Painful urination (or burning during urination) is one of the most common symptoms in clinical practice, receiving the name of dysuria in the medical community. Most people pain related to urinate only urinary tract infection, but many other problems urinary or gynecological tract may cause such symptoms.

In this text we will try to explain what are the conditions that must be thought of when a patient presents with complaints such as painful urination, burning during urination, bladder pain or burning in the urine channel.

The paper will address the following points about dysuria:

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  • What is dysuria.
  • What are its causes.
  • Symptoms associated with dysuria.
  • How to diagnose the causes of dysuria.
  • What is the treatment.


The dysuria covers a lot of similar symptoms that usually indicate inflammation of any genitourinary region. Symptoms encompassed in the term dysuria, include:

– Pain when urinating.
– Burning on urination.
– Burning sensation when urinating.
– Pang urination.
– Discomfort when urinating.
– Bladder pain when urinating.
– Pain in the urethra ( the canal that carries urine) to urinate.
– Heaviness when urinating.

Most episodes of dysuria occurs by inflammation or infection of the urethra and / or bladder. However, inflammation of the prostate, testis, epididymis, vagina and uterus may also have dysuria as one of its symptoms.

It is very important to know the causes of dysuria and know correlate them with the rest of the clinical picture to not fall into the trap of thinking that all painful urination is urinary tract infection.

Before we move on to the article, be sure to also watch the video on symptoms of urinary tract infection produced by MD.Saúde team:

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Meet our YouTube video channel: MD.Saúde on YouTube


Let’s start the explanation listing the main causes of dysuria for, then try to show how to distinguish from each other:

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Urinary tract infection:
a. Cystitis (read: INFECTION URINARY | CYSTITIS | Symptoms and Treatment ).
B. Pyelonephritis (read: pyelonephritis | INFECTION URINARY | Symptoms and Treatment ).

Urethritis (inflammation of the urethra):
a. Chlamydia (read: Chlamydia | Symptoms and Treatment ).
B. Gonorrhoea (read: GONORRHEA – Symptoms and Treatment ).
C. Genital herpes (read: HERPES LIP | GENITAL HERPES | Symptoms and Treatment ).

Vulvovaginitis (inflammation of the vagina and vulva) : (read: VAGINAL | VAGINITIS )
a. Trichomonas vaginalis. (read: TRICHOMONIASIS | Symptoms and Treatment ).
b. Candida albicans (read: CANDIDIASIS | Symptoms and Treatment ).

Prostate disease:
a. Prostatitis (read: PROSTATITIS | Symptoms, causes and treatment ).
B. Benign prostatic hyperplasia (read: Benign Prostatic Hyperplasia | Symptoms and Treatment ).
C. Prostate cancer (read: PROSTATE CANCER | Symptoms and Treatment ).

Other causes of dysuria:
a. Epididymitis (inflammation of the epididymis).
B. Bladder tumor.
C. Atrophic vaginitis.
D. Interstitial Cystitis (read: Interstitial Cystitis | syndrome painful bladder ).
And. Irritation of the urethra by substances such as soaps, fabric softeners, perfumes or medicines.
F. Trauma in the pelvic region.
G. Very concentrated urine (read: URINE WITH STRONG SMELL ).
H. Kidney stones (read: KIDNEY CALCULATION | STONE IN KIDNEY | Symptoms of renal colic ).

As you can see, painful urination is a symptom that is present in more than a dozen different diseases, and therefore required medical evaluation to establish a correct diagnosis.


How painful urination is a very common symptom, the doctor usually use the clinical history and symptoms associated with dysuria in the investigation of the frame. For example, painful urination in young women usually indicates cystitis. Already in young men, it is most likely the dysuria is due to prostatitis or urethritis. In elderly men, prostate disease should always be thought, and in women with discharge, urethritis and vulvovaginitis are the best bets.

We will show briefly what types of information help direct the diagnosis of dysuria.

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1. Cystitis is a likely diagnosis when the patient dysuria complaint and also has one or more of the following:
-. Young woman
. – Increased frequency of urine
. – Incomplete emptying of the bladder sensation
– Blood in the urine (read : hematuria | URINE WITH BLOOD .)
– Symptoms that began 24-48 hours after intercourse.

2. pyelonephritis is a likely diagnosis when the patient dysuria complaint more:
– High fever.
– Sweats & Chills.
– Vomiting.
– Asthenia.
– Intense backache.
– Blood in the urine.

3. urethritis by gonorrhea or chlamydia is a likely diagnosis when the patient dysuria complaint more:
– purulent urethral discharge.
– Recent history of sex without condoms (read: CONDOM | All you need to know ).

4. Prostatitis is a likely diagnosis when the patient dysuria complaint and also has one or more of the following:
– Male.
– Difficulties to urinate.
– Fever.

5. Atrophic vaginitis is a likely diagnosis when the patient dysuria complaint and also has one or more of the following:
– Women after menopause (read: 25 SYMPTOMS OF MENOPAUSE ).
-. Resected Vagina
– Pain during intercourse ( read: DURING SEX – DYSPAREUNIA and vaginismus ).

6. The IPV is a likely diagnosis when the patient dysuria complaint and also has one or more of the following:
-. Female gender
. – Vaginal discharge
. – Redness in the vagina
– pain during sexual intercourse.

7. The renal calculus is a possible diagnosis when the patient complains of dysuria and also has one or more of the following characteristics:
-. Pain that starts in the back and down towards the groin and genital
– Pain disappears after the stone It is excreted in the urine (may not disappear immediately if the stone injuring the urethra during the passage).
– Blood in the urine.

8. The enlarged prostate, either benign or tumor, is a likely diagnosis when the patient dysuria complaint and also has one or more of the following:
-. Man over 50
– weak urine jet.
– Difficulty to urinate.
– Need to get up at night several times to urinate.
– Blood in the urine.

9. bladder tumor is a likely diagnosis when the patient dysuria complaint and also has one or more of the following:
-. Age 55+
. – Thinning
. – Blood in the urine
– A history of smoking ( HARM CIGARETTE | Treatment of smoking ).


It is important to know that the dysuria is a symptom and not a disease. The pain passing urine is the consequence and not the cause. Diagnosis and treatment should aim at the disease that is causing the pain when urinating. In general, most tests used in the research are:

– Simple Analysis of urine (EAS or urine type I) (read: URINE TEST | Understand your results .)
– Urine culture (read: urine culture EXAM | Indications and how to harvest ).
– Analysis of urethral discharge.
– Analysis of vaginal discharge.
– Ultrasonography of the prostate, bladder and kidneys.
– blood PSA dosage.

The decision to request or not each of the tests mentioned above depends on the likely differential diagnoses established after the initial medical evaluation.

In young women, cystitis is triggered the main cause of painful urination, and sometimes unnecessary request additional tests to make the diagnosis. Not a misconduct doctor prescribe antibiotics for urinary tract infection after a single clinical evaluation.

However, in young women cystitis is the most likely diagnosis in cases of dysuria, the same does not apply to young men. In this group, cystitis is uncommon and urethritis and prostatitis should always be remembered as a differential diagnosis when there is burning complaints when urinating.


The treatment of dysuria obviously depends on the cause. Infections are treated with antibiotics, prostate disease should be evaluated by a urologist, the atrophic vaginitis improves with vaginal estrogen, etc. There is no single remedy that addresses all causes of dysuria simultaneously. So if there is no proper research, it can not be an appropriate treatment.

A very common mistake is to only treat painful urination with analgesics, such as Pyridium® (Phenazopyridine), leaving aside the true cause of dysuria. The patient takes the medicine, feels temporary pain relief but not cure. The pain back so that the effect of the medicine ends (in some cases the pain or even disappear completely). Such conduct and slows the healing of the frame, can cause complications for letting the disease causing dysuria progress.



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