Pain or Burning With Urination

Overall, the most common causes of burning or pain during urination are

• Bladder infection (cystitis)

• Infection of the urethra (urethritis) due to a sexually transmitted infection (STI)

In people who have pain or burning during urination, certain symptoms and characteristics are cause for concern. They include

• Fever

• Pain in the back or side (flank pain)

• Nausea and vomiting

• A recent history of insertion of a bladder catheter or other instrument

• Immune system disorders

• Repeat episodes (including frequent childhood infections)

• A known urinary tract abnormality

People with immune system disorders and pregnant women with warning signs should see a doctor that day (or in the morning if symptoms develop overnight) because complications of a urinary tract infection can be serious in such people. Other people with warning signs should see a doctor in a day or two, as should those whose symptoms are particularly bothersome. For people without warning signs who have mild symptoms, a delay of 2 or 3 days is not harmful.

Women with frequent bladder infections may recognize characteristic symptoms that suggest another episode.

Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What they find during the history and physical examination often suggests a cause of the burning or pain during urination and the tests that may need to be done (see table Some Causes and Features of Painful Urination).

Doctors may ask whether similar symptoms have occurred in the past. Doctors ask about symptoms that may accompany the pain and provide clues to the cause. For example, doctors may ask whether

• The urine is bloody, cloudy, or foul smelling

• Any discharge is noticed

• There has been any recent unprotected intercourse

• Potential irritants have been applied to the genitals

• A bladder catheter has recently been inserted or another urinary tract procedure has been done

Women are asked whether they might be pregnant.

In women, the physical examination usually includes a pelvic examination and the taking of samples of cervical and vaginal fluid to check for STIs. In men, the penis is examined for presence of a discharge, and doctors do a digital rectal examination to examine the prostate.

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 may be the cause. 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. Cervical discharge suggests cervicitis.

Doctors may also review the person's dietary history to check for food or drink that may cause symptoms.

Doctors do not always agree on the need for tests for certain adult women who have symptoms that suggest a bladder infection. Some doctors do urine tests, whereas others treat without doing any testing. All doctors do tests when the diagnosis is unclear. The first test is usually urinalysis. In many cases, doctors also do a urine culture to identify organisms causing infection and determine which antibiotics would be effective.

For women of childbearing age who are not known to be pregnant, a pregnancy test is done. Testing for STIs is often done, for example, for men who have a discharge from the penis and for many women who have a vaginal discharge.

Cystoscopy and imaging of the urinary tract may be needed to check for anatomic abnormalities or other problems, especially if antibiotics have not been effective. People who are male, older, or pregnant may need closer attention and a more thorough investigation.