When You Have Painful Urination and Burning (Dysuria)

Painful urination with burning, also known as dysuria, is not something to ignore. This type of pain is often most intense immediately after you stop urinating. It is often felt internally in the urethra (the tube that carries urine out of your body) and sometimes in the area surrounding the genitals.

Common Causes of Dysuria

Painful urination is often accompanied by a burning sensation, and it is a common symptom of urinary tract infection (UTI). A UTI is an infection of the bladder or urethra, and it is usually bacterial. Sometimes UTIs can spread, affecting the ureters (tubes that bring urine from the kidneys to the bladder) and the kidneys as well.

People with vaginas are far more likely than males to get UTIs. In addition to dysuria, a UTI can also cause urinary frequency, urinary urgency, blood in the urine, cloudy urine, or incontinence.

While UTIs are the most common cause of dysuria, there are other causes as well.

Common causes include:

• For males, infection or inflammation of the prostate, irritation, scarring, and strictures can also cause pain with urination.
• For females, vaginal dryness, candida dermatitis or vaginitis, vulvitis, and interstitial cystitis may also cause painful urination with burning.

Other Causes of Painful Urination

Other less common causes of painful urination include:

• Dehydration
• Bladder stones or kidney stones
• Sexually transmitted infections (STIs), also called sexually transmitted diseases (STDs), including chlamydia, genital herpes, gonorrhea, and others
• Soaps, perfumes, and other personal care products
• Drugs, such as those used in cancer treatment, that have bladder irritation as a side effect
• Radiation cystitis (damage caused by radiation therapy for cancer)
• Having a recent urinary tract procedure performed, including use of urologic instruments for testing or treatment
• Urinary retention (being unable to empty your bladder completely)
• Kidney infection
  
• Urethral stricture (narrowing of the urethra)

These other causes may also be accompanied by other symptoms. For example, STIs can be accompanied by visible skin changes, and a kidney infection may be accompanied by a fever.

When to See a Healthcare Provider

Make an appointment to see your healthcare provider if:

• You have pain, burning, or discomfort when you urinate.
• You have urinary urgency or frequency.
• You are not able to empty your bladder, or you are incontinent.
• You have drainage or discharge from your penis or vagina.
• You see blood in your urine, or your urine is cloudy.
• You have a fever.
• You have back pain or pain in your side (flank pain).
• You pass a kidney or bladder (urinary tract) stone.

Diagnosis

Your healthcare provider may be able to diagnose the cause of your painful, burning urination when you describe your physical symptoms. Often, you will need to have a urine sample tested as well.

If there is concern about an STI, your healthcare provider may also swab the lining of the vagina, penis, or urethra to check for signs of infection.

The urine and/or swab sample your healthcare providers take may be analyzed for white blood cells, red blood cells, viruses, or bacteria.

A urine culture, which takes about two days for results, will show which bacteria are causing the infection. It also helps the healthcare provider decide which antibiotics will help treat the bacteria.

Often, if there is a strong suspicion of a bacterial infection, antibiotics are started after the urine sample is taken, even before the results come back. However, if you have a bacterial infection that requires a different antibiotic than the one you were prescribed, your doctor may give you a different prescription.

If your urine sample shows no sign of infection, you may need additional tests to determine the cause of your symptoms, such as a physical examination or imaging tests of the bladder, pelvis, or prostate.