Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Pain or Burning With Urination

(Dysuria)

By

Geetha Maddukuri

, MD, Saint Louis University

Last full review/revision May 2021| Content last modified May 2021
Click here for the Professional Version
Topic Resources

Burning or pain during urination may be felt at the opening of the urethra or, less often, over the bladder (in the pelvis, the lower part of the abdomen just above the pubic bone). Burning or pain during urination is an extremely common symptom in women, but it can affect men and can occur at any age.

Causes of Pain or Burning With Urination

Burning or pain during urination is typically caused by inflammation of the urethra or bladder. In women, inflammation in the vagina or in the region around the vaginal opening (called vulvovaginitis Vulvitis Vulvitis is inflammation of the vulva. When both the vulva and vagina are inflamed, the disorder is called vulvovaginitis. The vulva is the area surrounding the opening of the vagina and containing... read more ) can be painful when exposed to urine. Inflammation that results in burning or pain is usually caused by infection but sometimes by noninfectious conditions. Sometimes acidic foods (for example, citrus fruits) and certain drinks (for example, alcohol and caffeine) act as irritants and cause burning or pain during urination.

Common causes

Evaluation of Pain or Burning With Urination

Not every person who has pain or burning during urination needs to see a doctor right away. The following information can help people decide how quickly a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

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

When to see a doctor

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.

What the doctor does

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 Some Causes and Features of Painful Urination Burning or pain during urination may be felt at the opening of the urethra or, less often, over the bladder (in the pelvis, the lower part of the abdomen just above the pubic bone). Burning... read more ).

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 STDs. 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 Urethritis Urethritis is infection of the urethra, the tube that carries urine from the bladder out of the body. Bacteria, including those that are sexually transmitted, are the most common cause of urethritis... read more is often the cause. If burning affects mainly the vagina and the woman has a discharge, vaginitis Vulvitis Vulvitis is inflammation of the vulva. When both the vulva and vagina are inflamed, the disorder is called vulvovaginitis. The vulva is the area surrounding the opening of the vagina and containing... read more 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.

Table
icon

Testing

Doctors do not always agree on the need for tests for certain adult women who have symptoms that suggest a bladder infection Bladder Infection Cystitis is infection of the bladder. Usually, bacteria are the cause of cystitis. A frequent need to urinate and pain or burning while urinating are the most common symptoms. Doctors can often... read more 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 STDs 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.

Treatment of Pain or Burning With Urination

The cause is treated. Often the cause is an infection, and antibiotics provide relief in a day or two. If pain is severe, doctors may give phenazopyridine for a day or two to relieve discomfort until antibiotics start to work. Phenazopyridine turns the urine a red-orange color and may stain undergarments.

Key Points

  • Although bladder infections are a common cause, many other disorders may cause painful urination.

  • Burning or pain during urination may be a sign of an STD.

  • Doctors may decide to treat women with an antibiotic and see whether symptoms resolve rather than do testing.

Drugs Mentioned In This Article

Generic Name Select Brand Names
No US brand name
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Others also read

Test your knowledge

Tubulointerstitial Nephritis
The kidneys contain tubules, which are structures in the kidneys that are involved in filtering fluids. Tubulointerstitial nephritis is inflammation that affects the tubules and the tissue surrounding them, called “interstitial tissue.” Onset of tubulointerstitial nephritis may be acute (sudden) or chronic (gradual) and often results in kidney failure. Which of the following is the most common cause of acute tubulointerstitial nephritis?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP