Pain when urinating

Pain when urinating (dysuria) has a wide range of possible causes, ranging from minor to potentially serious. It usually affects the bladder and/or surrounding tissues, causing symptoms ranging from mild discomfort to a stinging or burning sensation, or severe pain. As with any unexplained and persistent symptoms, it’s important to get it checked out by a doctor.

There are many possible causes of pain when urinating.

Irritation

• A poorly fitting contraceptive device
• Chemicals in products, such as perfumed soaps, toiletries, lubricants, condoms and feminine hygiene products
• Side effects from some drugs

Urinary tract infections (UTIs)

UTIs are the most common cause of pain when urinating and are usually caused by bacteria travelling from the urethra up into the rest of your urinary tract. This is why UTIs are more common in women as the urethra is shorter than in men — bacteria, therefore, have a shorter distance to travel to reach the bladder.

Infection can take hold in any part of the urinary tract, such as the bladder, but also your kidneys, ureter (the tube that carries urine from your kidneys to your bladder) and urethra.

UTI symptoms include:

• Abdominal pain on one side or back pain
• Cloudy or foul-smelling urine 
• Feeling unwell

Sexually transmitted infections (STIs)

Certain sexually transmitted infections (STIs) can cause pain when urinating, such as gonorrhoea, chlamydia and genital herpes. However, STIs don't always cause symptoms, which is why sexual health testing is so important if you are sexually active. 

Other infections

• Non-sexual infections affecting your genitals, such as thrush (candida) in both sexes, or bacterial vaginosis in women
• Pelvic inflammatory disease, a bacterial infection in women, which also causes pain in your lower abdomen

Inflammation

• Interstitial cystitis, also known as painful bladder syndrome — a painful inflammation of the bladder that isn’t caused by an infection
• Prostatitis — inflammation of the prostate gland

Other problems

• An enlarged prostate gland — this can prevent proper emptying of your bladder, causing pain or discomfort when urinating
• Bladder stones — these can form if you have problems emptying your bladder properly
• Cancer of the bladder or urethra
• Hormonal changes at menopause — this causes dryness and thinning of vaginal tissue, which leads to a stinging or burning sensation when urinating
• Kidney stones — these can get stuck in your kidney or ureter, causing an obstruction or infection

Your doctor will probably:

• Ask you questions about any symptoms you may have and your medical history
• Perform a physical examination of your abdomen and pelvic area, including the prostate gland for men
• Take a urine sample to detect infections and inflammation, which will enable your doctor to recommend specific treatment

Other possible tests include:

• A cystoscopy — a thin, flexible tube is inserted through your urethra and into your bladder to look inside and check for potential causes of pain
• An ultrasound scan or X-ray to detect blockages such as kidney stones or abnormal growths
• Tests for STIs, if relevant
• Vaginal swabs to test for infections

The treatment you receive will depend on the cause of your pain when urinating. 

Lifestyle changes

Avoiding potential irritants in products such as perfumed soaps, toiletries, lubricants, condoms and feminine hygiene products can help. Your GP may also recommend changing prescription medication if the cause is a side effect of a particular drug.

Medications

• Antibiotics for UTIs, certain bacterial infections or certain STIs
• Antifungal cream or pessaries for thrush
• Antiviral medication for viral infections such as genital herpes
• Medication to calm an irritated bladder
• Moisturisers or hormone replacement cream for menopausal symptoms
• Over-the-counter medications if the cause is interstitial cystitis

Whichever medication your doctor recommends, it is important to take it exactly as prescribed. Eg if you are given antibiotics for a bacterial infection and your symptoms improve before you finish the course of antibiotics, you should continue to complete the course. Bacterial infections usually clear up quite quickly when antibiotics are taken as prescribed. 

For more serious causes such as an enlarged prostate, kidney or bladder stones, or cancer, your GP or consultant will recommend tailored treatment for your condition.