Dysuria

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Dysuria Microchapters

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Patient Information

Overview

Classification

Causes

Differentiating Dysuria from other Diseases

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Synonyms and keywords: Micturition painful, pain passing urine, painful urination; painful micturition

Overview

Dysuria is define as pain or burning, stinging, or itching of the urethra or urethral meatus during or just after urination.
Dysuria happens due to bladder muscle contraction and peristalsis of the urethra, which cause the urine to come in contact with the inflamed mucosal lining, which in turn stimulates pain receptors and causes one to feel pain or burning.

Epidemiology

  • Dysuria can happen in both males and females. One of the most common causes of dysuria is urinary tract infection. Urinary tract infections are more common in females than males due to female anatomy, having a shorter and straight urethra compared to males who have longer and curved urethra due to male anatomy.
  • In females, bacteria can reach the bladder more easily due to shorter and straight urethra as they have less distance to travel.
  • females who use the wrong wiping technique from back to front instead of front to back can predispose themselves to more frequent urinary tract infections due to the opening of the urethra being closer to the rectum. Because of these reasons, females tend to experience dysuria more frequently compared to males

Classification

Dysuria can be divided broadly into two categories

  • Infectious
  • Infectious causes include
  • Urinary tract infection or urethritis
  • Kidney or prostate infections
  • Vaginal infections
  • Sexually transmitted diseases
  • interstitial cystitis
  • Non-infectious
  • Non-infectious causes include
  • Foreign body or stone in the urinary tract
  • Trauma
  • Benign prostatic hypertrophy
  • Tumors
  • Certain medications
  • Anatomic abnormalities
  • Menopause

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning Arsenicals, baneberry poisoning, chemical irritants
Dermatologic Balanitis xerotica obliterans, Behçet syndrome, genital herpes, irritative dermatitis, lichen sclerosus, malakoplakia, periurethral herpes simplex, Stevens–Johnson syndrome, toxic epidermal necrolysis
Drug Side Effect Abciximab, BCG vaccine, benzatropine, bicalutamide, clofibrate, dexchlorpheniramine, diflunisal, flavoxate, foscarnet sodium, hexaminolevulinate, hydroxyurea, indinavir, leflunomide, melarsoprol, meropenem, methenamine, milnacipran, nabumetone, nitazoxanide, oxcarbazepine, oxaprozin, phendimetrazine, pramipexole, pyrazinamide, rifaximin, spermicidal gel, sertraline, sulindac, tiagabine, tiaprofenic acid, valrubicin, zonisamide
Ear Nose Throat Behcet syndrome
Endocrine Hypercalciuria
Environmental No underlying causes
Gastroenterologic Appendicitis, bilharziasis, diarrhea, rectovesical fistula
Genetic Acute intermittent porphyria, adenine phosphoribosyltransferase deficiency, xanthine oxydase deficiency, xanthinuria, X-linked alpha thalassemia mental retardation syndrome
Hematologic Acute intermittent porphyria
Iatrogenic Radiation therapy, postoperative septicaemia, urethral catheterization
Infectious Disease Acute cystitis, acute urethritis, bacterial vaginosis, bilharziasis, candidal vaginitis, cervicitis, chlamydia, cystitis, diarrhea, epididymitis, fungal infection, genital herpes, genital schistosomiasis, gonorrhea, granulomatous prostatitis, hemorrhagic cystitis, hydatid cyst, kidney infection, Neisseria gonorrhoeae, non-gonococcal urethritis, nonspecific (chemical) urethritis, pelvic inflammatory disease, periurethral herpes simplex, pinworms, prostatic tuberculosis, prostatitis, pyelonephritis, renal tuberculosis, schistosoma haematobium, sexually transmitted disease, trichomoniasis, urethritis, urinary tract infection, vaginitis, vancomycin resistant enterococcal bacteremia, varicella, vulvitis
Musculoskeletal / Ortho Reactive arthritis, Reiter's syndrome
Neurologic No underlying causes
Nutritional / Metabolic Acute intermittent porphyria, adenine phosphoribosyltransferase deficiency, idiopathic hyperuricosuria, xanthine oxydase deficiency, xanthinuria
Obstetric/Gynecologic Atrophic vaginitis, bacterial vaginosis, candidal vaginitis, cervical cancer, cervicitis, complication of pregnancy, contraceptive foam, contraceptive sponge, cystocele, ectopic pregnancy, endometriosis, fallopian tube conditions , granulosa cell tumor of the ovary, labial adhesion, menopause, pelvic inflammatory disease, perineal trauma, prolapsed uterus, trichomoniasis, vaginal douche, vaginal lubricant, vaginal ulcers, vaginitis, vesicovaginal fistula, vulvar cancer, vulvitis
Oncologic Bladder cancer, cervical cancer, granulosa cell tumor of the ovary, prostatic carcinoma, urethral cancer, urinary tract neoplasm, vulvar cancer
Opthalmologic Behcet syndrome, reactive arthritis, Reiter's syndrome
Overdose / Toxicity No underlying causes
Psychiatric Functional disorders, psychogenic disorder, sexual abuse
Pulmonary Goodpasture syndrome
Renal / Electrolyte Acute pyelonephritis, congenital giant megaureter, dehydration, Goodpasture syndrome, hypercalciuria, kidney infection, kidney stone, pyelonephritis, renal nutcracker syndrome, renal tuberculosis, urolithiasis
Rheum / Immune / Allergy Behçet syndrome, Goodpasture syndrome, reactive arthritis, Reiter's Syndrome, Stevens-Johnson syndrome
Sexual Masturbation
Trauma Local trauma, urethral trauma
Urologic Acute abacterial cystitis, acute cystitis, acute urethritis, autoimmune orchitis, balanitis xerotica obliterans, balanitis, balanoposthitis, benign prostatic hyperplasia, bladder cancer, bladder diverticulum, bladder stone, cystitis, cystocele, dysfunctional elimination, eosinophilic cystitis, epididymitis, granulomatous prostatitis, hemorrhagic cystitis, Hunner ulcer, interstitial cystitis, malakoplakia, meatal stenosis, non-gonococcal urethritis, nonspecific (chemical) urethritis, paraurethral gland inflammation, pelvic lipomatosis, prostatic carcinoma, prostatic disease, prostatic tuberculosis, prostatitis, pyelitis, rectovesical fistula urethral cancer, urethral caruncle, urethral catheterization, urethral stricture, urethral syndrome, urethral trauma, urethritis, urinary incontinence, urinary obstruction, urinary stone, urinary tract infection, urinary tract malformation, urinary tract neoplasm, urolithiasis, vesicoureteral reflux, vesicovaginal fistula
Dental No underlying causes
Miscellaneous Poor perineal hygiene

Causes in Alphabetical Order

Differentiating Dysuria from other Diseases

Treatment

Treatment of dysuria depends on its cause the most common cause of dysuria is urinary tract infection for which empiric antibiotic are used.

References

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