Painful Urination in Women (Dysuria)

Urinary pain  is the pain that is felt when urinating. It can be very mild and little more than a minor irritation or it can be severe and excruciating to the point that a person fears urinating. The most common cause of painful urination is a urinary tract infection (UTI) which is more frequently seen in women than men. Sometimes urinary pain is not related to the urinary tract but is instead due to some pathology within the pelvis and  perineum with pain elicited with the increased pressured during urination.

It is not uncommon for women to ignore urinary pain but it may be an important indicator of underlying pathology. If urinary pain is accompanied by a high and unremitting fever, persistent severe pain in the lower abdomen, heavy vaginal bleeding, dizziness and/or confusion then it needs to be investigated immediately.

Causes of Painful Urination

A urinary tract infection (UTI) may involve the urethra (urethritis), bladder (cystitis) or even extend up the urethra to affect the kidney (pyelonephritis). Almost all cases are bacterial in nature and more often associated with bacteria from the rectum. It is more common in women due to the shorter urethra in females.

Other conditions like pelvic inflammatory disease (PID) may also cause painful urination. PID is the inflammation of the female reproductive organs more commonly due to infections like vaginal thrush. This includes sexually transmitted infections like chlamydia and gonorrhea.

Sometimes inflammation of the genitourinary system may not be associated with an infection. Instead an injury or irritation from drugs or even tumors may be responsible. Urinary stones are another possible cause particularly as the stones enter the narrower tracts  like the ureter or urethra.

The pelvic and abdominal cavities are continuous. Therefore pathology in the abdominal cavity may account for urinary pain. As the pressure in the abdominopelvic cavity increases with urination, other organs and structures out of the genitourinary system may also be irritated. This can elicit pain.

Less common causes may include :

  • Endometriosis
  • Inflammatory bowel disease
  • Peritonitis
  • Growths on or in the pelvic organs

Signs and Symptoms

Urinary pain is a symptom and not a disease. The pain is typically felt in the pelvis and extends to the external genitalia. When the ureters or kidneys are involved the pain can extend up the flanks to the kidney. Generalized abdominal pain may also be present. Urinary pain may be accompanied by other clinical features including :

  • Itching of the genitalia
  • Urethral or vaginal discharge
  • Foul odor from the genitalia including the discharge
  • Discoloration of the urine including blood in the urine (hematuria)
  • Urinary frequency
  • Difficulty urinating
  • Urinary incontinence
  • Pain with intercourse or during a bowel movement

The presentation depends on the causative condition. Other symptoms like fever and nausea may also be present.

Diagnosis of Urinary Pain

A thorough medical history should be followed by a clinical examination. Further testing may be then be necessary to identify the cause. This may include :

  • Urine dipstick
  • Urinalysis – cytology and culture
  • Laboratory analysis of a vaginal swab
  • Ultrasound
  • CT
  • MRI

Pregnancy needs to be taken into consideration when deciding upon the appropriate investigative technique.

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