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Dysuria

Dysuria – Causes, Diagnosis and its Treatment

 

Introduction

Dysuria is defined as painful and uncomfortable urination. Most people may also describe feeling a burning sensation while urinating.  The condition is found in both men and women but is more typically seen in sexually active young women.

The most common cause of dysuria is a urinary tract infection (UTI), though a host of other conditions may also be responsible. It is therefore recommended that one consult a medical health professional on encountering the first signs of dysuria.

Cause

Common causes of dysuria include

Infection of the urinary tract and/or genital area.

  1. Urinary tract infections: These commonly affect the urethra, bladder or kidneys. Urethritis is the inflammation of the urethra, pyelonephritis is the infection of the kidney and cystitis is the infection of the bladder. These infections are typically bacterial in origin.
  2. In women, vaginal infections such as vaginitis, candidiasis and bacterial vaginosis usually show symptoms of painful urination
  3. In men, infections leading to prostatitis, epididymitis and epididymo-orchitis can cause dysuria.
  4. Sexually transmitted infections (STIs) such as chlamydia, gonorrhea and herpes lead to painful urination.

Besides infections, other causes of dysuria include:

  1. Kidney stones
  2. Bladder stones
  3. Menopause related changes such as dryness in the vagina
  4. Strenuous physical activities such as bicycling
  5. Tumors in the urinary tract
  6. Genital irritation from the use of fragrant soaps or vaginal perfumes, lubricants, tampons and contraceptive devices such as diaphragms and vaginal rings
  7. Injury due to sexual abuse or other trauma
  8. External lesions on genitalia which cause a burning sensation when urinating
  9. Neurological conditions that affect emptying of the bladder
  10. Cancers of the urethra, penis, and prostate
  11. Congenital abnormalities affecting genitalia
  12. Reiter syndrome: is the chronic form of inflammatory reactive arthritis. It can lead to inflammation of the genital and urinary area.
  13. Obstruction of the urethra that is caused by urethral stricture (narrowing of the urethra)

 

  1. Appendicitis, ectopic pregnancy and other conditions that cause abdominal pain.
  2. Medications such as certain non-steroidal anti-inflammatory drugs and anticancer drug, cyclophosphamide

Risk Factors:

Risk factors for dysuria include diabetes, old age, pregnancy, having urinary catheters in place and enlarged prostate in men. Women are also more likely to suffer from dysuria.

Those engaging in high-risk sexual behavior have higher chances of getting STIs. STIs affect the genital area and usually cause painful urination.

Clinical Presentation

Dysuria is generally a symptom of other conditions such as infections and inflammations. Painful urination is therefore rarely seen by itself, and may be accompanied by high fever, abdominal discharge, abdomen or back pain and other symptoms associated with its underlying cause.

Differential

The differential diagnosis of dysuria includes trauma to the urethra or genital area, crystalluria (most commonly, calcium crystals) and urethral obstruction.

Diagnosis

A health care professional will review the patient’s medical history including sexual history. A doctor will also want information about other changes accompanying painful urination such as changes in urine flow, urine color, frequency of urination and incidence of blood or pus in urine.

An abdominal and/or pelvic exam may be done. Urine samples are usually obtained and tested using a dipstick test for the presence of bacteria or blood.  Laboratory tests are usually needed to confirm infections. Culture tests may be done to check for bacterial growth. Other possible diagnostic tests used when dysuria is identified, include:

  1. Pregnancy test if pregnancy is suspected
  2. Tests for STIs. This may include vaginal and cervical swabs, nucleic acid amplification tests such as PCRs, Enzyme linked immunosorbent assays (ELISA) and culture tests.
  3. Ultrasound or X rays if kidney stones or obstructions or tumors are suspected
  4. Urodynamic testing
  5. Cytology tests on urine samples
  6. Cystoscopy may be done to detect abnormalities in the bladder.

Treatment for Dysuria

Treatment depends on the underlying cause of dysuria.

In the case of UTIs and other bacterial infections, treatment involves antibiotics. Yeast infections such as candidiasis are treated with antifungal medication. Large kidney stones may be removed using laser surgery or called extracorporeal shock wave lithotripsy (ESWL).

Doctors also usually prescribe pain medication in the form of a general analgesic or a specific product to helpdeal with the pain in the urinary tract.

Prevention

The following precautions are recommended to prevent UTIs, a major cause of dysuria.

  1. Drinking plenty of water and other fluids. Cranberry juice is often found to be effective in preventing infections.
  2. Urinating after sexual intercourse is recommended to prevent bacterial infections.
  3. It is also important that one does not go long periods without urinating by holding their urine inside.
  4. Good personal hygiene in the genital area also lessens risk of UTIs.
  5. Avoid using products that may irritate the skin in the genital area.
  6. One should also finish the full course of antibiotics to prevent recurrent infections.