Dysuria

Dysuria is characterized as painful urination or feeling a burning sensation while urinating. Individuals of any age can experience dysuria, but it is more commonly experienced by women than men. The pain typically originates in the urethra, which is the tube that releases urine from the bladder. Dysuria is not a condition that is diagnosed. Instead, it is a sign or symptom of a health issue that needs to be addressed.

What Is Dysuria in Medical Terms?

The medical definition for dysuria is any form of discomfort that occurs during urination. This issue is distinctly different from urinary frequency. Dysuria is also different from urgency, which refers to the sudden, strong, overwhelming need to urinate. Pain that accompanies urination often indicates the presence of an infection in the urinary tract. Burning, itching, or stinging sensations may also be experienced. Persistent discomfort in the genitals or urinary tract warrants a consultation with a healthcare professional.

What Causes Dysuria?

A number of medical conditions and additional factors are associated with dysuria or painful urination. The following health issues are some of the most common causes.

Infections

A urinary tract infection (UTI) is one of the main reasons painful urination occurs. The infection may develop in any part of the urinary tract such as the kidneys, bladder, urethra, or ureters (the tubes that send urine from the kidneys to the bladder). Bacterial overgrowth in the urethra is the primary cause of UTIs. 

The following factors increase the risk of developing a UTI:

• Gender
• Diabetes 
• Kidney stones
• Enlarged prostate
• Advanced age
• Pregnancy
• Catheter placement

Although dysuria is a distinct symptom of a UTI, additional symptoms include fever, bloody or cloudy urine, increased urinary frequency, strong or foul-smelling urine, and flank pain. Flank pain occurs on one side of the body in the low back.

In some cases, dysuria is linked to a vaginal infection such as a yeast infection. This type of infection typically causes an odor and vaginal discharge that gradually worsens if left untreated.

Sexually transmitted infections such as genital herpes, chlamydia, and gonorrhea can also lead to dysuria. However, sexually transmitted infections may also cause itching, blisters or sores, and burning. 

Irritation and Inflammation

A wide range of health problems can lead to irritation or inflammation of the urinary tract or genital region that manifests as dysuria. These regions may become inflamed or irritated due to an infection, but other potential causes include:

• A tumor or kidney stone in the urinary tract
• Irritation of the urethra following sexual activity
• Vaginal changes that occur during menopause
• Reactions to certain supplements, medications, and treatments
• Interstitial cystitis (now known as Bladder Pain Syndrome) is a condition that is characterized by bladder inflammation
• Vaginal irritation or sensitivity to certain products (e.g., bubble bath solution, scented soaps, spermicides, douches, or toilet paper)
• Some dermatological conditions (e.g Lichen Planus) 

The signs and symptoms of dysuria may also differ between men and women. In some cases, the location of the pain can help a physician determine the cause.

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Symptoms of Dysuria

In men, dysuria is mostly experienced near the tip of the penis, whether the location of the underlying issue originates in the urethra or the bladder. The pain may also persist after urination is complete. An additional symptom that can help direct a diagnosis is discharge from the penis, especially in younger men. If discharge is present, the appearance and volume of the discharge are also important for diagnosis.

Sexually transmitted infections such as gonorrhea are usually accompanied by large amounts of white or yellow discharge, while an infection such as chlamydia is associated with a small quantity of mucus-like discharge. In older men, urinary intermittency, hesitancy, or straining may also develop. These types of complications may also cause a man to stand closer to the toilet or take longer than usual to start urinating. These types of symptoms indicate a possible obstruction—an issue that may occur due to a restriction in the urethra or prostatic enlargement. 

In women who experience dysuria, the discomfort may be internal or external. Furthermore, women may endure a UTI (or urinary infection & inflammation) as well as vaginal inflammation—in which pain may develop as urine comes in contact with inflamed labia (the protective outer layers of the vulva). However, if the pain or burning sensation is internal, the source of the underlying issue is more than likely the urinary tract. A UTI that is progressing or left untreated may also lead to kidney symptoms of back pain, fever, chills, nausea, or vomiting. 

Regardless of whether the symptoms appear to be internal or external, it is important to speak with a healthcare professional who can differentiate between an upper and lower urinary tract issue to initiate proper treatment.

Dysuria Differential Diagnosis

A differential diagnosis is a process in which a physician differentiates between two or more conditions that may be the underlying cause of a person’s symptoms. When a physician is making a traditional diagnosis, the diagnostic procedure focuses on one potential cause of an individual’s symptoms.

It is important to speak with a healthcare professional if pain or burning occurs for several days or becomes increasingly worse. Dysuria is often a symptom of a medical condition that needs to be treated. To identify and diagnose the cause of the pain, a healthcare professional will review a patient’s complete medical history. This includes asking questions about current and past medical conditions such as immunodeficiency disorders or diabetes mellitus. 

The healthcare professional may also ask about sexual history to determine if a sexually transmitted infection may be the cause of the discomfort. Tests that are used to screen for sexually transmitted infections may also be performed, especially for men who report discharge from the penis or a woman who has discharge from the vagina. For women who are of childbearing age, a pregnancy test may be administered.

In addition, a healthcare provider will ask about the use of over-the-counter pain relievers or prescription medication, as well as the use of any home remedies for the management of dysuria. Furthermore, the healthcare provider will ask about your current symptoms (e.g., itching, tingling) and obtain a clean catch urine sample. The urine sample will be checked for red blood cells, white blood cells, or foreign material. 

The presence of white blood cells in the urine indicates that inflammation has developed in the urinary tract. A urine culture that is sent to a lab for observation under a microscope can also reveal or confirm a UTI and the particular bacteria that caused the infection. This information helps the healthcare provider to choose an antibiotic that will be the most effective at treating the bacteria.

If no sign of an infection is detected in the urine sample, the healthcare provider may suggest additional tests (e.g., imaging procedures) to visualize the bladder or prostate. The healthcare provider may also obtain a swab sample of the lining of the urethra or vagina to check for signs of infection.

To help a healthcare provider determine the cause, a patient may be asked whether the painful urination:

• Began abruptly or gradually
• Is felt during the onset of urination or after emptying the bladder
• Occurred once or many times over an extended period

The healthcare provider may also ask if the dysuria is accompanied by other symptoms such as:

• Fever
• Nausea
• Dizziness
• Headaches
• Abdominal pain
• Flank pain (one-sided pain)

The healthcare provider may also enquire as to whether the painful urination is experienced along with any of the following changes in urine flow:

• Leaking or dribbling
• Difficulty initiating a urine flow
• Increased frequency or need to urinate
• A weak stream that causes straining or pausing

Furthermore, the provider may ask questions regarding whether the appearance of the urine has changed, including:

• Amount
• Color
• Bloody urine
• Cloudy urine
• Clumpy discharge in urine

Answering these questions truthfully helps the provider make an accurate diagnosis. 

The treatment that is recommended depends on the cause of dysuria and ranges from antibiotics to avoiding irritants, to treating the underlying medical problem. A healthcare professional may also provide a referral for pelvic physical therapy if dysuria develops due to hypertonic pelvic floor muscles, neuralgia (nerve pain) or incomplete bladder emptying.

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Physical Therapy for Dysuria

An infection or inflammation can irritate the bladder and cause strong urges to urinate. The Detrusor muscle of the bladder can repeatedly clench and relax which may cause urinary incontinence—the leaking of urine.

Urinary Incontinence develops with urgency or can also develop as stress urinary incontinence. Stress urinary incontinence (SUI) occurs when an individual sneezes, coughs, strains, or even laughs during regular activities. Over time, urinary incontinence can negatively impact mental health, social relationships, sexual function, sleep patterns, and independence. Physical therapy can help prevent this issue from interrupting an individual’s lifestyle.

After performing a thorough assessment, a physical therapist may do Pelvic Floor exercises or ask a client to track bladder habits, including the type of food and beverages that are consumed regularly to determine a possible connection between lifestyle habits and the worsening of symptoms.

Certain types of foods and beverages can worsen urine leakage by causing bladder irritation. These include:

• Chocolate
• Spicy foods
• Alcoholic beverages
• Artificial sweeteners
• Caffeine (e.g., tea, coffee, energy drinks)
• Tomatoes and tomato-based sauces and foods
• Carbonated drinks (e.g., soda, sparkling water)
• Citrus fruits and fresh juices (e.g., orange, grapefruit, lemon)

To help determine which foods or beverages may irritate the bladder, a physical therapist may ask a client to record daily bladder habits, including what, when, and how much of a particular type of food or drink is consumed. Providing this information can help a therapist develop an appropriate therapeutic regimen that focuses on bladder re-training.

The combination of lifestyle changes and therapeutic techniques such as Pelvic Floor exercises can help restore bladder function. Pelvic Floor exercises are specialized movements that are designed to improve coordination, relax tense muscles, and strengthen and re-train bladder function. Working with a physical therapist is helpful because many women do not realize that they are doing the exercises incorrectly and using the wrong muscles. Performing Pelvic Floor exercises too many times can make the muscles tired. Doing only a few Pelvic Floor exercises a day may also be counterproductive to strengthening the affected muscles.

To assess whether the right muscles are contracting and relaxing during Pelvic Floor exercises, a physical therapist may use a biofeedback device that detects muscle movement. This approach helps clients become more aware of their bodies as they clench or relax the pelvic floor muscles.

A therapist may also need to use electrical stimulation to administer brief, impulses to strengthen the muscles that control bladder function. This process may become necessary for women who are not strong enough to perform Pelvic Floor exercises without therapeutic assistance.

Summary

Dysuria refers to painful urination or burning sensations that may develop due to various reasons such as a UTI, sexually transmitted infection, inflammation, or catheter placement. Women tend to experience dysuria more often than men, but chronic discomfort warrants an assessment. Treatment involves determining the underlying cause of painful urination and may involve the use of antibiotics, irritant avoidance, or physical therapy.

The highly trained physical therapists at FYZICAL specialize in performing therapeutic techniques that help lengthen relax and coordinate tense muscles that may worsen dysuria symptoms. Pelvic Floor exercises are particularly useful for improving bladder control to help individuals overcome incontinence issues. Our dedicated therapists can also demonstrate effective strengthening exercises that help improve the stability of muscles and ligaments that control the bladder. 

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FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life®!

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