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Home :: Dysuria

Dysuria - Causes, Symptoms And Treatment

Alternative names :- Painful urination

Dysuria is defined as pain, burning, difficulty, or discomfort related to urination. It's a common problem; even so, its importance shouldn't be minimized because it could be an indication of a serious problem. Generally, dysuria occurs more frequently in women than men. Approximately 25% of women complain of acute dysuria each year. Its prevalence is greatest in women between ages 25 and 54 and in those who are sexually active.

What causes dysuria?

The most common cause of dysuria is infection. Bacteria can easily gain access through local contamination and ascend to the affected region. Escherichia coli is the most common offending organism. Dysuria may also be a symptom of genital herpes. Infection occurs differently depending on the part of the genitourinary tract that's affected. The various forms include: . cystitis

  • prostatitis
  • pyelonephritis
  • urethritis
  • vulvitis
  • vaginitis
  • cervidtis.

Non infectious causes can also cause dysuria:

  • Postmenopausal women can suffer from dysfunction of the lower urinary tract due to a decrease in estrogen; atrophy and dryness may give rise to dysuria and other symptoms, such as frequency and urgency.
  • Patients with renal calculi or cancer of the bladder and renal tract may present with dysuria as one of the symptoms.
  • Urethral trauma can occur during sexual intercourse.
  • Patients may be sensitive to scented creams, sprays, soaps, or toilet paper.
  • Physical activities, such as bicycle riding and horseback riding, can cause urethral trauma.
  • Dysuria may be a feature of some psychogenic conditions, such as depression and somatization disorder.
  • Medications, such as those used for chemotherapy, can inflame the bladder.

Sign and symptoms of dysuria

A thorough history is essential for evaluating the timing, frequency, and location of dysuria important areas for vestigation to ascertain possible causes for the dysuria. Vaginal infection may be suspected if the pain occurs as urine passes over the labia. Pain inside the body suggests urethritis or cystitis. If the pain occurs at the onset of urination, it's usually caused by inflammation of the urethra; however, if it occurs after urination, bladder infection may be the cause. Also, acute dysuria suggests bacterial infection, whereas gradual onset may be seen with Chlamydia trachomatis infection. Other signs and symptoms that may accompany dysuria also help the clinician determine the underlying cause. Associated findings may include:

  • hematuria, or blood in the urine
  • urinary frequency
  • urinary hesitation
  • urinary slowness
  • urinary urgency
  • urethral discharge
  • vaginal discharge
  • dyspareunia, or pain during sexual intercourse
  • abnormal vaginal bleeding.

Acute pyelonephritis is manifested by systemic symptoms, such as:

  • fever
  • chills
  • fatigue
  • back pain
  • flank pain
  • nausea
  • vomiting
  • costovertebral tenderness.
Diagnosis information

Urinalysis is an easy, inexpensive test to identify a urinary tract infection (UTD by evaluating the urine for the presence of blood, bacteria, and pus. However, a negative test doesn't rule out a UTI, and further testing is necessary. Urine culture and gram stain can identify the presence of a UTI and the specific offending organism.

If the patient has urethral or vaginal discharge or is sexually active. urethral and vaginal specimens should be evaluated using wet mount and gram staining. Vaginal pH testing, potassium hydroxide evaluation by microscopy, and yeast cultures are additional valuable diagnostic tools. Cultures for Chlamydia trachomatis and Neisseriae gonorrhoeae should also be done. These organisms can also be detected using ligase chain reaction and polymerase chain reaction tests.

More invasive testing is indicated when the diagnosis isn't clear, if a patient is severely ill, or a patient doesn't respond adequately to antibiotic treatment. These tests include:

  • urine cytology to screen for bladder cancer
  • radiographic examination of the kidneys, ureter, and bladder
  • excretory urography
  • voiding cystourethrography
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI)
  • cystoscopy.

Treatment of dysuria

Treatment of dysuria should focus on treating the underlying cause. Infections must be treated with the appropriate antibiotics for the offending organism. Urinary analgesics, such as phenazopyridine (Pyridium, Urogesic), may alleviate acute pain associated with UTI and can be used before a culture is done and antibiotic therapy is begun.

Special considerations or prevention

Education regarding the underlying cause of dysuria is essential. If dysuria is the result of infection, a focus on preventive measures would be beneficial to the patient.

  • It's also important to reinforce the need for medical evaluation should dysuria occur again. Attempts at self treatment should be discouraged due to the variety of possible causes.
  • Avoid tight clothes
  • Avoid feminine douching
  • Use condoms and have only one sexual partner.
  • After urination, wipe from front to back.
  • Avoid intercourse until infection is gone.


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