Painful Urination

Overview

Genitourinary problems become more common after a certain age. These diseases mainly arise from urinary tract infections. “Painful urination” is a very common manifestation in such cases. It is precipitated by hygiene factors and existing medical conditions. According to the reports of the National Kidney Foundation, around 20% of women having a history of urinary tract infection is likely to develop a similar infection accompanied by painful urination in future. On being left undiagnosed, these infections may lead to renal dysfunctions of fatal nature.

What is painful urination?

Painful urination or “painful micturition” or “dysuria” is a disorder of the renal tract which is characterized by pain, burning sensation and discomfort during passing urine.

It is primarily caused by the bacteria residing in the urinary tract.

Poor hygiene conditions combined with a weak immunity and existing kidney diseases can worsen the symptoms. Around 50-60% of women experience painful urination after the age of 40.

Causes of painful urination

Painful urination is caused by a number of etiological factors. The most common contributors to painful urination are listed below-

• Failure of the renal system to eliminate bacteria from the body, which leads to excess accumulation of Escherichia coli bacteria along the linings of the urinary tract, thereby causing infections
• Infection of the urethra due to Chlamydia or Mycoplasma species
• Infections of the vagina in Vaginal Candidiasis and Atrophic Vaginitis
• Inflammation of the urinary bladder due to activation of the mast cells
• Direct contact of the sub-mucosal nerve filaments with the harmful elements in urine
• Urothelial dysfunctions
• Auto-immune diseases (vascular immune-pathology with immune deposits on the bladder wall, T-cell infiltrates and B-cell nodules)
• Elevated levels of IgA and IgG in the urine
• Functional abnormalities of the enzyme responsible for urinary nitric oxide metabolism
• Abnormally reduced microvascular density in the suburothelium
• Obstruction of the renal tract due to constriction of the urethra or enlarged prostate in men
• Accumulation of calcium or protein wastes
• Urinary schistosomiasis
• Tumors present in the urethra, kidney or the urinary bladder
• Pelvic floor diseases or pressure exerted by some abnormal pelvic mass
• An injury caused to the vagina or urethra due to sexual abuse (For example, forced entry of some foreign object through the vagina)
• Unprotected sexual activities or engaging in sexual activities from a very young age
• Vaginal irritation caused by a defective contraceptive diaphragm
• Overuse of some drugs like danazol, cyclophosphamide or allopurinol
• Irritation caused due to allergies caused by chemicals contained in soaps, vaginal lubricants, and spermicides
• Existing diseases like Arthritis, Diabetes mellitus, Sickle cell disease or Behçet’s disease
• Polycystic kidney disease or glomerular disease
• Hormonal fluctuations during menopause or pregnancy
• An occurrence of cysts or scars in the kidneys
• Using urinary catheter for a long time
• Poor hygiene habits like using unclean sanitary napkins, using poorly sanitized toilets and improper cleaning after a bowel movement
• A regular diet rich in sodium and purine
• Low intake of fluids on a regular basis (causes dehydration)
• Congenital defects of the urinary tract or a family history of urinary infections
• Instrumental surgeries in the past
• Unprotected exposure to ionizing radiations during the treatment of some existing diseases

Symptoms of painful urination

Dysuria is not only accompanied by painful urination but also has several other symptoms. The general symptoms of painful urination and dysuria are discussed below-

• Pain, irritation and burning sensation during passing urine
• Pain in the bladder and urethra
• Pain and discomfort in the lower abdomen
• Pain radiating to the lower extremities and groin
• Passing very small volumes of urine in spite of the excessive need to urinate
• Feeling of urine retention and bladder fullness immediately after passing urine
• Presence of trace amount of blood in the urine (indicates kidney stones or tumors)
• The frothy or foamy appearance of urine (Proteinuria)
• A release of excess vaginal discharge along with urine
• Malodour from urine
• Yellowish-brown discoloration of urine
• Fever and fatigue
• Abdominal swelling (due to an accumulation of urine)
• Frequent need to pass urine, particularly at night (observed in aged people)
• Swelling of face, hands, and feet
• Muscle cramps and body pain

Conditions related to painful urination

Four primary conditions are related to painful urination. These are described below-

• Lower urinary tract infection: It is associated with urinary bladder infection or cystitis. In this case, the bacteria enter the urethra through the vaginal passage. This may occur during unprotected sexual intercourse with an infected partner or during improper wiping after a bowel movement. From the urethra, the bacteria reach the bladder within a very short time and cause infections.
• Upper urinary tract infection: This is evident in people suffering from kidney stones, bladder dysfunctions or enlarged prostate. In this condition, the bacterial infection spreads from the bladder to the kidney. A common example of the upper urinary tract infection is Pyelonephritis. In some children, reverse flow of urine from the bladder to the kidneys occurs. This is called Vesicoureteral reflux and it leads to painful urination.
• Urethritis: Acute inflammation of the urethra occurs in this condition. This disease is normally triggered by the Gonorrhoea or Chlamydia species. Urethritis is also caused by an Indwelling Catheter (IDC) or as an inflammatory response to certain chemicals present in spermicides, antiseptics or bubble bath soaps.
• Vaginitis: Vaginitis is characterized by inflammation of the vagina. It may be caused due to an allergic response to bath soaps and spermicides, infected tampon or dropped estrogen level after menopause.

Diagnosis

The following diagnostic tests are recommended-

• Voiding cystourethrogram
• Radionuclide scan
• Cystoscopy
• Urodynamics
• Ultrasonography

Treatment & Prevention

Treating episodes of painful urination often includes:

• Antibiotic treatments can help in treating UTIs which are a primary cause of causing painful urination.
• Pain medications are also prescribed to help relieve the painful symptoms.
• Getting treatment for the underlying STI (sexually transmitted infection) also helps control the symptoms.
• There are several home remedies that are used to treat urinary tract infections. Few of these include cranberry juice, vitamin C rich foods, and bearberry leaves.

You can prevent the onset of painful urination by following these steps:

• Drinking lots of water and regularly emptying your bladder.
• Not indulge in tobacco and alcohol consumption.
• If you have a tendency to get urinary infections, limit your caffeine intake.
• Keep the genital area clean.
• Refrain from using unsanitary toilets.
• Practice safe sex and get regularly screened for STIs.

 
References