Painful Urination

Urination may present with various associated symptoms which are described below:

• Pain
  The symptoms of painful urination are mostly seen while passing urine. You may experience pain while initiating or for the entire duration of urination. The pain is mostly sharp, unpleasant and discomforting. Your pain may or may not persist after urination.  
   
• Fever
  When your urinary tract is infected, you may often experience a rise in your body temperature. Your fever may be of mild to moderate degree (above 38.5⁰C). Your fever may also be associated with chills.
   
• Cloudy or bloody urine
  Along with pain, you may notice a change in your urine colour. Your urine may not be clear, pale yellow anymore and may show cloudiness or a tinge of redness because of blood as you urinate.
   
• Abnormal discharge of pus/ blood/ any other fluid
  Sometimes, you may also notice fluid, blood or pus discharge during or after urination.  
   
• Odour
  Your urine may also have a pungent and unpleasant smell.
   
• Frequency of urination
  In some cases, painful urination is also associated with an increased frequency of urination and also an increase in urge to urinate.  
   
• Flank pain
  Flank pain is the pain or discomfort which occurs between the ribs and the pelvic area (near the iliac bone; a part of the hip bone which is present on either side)
   
• Rashes, itching, burning
  Painful urination which is associated with an underlying infection often has rashes, redness, and burning sensation because the person experiences itchiness in the pelvic area and hence scratches it in order to get some relief.
   
• Blisters/sores
  Blisters and sores are usually seen in painful urination caused by sexually transmitted diseases. These blisters are present in the pelvic area around the vagina and on the penis.

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Causes of Painful urination are as follows:

• Infection
  Infection in the pelvic area is the most common cause of painful urination. Since the urinary and the reproductive organs are closely placed in both men and women, the infection of either of the two will result in a painful and uncomfortable urination.
   
• Infection of the Urinary system:
  Our urinary system is a system of organs which are connected together and with the rest of our body through blood. It is specifically involved in removing our body waste through urine. The organs of the urinary system include the kidneys, ureters (tubes that come out of the kidneys and connect them with the urinary bladder), urinary bladder (a bag like structure in which the urine gets collected), and urethra (a small tube which is connected to the urinary bladder and through which the urine is passed out of the body). If you are experiencing discomfort while passing urine, the infection can be present at any level in your urinary system. You may have an infection in the kidneys, or ureters, or urinary bladder, or urethra. The infections of the urinary system irrespective of the part involved are collectively called as Urinary Tract Infections (UTIs). In females, the length of the urethra is shorter, and hence, the infection can travel up easily through the urethra to other parts of the urinary system. You can get an infection of the urinary system on using a contaminated toilet, touching the pelvic area with infected hands, and sometimes it can also be blood-borne (an infection which is already in the blood and reaches the urinary system).
   
• Infection of the Reproductive system
  In both female and male bodies, the reproductive and the urinary systems are present adjacent to each other. In males, there is a common tube for urinary as well as reproductive secretions which lies in the penis. In females, the opening for urethra lies close to the opening of vaginal secretions. Hence, any infection in your reproductive system may cause pain while urinating. You may contract sexually transmitted infections from your sexual partners who have herpes, gonorrhoea, or chlamydia infections. In females, fungal infections in the vagina are common and painful. These infections cause changes in the affected skin which, when comes in contact with the passing urine causes severe pain. The infection of the female reproductive organs is collectively known as pelvic inflammatory disease.
   
• Inflammation
  Inflammation in your pelvic area is another common reason that you are experiencing painful urination. As we have already explained, an inflammation in either of the urinary system or the reproductive system can cause discomfort while you urinate. The inflammation can occur at any level in the urinary or the reproductive system. For example, nephritis (inflammation or swelling in the kidneys), pyelonephritis [inflammation of the renal pelvis (funnel-shaped dilated part of the ureters which originate from the kidneys)], ureteritis (inflammation of the ureters), urethritis (inflammation of the urethra), vaginitis (inflammation of the vagina), cervicitis [infection of the cervix (a part of birth canal which connects the vagina with the uterus)], etc.
   
• Diet, Medications, and Treatments
  If you are not treating your body with enough fluids, you’re certainly setting it up to catch infections easily. Dehydration causes irritation of your urethra and increases the concentration of your urine. Both of them may cause pain while urination along with a high chance of contracting UTIs. If you’re filling your tummy with alcohol, coffee, tea, too much sugar, acidic and spicy food, carbonated drinks, etc then you are most likely causing irritation to your urinary bladder. Your urinary bladder, thus, responds with pain whenever you go to urinate.
  Some medications used in chemotherapy (cancer treatment using drugs) such as cyclophosphamide, tiaprofenic acid and other non-steroidal anti-inflammatory drugs (NSAIDs: drugs used for pain relief), allopurinol (used in gout and kidney diseases), etc cause inflammation of the urinary bladder and may also cause urinary incontinence (inability to control urination).
   
• Radiotherapy
  This is a type of cancer treatment in which radiation is used to reduce the size of the tumour or cancer. Radiotherapy also has a side effect of irritating the urinary bladder, thus causing painful urination.
   
• Tumours
  Tumours of the urinary system such as that of the kidney, adrenal glands (glands which are present on top of kidneys), ureters, or the urinary bladder can obstruct the normal flow of urine out of the body. Tumours of reproductive organs such as that of the uterus, cervix, ovaries, prostate gland, testis etc can also cause compression of the organs and tubes of the urinary system, thus making it painful for the affected person to urinate.
   
• Urinary Tract Obstructions
  Some people may have congenital (something which is present by birth) narrowing of the urinary tubes and their openings, stones in the urinary tract, and abnormal thickening in the walls of ureters or urethra, which may obstruct the normal flow of the urine.
   
• Surgery of the urinary system
  If you have recently or in the past had a surgery in the urinary tract area or the pelvic area, it might cause painful urination either due to infection caused during or after the surgery, inflammation (swelling and fluid build-up) at the site of surgery, or obstruction due to narrowing of tubes because of the scar tissue.  
   
• Allergies
  Some females have a sensitive vagina which can get easily irritated by using scented soaps, bath salts, toilet papers, sanitary pads, spermicides, etc. This can also cause a painful urination.

Risk factors
There are certain factors or conditions which make you more prone to have painful urination than other. They are known as risk factors. Some of the risk factors for painful urination are as follows:

• Gender
  Painful urination is more common in women than in men because it’s easy to get an infection in the urethra in women owing to its short length as compared to that of the urethra in men.
   
• Age
  With age, the functions of the kidneys and the whole body in general slow down because of ageing cells and wear and tear of the organs. The defence system of the body also becomes weak with age, making you more susceptible to infections. In such cases, you are likely to suffer from a UTI and experience painful urination.
   
• Diabetes
  If you are diabetic, your doctor might have brought this to your notice that since your blood has more sugar (glucose) available for the microbes to feed on, along with a decrease in the intensity of body defence, you are prone to contract urinary tract infections more easily than healthy people. This will cause painful urination. (Read more: Diabetes treatment)
   
• Prostate enlargement
  The prostate gland is one of the glands present in the male reproductive system. Men above 40 years of age are prone to prostate gland enlargement which can possibly cause compression of the urethra making it painful and uncomfortable to urinate.
   
• Kidney stones
  Kidney stones vary in size. Some kidney stones are small and can easily pass through your urinary tract, whereas the others which are slightly larger in size may obstruct the tubes and cause severe pain while urinating.
   
• Pregnancy
  In pregnancy, your body undergoes various changes in the body because of pregnancy hormones. These changes provide a favourable environment for the bacteria or viruses to grow. Hence, you are highly susceptible to UTIs during pregnancy.
   
• Urinary catheter
  If you have an obstruction in the ureters and cannot pass urine easily, doctors use urinary catheters to help in the continuous flow of the urine from the urinary system. Sometimes, your urinary catheter might get infected and in turn transfer that infection to your urinary system. This infection might persist even after removing the catheter causing painful urination.
   
• Immunodeficiency
  Immunodeficiency is defined as the decrease in the defensive power or fighting capacity of the body against disease-causing bacteria and viruses. It can be present by birth (resulting from defects in the genes of the baby), for example, Severe Combined Immunodeficiency Syndrome, DiGeorge syndrome, Bruton’s disease, or may be acquired because of the presence of certain diseases, for example, HIV-AIDS. When your body’s defence decreases because of the above-mentioned diseases, it makes it easy for the bacteria or viruses to cause infection in the urinary tract. This infection irritates the urinary tract and causes pain while you urinate.
   
• Menopause
  Menopause makes certain hormonal changes in the body which makes the vaginal area susceptible to infections.

To diagnose your pain upon urination, the physician will start with a detailed history of the pain, followed by physical examination and diagnostic tests.

History
Your physician will start the diagnosis by asking a few questions about your pain such as its severity, location, frequency, associated symptoms such as fever, chills, stomach pain, pus or blood drainage with the urine, your pregnancy status, medications that you are currently taking, alcohol consumption and its amount, whether the pain occurs in initiating or during urination, how the urine flow is, if there is an increase in the frequency of urination or there is an urge to pass urine, if you have suffered from urinary tract infection in the past, etc.

Physical examination
Following the history, your physician may conduct a thorough physical examination of your pelvic area to know the origin, severity, and the nature of pain, etc. After taking the detailed history, and conducting the physical examination, your physician may advise a few of the following laboratory and radiological tests for confirming the diagnosis:

Urinalysis
Urinalysis involves a set of laboratory tests carried out after taking your urine sample. Chemical analysis of your urine includes conducting tests using chemicals which react with the urine, provide information regarding its composition and the presence of an abnormal substance produced in the body which is not usually present in the urine. Microscopic examination is done using a telescopic device which enlarges the structures and helps the lab technician recognize any abnormal substances present in your urine such as blood cells, pus cells, crystals, etc.

Urine culture
In urine culture, some amount of your urine sample is taken and put on a medium which is favourable for the growth of bacteria. After some time, it is examined if there is any growth on the medium. If there is no growth, your urine is free of infection. But, if some growth is seen, it is processed further and examined under a microscope to investigate the kind of infection your urinary tract might be carrying.

Vaginal swabs (in females) and Urethral swabs (in males)
Vaginal swabs and urethral swabs are taken using a sterile (bacteria-free) swab and the sample is put on a bacterial growth medium for some time. Once there is some growth, it is examined under the microscope to check the kind of bacteria present in your urinary tract.

Radiological examination
When the lab tests are inconclusive, the physician might advise you to undergo some radiological tests to know the cause of your pain:

• X-ray
  Your physician may advise you get an X-ray done in order to have a better picture of your urinary system and its adjacent organs. X-rays can easily detect the presence of stones or tumours which might have caused a blockage in the urine flow. In men, X-ray can show the condition of the prostate gland (a gland of the male reproductive system which is present just adjacent to the urinary bladder and surrounds the urethra). There are a few x-rays which are taken after injecting a contrast medium. These include IVP (Intravenous pyelogram) and VCUG (Voiding cystourethrogram).
• Intravenous Pyelogram
  In this test, a contrast medium is injected in the vein of the person's arm and after some time, as the blood filters through the kidneys, X-rays are taken which show a very clear image of the organs of the urinary system. It can also show the presence of any obstruction present in the urinary tract.
• Voiding Cystourethrogram (VCUG)
  In this test, your doctor may ask you to drink water before the test. After some time, a catheter is inserted and X-ray is taken both when the bladder is full, as well as when it is emptying (voiding). This test is also good in determining whether there is a problem with your bladder, ureters, or urethra.   
• Cystoscopy
  This test is done to view your urinary bladder. A thin cystoscope (a device with a telescope) is passed through the urethra until it reaches the bladder. Cystoscopy is of two types: rigid and flexible.
  Flexible cystoscopy doesn’t hurt much because the device is flexible, and hence does not require numbing of the pelvic area. However, in rigid cystoscopy, your doctor may either put you to sleep or make your pelvic area numb before the procedure is started. Your physician might need to pump some water into the bladder in order to get a better picture of it.
• Ultrasound
  Ultrasound is a device which uses sound waves to look at the internal organs and structures of your body. There are two types of ultrasounds, abdominal (the area between your ribs and pelvis) and transrectal (through the rectum).
  In an abdominal ultrasound, a gel is applied to your stomach area and the device is moved over the skin. The organs are then examined on a screen which receives the images. In transrectal ultrasound, the device which is of a size slightly wider than a pen is inserted into your rectum through the anus. When it reaches near the prostate gland, the doctor examines the images for any abnormal increase in the size of the prostate gland or its adjacent area.
• MRI (Magnetic Resonance Imaging)
  In this procedure, a series of pictures of your internal organs are taken from different angles. You are asked to lie down as your body enters the tunnel-like part of an MRI machine and the images are taken. The procedure may sometimes need injecting a contrast medium (a dye). This test will provide a series of pictures of your urinary tract from different angles.
• CT (Computed Tomography) scan
  This procedure also requires you to lie down and pass through a tunnel-like machine. It may also involve injecting a contrast medium. This machine takes images from different angles using X-rays and provides a three-dimensional picture of your internal organs on a computer screen. A CT scan can show kidney stones, obstructions in the urinary tract, tumours, swellings, enlargement of your body organs, etc.
• Radionuclide scans
  In radionuclide scan, a small amount of radioactive (chemicals which emit radiation) material is injected in the blood. This radioactive material reaches your urinary tract and images are taken by special cameras as they pass through the system. This test checks whether your kidneys are functioning properly.

You should strictly follow your doctor’s instructions prior to all the tests mentioned above. There are certain requirements for eating and drinking schedule to be taken care of before these tests.

The treatment of painful urination depends on the underlying medical cause.

Medications
If the cause is an infection of the urinary tract or the reproductive system, your physician may advise some medications (antibiotics or antivirals). After taking medications for the prescribed amount of time, your doctor may ask you to follow up and get yourself checked again to see if the symptoms have subsided.

If the cause is kidney stones then depending on the size of the stones the treatment differs. If the size of your kidney stone is small, your doctor may ask you to wait until you pass the stones in the urine. Some medications may also be prescribed to dissolve the stones.

Surgery
In case of bigger kidney stones, an obstruction, a tumour, or narrowing of the urinary tract, your physician may advise you to undergo a surgery to resolve it.

If your condition is left untreated, it might cause severe complications which can sometimes be life-threatening. The possible complications are:

Recurrent infection
If your pain is due to infection of the urinary tract, it may become severe. If left untreated, it may cause recurrence of infection every once in a while after subsiding for some time.

Sepsis
In case you have an infection of the urinary tract, it might spread and enter the bloodstream. This is known as sepsis or urosepsis (an infection that spreads from the urinary system to the bloodstream). It is a life-threatening condition and requires urgent medical attention.

Kidney damage
It can get really serious if the infection spreads to the entire urinary system and enters your kidneys. When it enters the kidney, it can cause a permanent damage to it. Similarly, a kidney stone which is left untreated for a long time can also cause kidney damage.

Premature delivery or low birth weight
An untreated UTI in a pregnant lady is dangerous for the mother as well as her baby. It can cause premature delivery of the baby or a low birth weight.

As we often say, our health is more in our hands than in the hands of the doctor. By following a few basic things, you may not only prevent painful urination and its underlying causes but many other diseases. We have mentioned below is a list of things to do to prevent painful urination:

• Maintain personal hygiene
  It has been observed that when you successfully maintain personal hygiene effectively, you prevent an infection of your urinary tract.  
• Eat a healthy nutritious diet
  Eating right is the key to a healthy body. Strong immunity is not built in a day. It is developed by always nourishing your body with the required vital nutrients such as vitamins, minerals, carbohydrates, and proteins. This will help you fight infection, prevent the formation of kidney stones, and reduce your chances of developing a tumour.
• Wipe yourself in a forward to backward direction after taking a dump
  This will prevent bacteria from the anus to cause infection in your vagina or urethra.
• Limit alcohol intake and stop smoking
  Alcohol dehydrates your body and makes it prone to infections. It is also harmful to your kidneys.
• Take ample rest at home if you are suspecting an infection
  Take your medications on time and rest up adequately. This will support your body to fight against the infection.
• Practice safe sex
  It is always advised not to have multiple sexual partners and to use physical methods of birth control (such as condoms, diaphragm, etc) which protect you from contracting a sexual disease. Also, it helps to flush bacteria if you urinate after every sexual activity.
• Exercise daily
  Exercising improves your blood circulation and helps in improving your immunity to fight diseases.
• Don't hesitate to see a doctor
  Whenever you suspect an abnormal condition in your body, do visit a doctor and get yourself checked for early diagnosis and treatment.
• Maintain a healthy weight
• Get a routine blood test done every 6 months
  It will help in ruling out blood-related as well as other diseases and disorders. It also keeps a check on your body function.
• Get a full body check up done once in a year
  Make it a habit to get yourself checked once in a year to make sure that you are disease free and healthy.
• If you already have a medical condition such as diabetes, HIV, etc, make sure you keep it under control to prevent contracting an infection.

On an average, a healthy adult voids urine at least five to six times a day and normally, 1.2 to 1.5 L of urine is passed every day. When urination is accompanied by pain or discomfort while initiating or throughout the duration of urination, it is known as dysuria (painful urination). It is one of the most commonly reported symptoms of diseases of the urinary tract.