Pain During Urination: Causes and What to Do

Where the pain is felt

The timing and location of the pain give clues:

Causes in women

Bladder infection (cystitis)

Urinary tract infections are the most common cause. About half of women have at least one in their lifetime. Typical symptoms: burning, needing to go often and urgently, passing small amounts, cloudy or smelly urine, and sometimes blood. Risk rises with sex, spermicides, menopause, pregnancy and diabetes. See cystitis.

Kidney infection

If a bladder infection spreads upward, it causes a kidney infection: fever, chills, back or side pain, nausea and vomiting. This needs prompt antibiotics.

Vaginal infections

• Vaginal yeast infection: itching, thick white discharge, and outer burning when urine touches sore skin.
• Bacterial vaginosis: thin gray discharge with a fishy smell; usually not painful.
• Trichomoniasis: frothy yellow-green discharge, itching, burning.
• Atrophic vaginitis after menopause: dryness and burning from low estrogen.

Sexually transmitted infections

Chlamydia and gonorrhea often cause mild burning with a normal-looking urine test, sometimes with discharge or bleeding between periods. Genital herpes causes painful sores and intense stinging. Any new sexual partner and burning warrants STI testing.

Causes in men

Dysuria is less common in men, and a UTI in a man is considered complicated, so men should always be checked.

• Urethritis, most often from chlamydia or gonorrhea: burning and discharge from the penis
• Prostatitis: burning, pain in the perineum, lower back or testicles, difficulty passing urine, fever in acute cases
• UTIs, often related to an enlarged prostate or a catheter
• Epididymitis: a painful, swollen testicle with burning
• Kidney or bladder stones

Causes in children

In young children, UTIs may cause only fever, irritability or poor feeding. Older children may complain of stinging. Other causes include irritation from bubble baths, pinworms, constipation and poor hygiene. Any child with fever and painful urination should be seen promptly. Sexual abuse is a rare cause that doctors consider sensitively.

Burning without infection

When urine tests are negative, think about:

• STIs, which standard urine dipsticks do not detect
• irritants: scented soaps, bubble baths, douches, spermicides, tight or synthetic underwear
• interstitial cystitis (bladder pain syndrome): chronic bladder pressure and pain with urgency
• kidney stones moving down the ureter
• medicines: some chemotherapy drugs, ketamine use
• foods and drinks that irritate a sensitive bladder: coffee, alcohol, citrus, spicy food
• rarely, bladder cancer, especially with blood in the urine in a smoker

How doctors find the cause

• Urine dipstick: looks for white blood cells (leukocytes), nitrites and blood.
• Urine culture: identifies the bacteria and the right antibiotic; needed for men, children, pregnancy, and recurrent or complicated infections.
• STI testing: a urine sample or swab for chlamydia and gonorrhea, plus other tests as needed.
• Vaginal swabs and examination for discharge or sores.
• Pregnancy test in women of childbearing age.
• Ultrasound or CT for stones, kidney infection that is not improving, or recurrent infections.

In otherwise healthy, non-pregnant women with typical cystitis symptoms and no vaginal discharge, many doctors can diagnose and treat a UTI by phone or telehealth.

Treatment

• UTIs: a short course of antibiotics, usually 3 to 5 days for uncomplicated cystitis in women; longer for men, kidney infections and complicated cases.
• STIs: specific antibiotics, plus treatment of partners and avoiding sex until treatment is complete.
• Yeast infections: antifungal cream, pessary or tablet.
• Prostatitis: several weeks of antibiotics for bacterial prostatitis.
• Interstitial cystitis: diet changes, bladder training, physical therapy and medicines.

Relief while you wait

• Drink plenty of water to dilute urine.
• Take acetaminophen (paracetamol) or ibuprofen for pain, following the label dose.
• Phenazopyridine, sold over the counter in the US, numbs the bladder for up to 2 days. It turns urine orange and does not treat infection.
• Avoid caffeine, alcohol and scented products.

Preventing repeat UTIs

• Urinate soon after sex.
• Avoid spermicides and douching.
• Stay well hydrated.
• After menopause, vaginal estrogen reduces recurrent infections.
• Cranberry products may modestly reduce recurrences in some women.

Frequently asked questions

What causes pain during urination?

The most common cause is a urinary tract infection. Other causes include sexually transmitted infections, vaginal yeast infections, prostatitis in men, kidney stones, irritation from soaps or spermicides, and interstitial cystitis. Fever or back pain suggests a kidney infection.

Why does it burn when I pee but I have no infection?

A standard urine test can miss STIs such as chlamydia, so ask for specific testing. Irritation from soaps, bubble baths or spermicides, vaginal infections, menopause-related dryness, kidney stones and bladder pain syndrome are other common reasons.

Can a UTI go away on its own?

Some mild bladder infections in healthy women clear without antibiotics, but many do not, and untreated infection can spread to the kidneys. See a doctor if symptoms last more than a day or two, and right away if you have fever, back pain, are pregnant or are a man.

Is painful urination in men serious?

It always needs assessment. In men, burning is often due to an STI or prostatitis, and UTIs are considered complicated. Fever, pain in the perineum or difficulty passing urine need prompt care.

How long does burning after urination last with treatment?

With the right antibiotic, burning from a bladder infection usually eases within 24 to 48 hours. If it has not improved after 2 days of treatment, contact your doctor, because the bacteria may be resistant or the cause may be something else.