Painful urination is any pain or discomfort that results when a person urinates. This pain can occur by itself or it can be associated with other symptoms.
What is going on in the body?
The urinary tract consists of several parts, each with a different function. The kidneys filter and remove waste products and water from the body and produce urine. Urine travels from the kidneys through two narrow tubes called ureters down to the bladder, where it is stored. When the bladder becomes full, it empties the urine through the urethra to the outside of the body.
Painful urination can range from mild discomfort or a burning sensation in the urinary tract to severe, intense pain. This pain may be acute, when it occurs suddenly, or chronic, when the pain lasts for a long period of time. Painful urination usually results from infection, trauma, or something blocking the urinary tract.
Because of the close association of the urinary tract to reproductive organs in both men and women, sexually transmitted infections and other conditions involving the reproductive tract also cause urinary symptoms. These are experienced differently by women than by men.
What are the causes and risks of the condition?
There are many possible causes of painful urination. Some of these include:
urinary tract infections
trauma to the urinary tract, such as genital injuries in males and females
inflammation to any part of the urinary tract including the bladder, the kidney, or the urethra
prostatitis, or inflammation or infection to the prostate gland in men
vaginal infection, such a vaginal yeast infection
sexually transmitted infections, including gonorrhea, chlamydia, HIV, and genital herpes
chemical irritation to the lining of the genitals and urethra, such as from soaps, bubble bath, or detergents used to wash undergarments
conditions or diseases of the kidney, such as polycystic kidney disease or medullary cystic kidney disease
sudden rupture of one of the small sacs, or cysts, in the kidney
urinary obstruction, such as kidney stones
autoimmune disorders, which are conditions in which a person's immune system attacks his or her own body for no apparent reason
traumatic sexual experiences, including rape
certain antidepressant medications
tumors or cancer of any part of the urinary tract
What can be done to prevent the condition?
Preventing painful urination depends on the cause of the pain. Protecting the urinary tract from trauma and seeking early care for possible infection may decrease the risk of further pain. Avoiding irritating bubble bath solutions, wearing cotton-lined underwear, and avoiding tight-fitting clothes may reduce the pain that goes along with allergic reactions or genital irritation.
Limiting caffeine intake may also reduce a person's risk of having painful urination. Safer sex practices can reduce, but not eliminate, the risk of a sexually transmitted infection. Many causes cannot be prevented.
How is the condition diagnosed?
Diagnosing the cause of painful urination depends on the symptoms. A medical history and a history of activity, trauma, or illness may help in diagnosing the cause of the pain. The healthcare professional will want to know when the pain occurs during urination. This may help pinpoint a diagnosis. A thorough physical exam may be necessary.
Urine tests, such as a urinalysis and a urine culture, are usually necessary to check for infection. Vaginal or cervical swabs in a woman, and a urethral swab in a man, may be needed to check for sexually transmitted infections. Blood tests may be ordered if an infection is suspected throughout the body.
Several other tests that may be done include the following:
an ultrasound of the kidney and bladder, which uses sound waves to look for abnormalities
a voiding cystourethrogram (VCUG), which shows the urethra and bladder while the bladder fills and empties. A liquid is put into the bladder through a catheter or tube inserted through the urethra. An x-ray shows the liquid traveling through the bladder and urethra. This test can reveal abnormalities of the inside of the urethra and bladder. It can also tell if any urine is traveling the wrong direction up the urinary tract.
an intravenous pyelogram, which allows the doctor to examine the whole urinary tract. A liquid is injected through a tube inserted into a vein. Then x-rays are taken as the liquid flows through the urinary tract. This test may reveal obstructions.
- a nuclear scan, which uses radioactive materials injected into a vein. An image is made that shows how well the kidneys work, how the kidneys are shaped, and how urine drains from the kidneys.
Long Term Effects
What are the long-term effects of the condition?
Long-term effects of painful urination will depend on the underlying cause of the pain. Pain caused by a genital injury may heal without any long-term effects. A person with a history of chronic urinary tract infections may need antibiotics for a longer period of time.
Some injuries or infections may lead to permanent urinary tract damage or pain. A person who has a tumor in the urinary tract may require surgery and medications over a long period of time. A person with a malignant tumor may die if treatment is not successful.
What are the risks to others?
Painful urination is not necessarily contagious and poses no risk to others. Most urinary tract infections come from a patient's own organisms and are not transmissible to others. Sexually transmitted infections are communicable to the individual's sexual partner(s).
What are the treatments for the condition?
Treatment of painful urination depends on the underlying cause of the pain. When an injury occurs, the person should apply an ice pack off and on for the first 24 hours to reduce pain and swelling. Heat, such as in a warm sitz bath, may be recommended for some causes of painful urination. Antibiotics may be prescribed for infections. Medications to stop the growth of kidney stones
may be prescribed, as well as medications to stops spasms caused by kidney stones or infection.
Other treatments will vary greatly depending on the cause of the pain. Those with cancer may need surgery, chemotherapy, or radiation therapy. Surgery may be needed for those who have kidney stones or damage to the urinary tract from an injury or recurrent infections.
What are the side effects of the treatments?
Side effects to treatment depend on the treatment used. There are usually no side effects to ice packs or heat as long as they are not applied to the skin for long periods of time. There may be stomach upset, headache, or allergic reaction to antibiotics. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.
What happens after treatment for the condition?
If painful urination was caused by a urinary tract infection, a urinalysis may be done after the person finishes the full course of antibiotics. A person with minor pain and no other conditions may heal well and may not need any further treatment. If a person had surgery, he or she may need to rest for a few days to a few weeks and may need follow-up care.
How is the condition monitored?
Monitoring painful urination is important. If the pain worsens or any other symptoms are present, a healthcare professional may need to monitor the person carefully.
Professional Guide to Signs and Symptoms, Springhouse, 1997
Harrison's Principles of Internal Medicine, 1998, Fauci et al.