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Urination - painful

Dysuria; Painful urination

Painful urination is any pain, discomfort, or burning sensation when passing urine.

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Considerations

Pain may be felt right where the urine passes out of the body. Or, it may be felt inside the body, behind the pubic bone, or in the bladder or prostate.

Pain with urination is a fairly common problem. People who have pain with urination also may have the urge to urinate more often.

Causes

Painful urination is most often caused by an infection or inflammation somewhere in the urinary tract, such as:

• Bladder infection (adult)
• Bladder infection (child)
• Swelling and irritation of the tube that carries urine out of the body (urethra)

Painful urination in women and girls may be due to:

• Changes in the vaginal tissue during menopause (atrophic vaginitis)
• Herpes infection in the genital area
• Irritation of the vaginal tissue caused by bubble bath, perfumes, or lotions
• Vulvovaginitis, such as yeast or other infections of the vulva and vagina

Other causes of painful urination include:

• Interstitial cystitis
• Prostate infection (prostatitis)
• Radiation cystitis - damage to the bladder lining from radiation therapy to the pelvis area
• Sexually transmitted infections (STIs), such as gonorrhea or chlamydia
• Bladder spasms

When to Contact a Medical Professional

Contact your health care provider if:

• There is drainage or a discharge from your penis or vagina.
• You are pregnant and are having any painful urination.
• You have painful urination that lasts for more than 1 day.
• You notice blood in your urine.
• You have a fever.

What to Expect at Your Office Visit

Your provider will perform a physical exam and ask questions such as:

• When did the painful urination begin?
• Does the pain occur only during urination? Does it stop after urination?
• Do you have other symptoms such as back pain?
• Have you had a fever higher than 100°F (37.7°C)?
• Is there drainage or discharge between urinations? Is there an abnormal urine odor? Is there blood in the urine?
• Are there any changes in the volume or frequency of urination?
• Do you feel the urge to urinate?
• Are there any rashes or itching in the genital area?
• What medicines are you taking?
• Are you pregnant or could you be pregnant?
• Have you had a bladder infection in the past?
• Do you have any allergies to any medicines?
• Have you had sexual intercourse with someone who has, or may have, gonorrhea or chlamydia?
• Has there been a recent change in your brand of soap, detergent, or fabric softener?
• Have you had surgery or radiation to your urinary or sexual organs?

A urinalysis will be done. A urine culture may be ordered. If you have had a previous bladder or kidney infection, a more detailed history and physical exam are needed. Extra lab tests will also be needed. A pelvic exam and exam of vaginal fluids are needed for women and girls who have vaginal discharge. Men who have discharge from the penis may need to have a urethral swab done. However, testing a urine sample may be sufficient in some cases.

Other tests may include:

• Ultrasound of the kidneys and bladder
• An exam of the inside of bladder with a lighted telescope (cystoscope)

The treatment depends on what is causing the pain.

References

Cody P. Dysuria. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 21.

Cooper KL, Badalato GM, Rutman MP. Infections of the urinary tract. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 55.

Germann CA. Urologic disorders. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 85.

Sobel JD, Brown P. Urinary tract infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 72.

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Review Date: 1/1/2025  

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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