can be sitz baths or heating pads applied to the bladder area. But heat can be applied only when the cause of the urinary disturbance is established.If the diagnosis is unclear, it is better to refrain from thermal procedures. Heat increases blood circulation, which can be dangerous for the patient, especially with tuberculous lesions and gross hematuria. 
In acute inflammation of the inner mucous membrane of the bladder, special attention should be paid to diet. It is necessary to remove from the diet all foods that irritate the stomach :
- alcoholic beverages;
- foods that cause constipation;
- spicy, spicy dishes.
The diet should be dominated by fruits and vegetables. Fermented milk products with lactobacilli, which prevent re-inflammation, are very useful for patients with cystitis. 
Acute cystitis: treatment with phytopreparations in women
The use of phytopreparations is advisable as part of complex therapy. Many studies show that this approach can reduce the rate of relapse. A more expedient option is the use of herbal remedies in conjunction with short courses of antibiotic therapy.This reduces the number of antibiotics used without compromising the effectiveness of treatment. 
One of the modern herbal remedies used for the treatment of cystitis in women is Fitolysin®.
Fitolysin® is available in the form of a paste intended for the preparation of oral suspension. In this form, the active medicinal components are absorbed much better, while the drug begins to act faster than when taking pills. 
Phytolysin® is produced in Europe according to GMP standards .It has several advantages:
- suppresses the inflammatory process ;
- helps to reduce pain, eliminate spasms of smooth muscles of the bladder ;
- helps to eliminate false urge to urinate .
Fitolysin® should be taken as directed by a urologist 3-4 times a day after meals .
Chapter from the book.Al-Shukri S.Kh., Tkachuk V.N. Urology (2012)
Bladder stones are one of the first urological diseases that medieval Kamnesechens learned to diagnose and treat surgically. This clinical form of urolithiasis is common, especially in older men and boys. In women, bladder stones are extremely rare due to the anatomical features of the urethra. Bladder stones can be of secondary origin – these are stones that have descended through the ureters from the kidneys.Primary calculi formed in the bladder are common.
Stagnation of urine in the bladder is one of the main conditions for primary stone formation. It is facilitated by malformations (phimosis, valves of the urethra and diverticula of the bladder, narrowing of the external opening of the urethra), as well as neurogenic dysfunction of the bladder.
Foreign bodies trapped in the bladder (metal fragments, bullets, catheters, ligatures, etc.)) can become the nucleus on which the stone forms. Bladder stones are common in men with an enlarged prostate gland due to benign prostatic hyperplasia or cancer and urethral stricture. Bladder stones usually have an ovoid shape, are single and multiple, differ in chemical composition. There are cases when several thousand calculi were removed from the bladder.
Symptoms and clinical course.The main symptoms of bladder stones are pain, dysuria, and hematuria. Pain in the suprapubic area is dull in nature, associated with walking, shaking riding, physical exertion. Pain radiates to the glans penis, perineum, anus. Sometimes the pain does not bother at all, which is observed with large stones.
With bladder stones, dysuria is most pronounced, it is often associated with the underlying disease – BPH or urethral stricture. However, if the patient has a stone in the bladder, pollakiuria may be more pronounced in the daytime, when the patient is more physically active and the stone, moving in the bladder, irritates the neck, causing false urge to urinate.
The most characteristic symptom of a bladder stone is trembling and interruption of the urine stream – a sudden “slamming”, and restoration of the act of urination when the position of the body changes. That is why men with bladder stones prefer to urinate while sitting.
With bladder stones, hematuria is noted (especially after brisk walking, shaking driving, physical work). Trauma to the mucous membrane of the bladder leads to chronic cystitis, which gives frequent exacerbations, causes dysuria and is accompanied by terminal hematuria and leukocyturia.A stone in the bladder can injure dilated veins in the neck, cause bladder bleeding, and even bladder tamponade.
Diagnostics. Bladder stones are easily recognized by the characteristic complaints of patients with typical dysuria and, of course, based on the data of ultrasound, endoscopic and X-ray studies. The simplest and most non-invasive method for obtaining information about the condition of the walls of the bladder and the presence of stones in it is its ultrasound scan.With the help of an overview X-ray of the pelvis, you can see the shadow of the calculus in the projection of the bladder, evaluate its size, get an idea of the density of its structure, which is important for determining the method of stone crushing.
Despite the importance of information obtained when performing plain radiography, it should be remembered that bladder stones containing uric acid salts (urates) do not delay X-rays and are not detected during this study. The overview image allows you to determine the number of stones and their sizes.For X-ray stones, it is recommended to perform pneumocystography or cystography with a weak solution of a radio-opaque substance.
For a long time, a metal bougie-stone probe was used to determine a stone in the bladder. When a metal instrument is inserted into the bladder, there is a characteristic sensation of metal rubbing against a stone. The most informative is an invasive study – cystoscopy, which allows you to determine the capacity of the bladder, the state of its mucous membrane, the number of stones, their size and type.
Treatment of patients with bladder stones cannot consist only in removing the calculus, because very often the stone is a consequence of a pathological process in the urinary tract. Removal of the stone should be preceded by the identification and elimination of the causes of stone formation. Often these two interventions are performed simultaneously. So, usually combine the removal of stones from the bladder with transvesical prostatectomy for BPH, complicated by the formation of a stone in the bladder; transurethral resection of the prostate – with contact lithotripsy.
There are two methods of treating patients with bladder stones: stone crushing (cystolithotripsy) and stone cutting (cystolithotomy). The bladder stones are crushed with the use of a vesical lithotripter, which, after being introduced into the bladder through the urethra, allows, under visual control, to capture and destroy the stone to small fragments, washed through a evacuator using an aspirator; a urethral catheter is inserted into the bladder for 2-3 days.
A relative contraindication to cystolithotripsy is urethral stricture, therefore, optical ureterotomy precedes the insertion of the lithotripter into the bladder.Cystolithotripsy, like other endoscopic manipulations, is not performed against the background of acute cystitis, small bladder capacity and in the active phase of chronic pyelonephritis.
In our country, a unique device “Urat-1” was created for contact electrohydraulic cystolithotripsy. In addition, ESWL is currently used to crush stones in the bladder. However, this method can be used only in the absence of bladder outlet obstruction in patients.
If cystolithotripsy is impossible or if stone crushing is contraindicated, a high section of the bladder and cystolithotomy are performed.If a patient with a bladder stone has eliminated the causes that caused lithogenesis, relapses are practically not observed. To prevent the formation of stones in the bladder, the urinary tract should be sanitized with the use of uroantiseptics, as well as the factors that impede the outflow of urine from the bladder should be eliminated.