Dysuria - Pain During Urination - Main Causes

Pain while urinating (or burning when urinating) is one of the most common symptoms in clinical practice, receiving the name of dysuria in the medical environment. Most people relate the pain to urinating only with a urinary tract infection, but several other urinary or gynecological problems can cause this type of symptom.

Pain during urination
Pain during urination
 


What is dysuria

Dysuria encompasses a date of similar symptoms that usually indicate inflammation of some region of the genitourinary tract. Any of the following symptoms may be considered dysuria if it occurs at the time of urination:
  • Ache
  • Burning
  • Burning
  • Spit
  • Discomfort
  • Pain in the bladder
  • Pain in the urethra (canal leading to urine)
  • Feeling of weight

Most episodes of dysuria occur due to inflammation or infection of the urethra and/or bladder. However, inflammation in the prostate, testis, epididymis, vagina, and uterus may also present with dysuria as one of its symptoms.

It is very important to know the causes of dysuria and to correlate them with the rest of the clinical picture so as not to fall into the trap of feeling that all pain when urinating is a urinary infection.

Causes

Let us begin the explanations listing the main causes of dysuria, and then try to show how to distinguish one from the other:

Urinary tract infection:
  • a. Cystitis
  • b. Pyelonephritis

Urethritis (inflammation of the urethra):

Vulvovaginitis (inflammation of the vagina and vulva)
  • a. Trichomonas vaginalis
  • b. Candida albicans

Prostate diseases:

Other causes of dysuria:
  • a. Epididymitis (inflammation of the epididymis)
  • b. Bladder tumor
  • c. Atrophic vaginitis
  • d. Interstitial cystitis
  • e. Irritation of the urethra by substances such as soaps, fabric softeners, perfumes or medicines
  • f. Trauma in the pelvic region
  • g. Very concentrated urine
  • h. Renal calculus

As can be seen, pain when urinating is a symptom that is present in more than a dozen different diseases, and therefore, medical evaluation is necessary to establish a correct diagnosis.

Common symptoms

Because pain when urinating is a very common symptom, the doctor usually uses the medical history and symptoms associated with dysuria in the investigation of the condition. For example, pain when urinating in young women usually indicates cystitis. In young men, dysuria is more likely to be due to prostatitis or urethritis. In old men, prostate diseases should always be thought of, and in women with discharge, urethritis and vulvovaginitis are the best bets.

We will briefly show what types of information help direct the diagnosis of dysuria.

1. Cystitis is a probable diagnosis when the patient complains of dysuria and also has one or more of the following characteristics:
  • Young woman
  • Increased urine frequency
  • Feeling of incomplete emptying of the bladder
  • Blood in urine
  • Symptoms that started 24-48 hours after intercourse

2. Pyelonephritis is a likely diagnosis when the patient complains of further dysuria:
  • High fever
  • Sweating and Chills
  • Vomiting
  • Asthenia
  • Intense low back pain
  • Blood in the urine

3. Gonorrhea or chlamydia urethritis is a probable diagnosis when the patient complains of dysuria:
  • Purulent urethral discharge
  • Recent history of sex without condoms

4. Prostatitis is a probable diagnosis when the patient complains of dysuria and also has one or more of the following characteristics:
  • Male gender
  • Difficulties to urinate
  • Fever

5. Atrophic vaginitis is a probable diagnosis when the patient complains of dysuria and also has one or more of the following characteristics:
  • Woman after menopause
  • Dry vagina
  • Pain during sexual intercourse

6. Vulvovaginitis is a probable diagnosis when the patient complains of dysuria and also has one or more of the following characteristics:

7. Renal calculus is a probable diagnosis when the patient complains of dysuria and also has one or more of the following characteristics:
  • Pain that starts in the back and descends towards the groin and genitalia
  • Pain that disappears after the stone is expelled in the urine (it may not go away immediately if the stone injures the urethra during passage)
  • Blood in the urine

8. The enlargement of the prostate, either benign hyperplasia or tumor, is a probable diagnosis when the patient complains of dysuria and also has one or more of the following characteristics:
  • Man over 50 years
  • Poor urine stream
  • Difficulty in urinating
  • Need to get up at night several times to urinate
  • Blood in the urine

9. Bladder tumor is a likely diagnosis when the patient complains of dysuria and also exhibits one or more of the following characteristics:

Diagnosis of dysuria

It is important to know that dysuria is a symptom and not a disease. The pain to urinate is the consequence and not the cause. The diagnosis and treatment should aim at illness that is causing pain when urinating. In general, the most used tests in the investigation are:
  • Simple urinalysis
  • Uroculture
  • Analysis of urethral discharge
  • Analysis of vaginal discharge
  • Ultrasonography of prostate, bladder and kidneys
  • Blood PSA dosage

The decision whether or not to request each of the aforementioned exams depends on the probable differential diagnoses established after the initial medical evaluation.

In young women, cystitis is triggered as the main cause of pain when urinating, and it is sometimes unnecessary to request additional tests to make the diagnosis. It is not wrong for the doctor to prescribe antibiotics for urinary tract infection after a simple clinical evaluation.

However, if cystitis in young women is the most likely diagnosis in cases of dysuria, the same does not apply to young men. In this group, cystitis is uncommon and urethritis and prostatitis should always be remembered as a differential diagnosis when there are burning complaints when urinating.

Treatment

The treatment of dysuria obviously depends on the cause. Infections are treated with antibiotics, prostate diseases should be evaluated by a urologist, atrophic vaginitis improves with vaginal estrogen, etc. There is no single remedy that treats all the causes of dysuria at the same time. Therefore, if there is no proper investigation, it is not possible to have adequate treatment.

A very common mistake is to treat only pain when urinating with painkillers, such as Pyridium (fenazopyridine), leaving aside the true cause of dysuria. The patient takes the medication, feels temporary relief from the pain, but does not heal. The pain returns as soon as the effect of the remedy is over (in some cases the pain does not even disappear completely). This conduct, in addition to delaying the healing of the condition, can bring complications by allowing the disease to cause dysuria to progress.

General keywords

User discussion


Site indexMedicines onlineInteresting to readCommentariesAuthor
TabletsManual.com © 2012