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Burning or pain with urination (dysuria) may be felt at the opening to the urethra or, less often, over the bladder (in the pelvis, the lower part of the abdomen just above the pubic bone). Occasionally, if a woman has vaginal irritation (for example, due to inflammation or infection of the vagina or of the area surrounding the vaginal opening, called vulvovaginitis), she may feel a burning sensation when urinating.
Causes
Dysuria is very common, particularly among adult women, in whom it is often caused by urinary tract infections, such as cystitis and urethritis. However, dysuria can occur in men and women of any age and can have many noninfectious causes.
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| Common Causes of Dysuria |
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Type
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Examples
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Infectious*
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Cervicitis
Cystitis (more common among women)
Epididymo-orchitis
Prostatitis
Urethritis
Vulvovaginitis
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Inflammatory
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Inflammatory connective tissue disorders (reactive arthritis or Behçet's syndrome)
Interstitial cystitis (noninfectious bladder inflammation)
Vulvar vestibulitis (increased vulvar sensitivity to pain)
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Physical
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Catheterization of the bladder
Obstruction of the bladder neck (for example, due to benign prostatic hyperplasia) or urethra (due to strictures)
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Other
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Atrophic vaginitis or urethritis
Tumors
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*Common infectious organisms include nonsexually transmitted bacteria (mostly Escherichia coli) and sexually transmitted organisms (such as those that cause gonorrhea, chlamydial infection, and trichomoniasis).
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Evaluation
Doctors can sometimes get clues to the cause based on where symptoms are most severe. For example, if symptoms are most severe just above the pubic bone, a bladder infection (cystitis) may be the cause. Women with frequent episodes of cystitis may recognize characteristic symptoms that suggest another episode. If symptoms are most severe at the opening of the urethra, urethritis may be the cause. In men with a penile discharge, urethritis is often the cause. If burning affects mainly the vagina and the woman has a discharge, vaginitis may be the cause.
Examination may confirm a condition that could be causing dysuria. For example, vaginal or penile discharge can be confirmed. Inflammation or atrophy of the vagina or vulva may confirm vulvovaginitis. An enlarged prostate may confirm benign prostatic hyperplasia. Tenderness of the epididymis or testes may suggest epididymo-orchitis, and tenderness of the prostate may suggest prostatitis.
Doctors do not always agree on the need for tests. Some doctors just treat adult women who have symptoms that suggest cystitis. Other doctors usually do testing for all people or for people in whom the diagnosis is not clear. The first test is usually a urinalysis. Urine culture is often done to identify the organism causing infection and to determine which antibiotics will be effective. For women, a sample of vaginal discharge is examined on a slide using a microscope. Men and women with a urethral discharge are tested for gonorrhea and chlamydia.
Treatment
The cause is treated. Often, the cause is an infection, and treatment produces relief in 1 or 2 days. If dysuria is severe, phenazopyridine can be taken for the first 2 days to relieve discomfort. Phenazopyridine turns the urine a red-orange color.
Last full review/revision March 2007 by Ralph E. Cutler, MD
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