Painful Urination (Dysuria): Causes and Treatment

What dysuria feels like and what the timing means

Dysuria can be felt as burning, stinging, sharp or aching pain. Where and when it hurts gives clues:

Common causes

Urinary tract infection

A UTI is the commonest cause, especially in women, whose shorter urethra lets bacteria (usually E. coli) reach the bladder easily. Bladder infection (cystitis) causes:

• burning when passing urine
• needing to go often and urgently, passing small amounts
• cloudy, strong-smelling or blood-tinged urine
• lower belly pressure or pain

If bacteria travel to the kidneys, fever, back or side pain, nausea and vomiting follow. See kidney infection.

Sexually transmitted infections

• Chlamydia and gonorrhea: urethritis with burning and discharge in men. Women often have mild or no symptoms, or burning that is mistaken for a UTI with negative urine cultures.
• Trichomoniasis: frothy, yellow-green discharge with itching.
• Genital herpes: painful sores. Urine stings when it touches them.
• Mycoplasma genitalium: a less common cause of urethritis.

Vaginal infections and irritation

• Vaginal yeast infection: itching, thick white discharge, external burning.
• Bacterial vaginosis: thin gray discharge with a fishy odor.
• Irritants: scented soaps, bubble baths, douches, spermicides, lubricants and some toilet papers.
• Vaginal atrophy: thinning of vaginal and urethral tissue after menopause, causing burning, frequency and recurrent UTIs.

Causes in men

• Prostatitis: pain in the perineum, lower back or penis, painful ejaculation, and fever in the acute bacterial form.
• Urethritis from STIs.
• Epididymitis, with testicular pain.
• Urethral stricture after infection or injury.

Other causes

• Kidney or bladder stones: dysuria and frequency when a stone reaches the bladder end of the ureter.
• Interstitial cystitis (bladder pain syndrome): long-term bladder pain, urgency and frequency with negative cultures.
• Medicines: some chemotherapy drugs (such as cyclophosphamide) and ketamine misuse.
• Reactive arthritis: urethritis with joint pain and red eyes after a gut or genital infection.
• Bladder cancer, rarely, especially with blood in the urine.
• In children: UTIs, bubble baths, pinworms and poor hygiene.

Painful urination in women vs men

How doctors find the cause

A clinician will ask about the pain, urinary frequency, urgency, blood, fever, back pain, discharge, new sexual partners, pregnancy and previous UTIs. Some women with typical cystitis symptoms and no vaginal symptoms can be treated after a short phone or video consultation.

Tests may include:

• urine dipstick for nitrites and white cells
• urine culture to identify the bacterium and the right antibiotic
• STI testing with a urine sample or swab (nucleic acid amplification tests)
• pelvic examination and vaginal swabs for discharge
• prostate examination in men with suspected prostatitis
• imaging such as ultrasound or CT for stones, recurrent infections or kidney infection not responding to treatment
• cystoscopy for persistent symptoms or blood in the urine

Treatment

• Bacterial UTI: antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole or fosfomycin, chosen according to local resistance. Symptoms usually ease within 1 to 2 days.
• STIs: specific antibiotics or antivirals. Partners need testing and treatment.
• Yeast infection: antifungal creams, suppositories or a tablet.
• Prostatitis: a longer course of antibiotics for bacterial prostatitis.
• Vaginal atrophy: low-dose vaginal estrogen, which also reduces recurrent UTIs.
• Interstitial cystitis: diet changes, bladder training, medicines and bladder instillations.

Relief at home while you wait for treatment

• drink enough water to keep urine pale
• take acetaminophen (paracetamol) or ibuprofen at the label dose
• phenazopyridine, sold over the counter, numbs the urinary tract for up to 2 days. It turns urine orange and does not treat infection
• use a warm pad on the lower belly
• avoid caffeine, alcohol and fizzy drinks, which can irritate the bladder
• avoid scented soaps and douches

Prevention

• drink plenty of fluids and do not hold urine for long periods
• urinate soon after sex
• wipe from front to back
• avoid spermicides and scented products if you get recurrent UTIs
• use condoms to reduce STIs
• for recurrent UTIs, ask about vaginal estrogen after menopause or preventive antibiotics

Frequently asked questions

What causes painful urination?

The most common cause is a urinary tract infection. Others include sexually transmitted infections such as chlamydia and gonorrhea, vaginal yeast infections, prostatitis, kidney or bladder stones, interstitial cystitis, and irritation from soaps, spermicides or sex.

Can painful urination go away on its own?

Mild irritation from soaps or sex often settles within a day. Some mild bladder infections in women clear on their own, but many do not and can spread to the kidneys. See a clinician if burning lasts more than a day or two, or if you have fever, back pain or discharge.

Is burning urination always a UTI?

No. Burning can also come from STIs, yeast infections, bacterial vaginosis, prostatitis, stones and skin irritation. If your urine test is negative, or you have discharge, itching or genital sores, other causes should be tested for.

What does painful urination in men mean?

In men under 35 it is often caused by an STI such as chlamydia or gonorrhea. In older men, prostatitis, UTIs linked to an enlarged prostate, and stones are more common. Men with dysuria should usually have a urine culture and STI testing.

What can I drink to stop burning urination?

Water is best: it dilutes urine and helps flush bacteria. Cranberry products may slightly reduce the risk of future UTIs in some women but do not treat an active infection. Avoid alcohol, coffee and fizzy drinks while symptoms last.