Painful urination
introduction
If there is a burning sensation and / or pain sensations during the urine excretion, one speaks colloquially of "pain when urinating".
In medicine this phenomenon is referred to as Alguria designated. In general, there are two types of painful urination.
On the one hand, the unpleasant feelings can occur at the beginning of the urination, on the other hand, many patients describe such painful sensations at the end of the toilet.
Causes of painful urination
The most common causes of pain when watering are:
- Urinary tract infection or cystitis
- Pelvic inflammation
- Inflammation of the vagina in women
- Bladder stones
- Inflammation of the prostate or glans in a man
- Irritable bladder
- rarely tumors in the urinary tract
There can be various causes for burning sensations and / or pain when urinating. In general, it can be observed that women suffer from painful urination significantly more often than men. This fact can be explained by the fact that the urethra of the woman with a length of about 3-5 cm is significantly shorter than that of the man (20-25 cm). From this context it can be deduced that the most common causes of pain when urinating must also differ depending on gender.
Despite the fact that the onset of painful urination can be due to a variety of possible causes, the danger of this symptom should not be overlooked. If you experience pain when urinating, you should definitely consult a doctor and determine an exact cause.
Read more on the subject below Problems urinating.
Cystitis
By far the most common reason for a painful one micturition is the typical cystitis that can develop quickly, especially in women. Urinary tract infections, on average, are the most likely causes that cause discomfort during urination. This type of infection can be provoked both by bacterial pathogens and by various strains of fungi. In most cases, the pathogens are carried into the urethra through incorrect cleaning of the anal region after defecation. From there they rise to the bladder or the upper parts of the urinary tract. Viral or parasitic infections are rather rare in this context. Also sexually transmitted diseases like syphilis can lead to painful urination. Especially in those cases in which the pathogens attack the mucous membranes of the lower urinary tract (especially the urinary bladder and urethra), the typical pain occurs when urinating. However, since infections of the upper urinary tract (kidneys and ureters) usually spread to the lower urinary tract, unpleasant sensations can also occur in such cases. On the basis of the symptom “painful urination”, a disease of the upper urinary tract cannot be differentiated from an infection of the lower urinary tract.
Pelvic inflammation
Inflammatory processes in the kidneys, bladder and / or urethra can also lead to severe pain and burning sensation when urine is passed. In most cases, these inflammations are not triggered by bacteria or other infectious agents, but rather by other stimuli (so-called non-infectious stimuli). Kidney inflammation is also one of the reasons that lead to painful urination particularly often and that requires urgent treatment. Irradiation of the pelvic region (for example when taking X-rays) provokes the development of such inflammatory processes in some patients (radiogenic cystitis; cystitis caused by radiation).
Inflammation of the vagina
In women, pain when urinating is often associated with inflammation of the vagina (colpitis). Although the burning sensation and painful sensations associated with this disease tend to arise directly in the vagina area, when urinating occurs, direct contact between the urine and the irritated areas can lead to painful urination. The additional occurrence of increased discharge in combination with the basic symptom can be used to differentiate such a vaginal inflammation from a pathological change in the urinary tract. Inflammatory processes on the labia and vagina (so-called Vulvovaginitis) primarily cause pain during sexual intercourse and increasing itching, but abnormal sensations when urinating can also be possible symptoms of such a disease.
Bladder stones
By exerting pressure on the sensitive tissue, bladder stones can also lead to irritation or injuries and thus to painful urination.
Irritable bladder
The term irritable bladder is a disease of the urinary bladder that shows itself through different signs. In addition to the pain when urinating, many people suffer from frequent urination with a small amount of urine (Pollakiuria) and / or incontinence.
An irritable bladder can develop, on the one hand, due to a chronic cystitis; on the other hand, it cannot be ruled out that such symptoms are a first indication of the presence of a bladder tumor. In these cases one speaks of a so-called secondary irritable bladder. In contrast, with a primary irritable bladder, no cause can be found despite the most modern diagnostic procedures.
Urinary tract tumors
Urinary tract tumors can be found in some patients who have painful urination. This option should be considered especially in the elderly or in the absence of another diagnosis. In most cases, in the presence of tumors of the urinary tract, in addition to the unpleasant sensations during urination, bloody deposits in the urine can be detected. Although the typical cystitis is far more common in women as the reason for uncomfortable urination, it does not, strictly speaking, belong to the so-called gender-specific causes (causes that are either only found in women or only in men).
Medication
In addition, drug treatment can lead to tissue irritation in the urinary tract.
Inflammation of the prostate or glans penis
In men, pain when urinating can be caused by the presence of inflammatory processes in the area of the prostate gland (lat. prostate) are provoked. Such inflammation of the prostate (Prostatitis) also leads to severe pain in the genital area and / or during ejaculation.
In some cases, inflammation of the glans can also lead to painful urination in men.
Read more on the topic: Pain when urinating in men
Illustration painful urination
Painful urination
Urinary bladder infection
- Urinary bladder - Vesica urinaria
- Ureter - Ureter
- Muscle wall,
Urinary bladder ejector -
Tunica muscularis,
Detrusor vesicae muscle - Mucous membrane -
Tunica mucosa - Ureter orifice -
Ureteral ostium - Bladder triangle -
Trigonum vesicae - Bladder neck -
- Cervix vesicae
- Urethra - urethra
- Escherichia coli bacteria,
Proteus mirabilis, mushrooms
(Candida albicans) - Ovary - Ovary
- Uterus - uterus
- External urethral mouth -
Ostium urethrae externum - Vaginal mouth -
Ostium vaginae - Anal canal -
Canalis analis - Rectum -
Rectum - Male member -
penis - Prostate gland -
prostate - Vesicle gland -
Glandula vesiculosa
A. - Flat section through a female
Urinary bladder from the front, inflamed on the left
and right healthy bladder
B - Flat section through a male
Urinary bladder from the front
C - female pelvis:
Around the urinary bladder,
Median section
D - Male pelvis:
Around the urinary bladder, Median section
You can find an overview of all Dr-Gumpert images at: medical illustrations
Concomitant symptoms
The most common symptoms accompanying painful urination are:
- increased need to urinate
- Blood in the urine
- Fever and chills
- Itching around the urethra
- discharge
- Back pain in the area of the flanks
- colicky pain
- Conjunctivitis or joint inflammation
The various accompanying symptoms also provide information about the cause of the pain. The symptoms and their relationships are explained in more detail below.
Increased urination
By far the most common cause of dysuria is the urinary tract infection, popularly known as cystitis (Urocystitis or simply cystitis). It is caused by the migration of bacteria into the urethra (urethra) and the urinary bladder. The most common pathogen causing uncomplicated cystitis is Escherichia coli (E. coli). A urinary tract infection, in addition to the mostly burning pain when urinating, is usually also characterized by a frequent urge to urinate with only small amounts of urine being withdrawn (Pollakiuria) accompanied. In women, the inflammation may spread to fallopian tubes and ovaries (Adnexitis) lead to sticking and thus in the worst case to infertility (sterility) can lead.
Another very common cause of urination discomfort in men aged 50 and over is an enlarged prostate (benign prostatic hyperplasia = BPH).
However, it usually goes with an increased urination frequency (more frequent urination), Sensation of residual urine, weakened urine stream, dribbling and nocturnal urge to urinate (Nocturia) hand in hand.
Pain only occurs when a urinary tract infection occurs.
Blood in the urine
Occasionally there is also blood in the urine (Hematuria). This can be seen with the naked eye (Macrohematuria) or not visible but detectable with a urine strip test (Microhematuria). On the one hand, this can indicate a urinary tract infection with damage to the tissues of the urethra or bladder. Blood in the urine also occurs in tumors.
The discontinuation of flaky and / or strongly smelling urine must also be urgently clarified medically, as injuries to the urinary bladder, the ureter or other organ defects can be the cause.
Fever and chills
An important complication of untreated urinary tract infection is the spread of the inflammation to the kidney tissue up to the development of pelvic inflammation (Pyelonephritis).
This is usually accompanied by a severe feeling of illness, fever and chills and requires urgent and prompt treatment. Inflammation of the prostate gland is considered a complication of urethritis in men (Prostatitis) which is usually accompanied by a strong feeling of illness, fever and chills and an inflammation of the epididymis (Epididymitis).
Even with acute appendicitis (appendicitis) painful urination combined with a fever may occur. In most cases, however, the symptoms begin with pain in the area of the navel, which then migrates to the right lower abdomen. Inflammation of large intestinal bulges called sigmoid diverticulitis can also cause pain when urinating. However, pain in the left lower abdomen is much more common.
Discharge and itching
Another cause of dysuria can be an isolated inflammation of the urethra without involvement of the urinary bladder, this is known as urethritis.
A distinction is made between non-specific urethritis, which can be triggered by numerous bacteria, and specific urethritis caused by gonococci (Neisseria gonorrhoeae) is triggered (Gonorrhea), it is popularly known as gonorrhea. In addition to the burning pain when urinating, patients with urethritis often complain of constant itching around the urethra and discharge from the urethra (Urethral fluorine). It should not be forgotten that the sexual partner should also be examined and, if necessary, treated as well, as otherwise the inflammation may not heal even with antibiotic therapy of one partner, because a renewed infection from the partner who has not been treated is possible.
Back pain in the area of the flanks
Other possible accompanying symptoms are back pain in the area of the flanks, which is particularly common with inflammation of the kidney pelvis (Pyelonephritis) occur. In this case, a doctor should be consulted, since if the renal pelvic inflammation is not treated, the bacteria can be washed out into the blood and thus life-threatening urosepsis can occur.
Colic pain
Stones in the bladder or urethra area can also cause pain when urinating. Most of the time, however, the stones are located a little higher in the area between the kidney and bladder, in the ureter. Here they lead to typical colicky pains and marked discomfort. Colic-like pain also occurs with inflammation of the kidney pelvis.
Conjunctivitis or joint pain
A special form of urethritis is the so-called Reiter syndrome, a complex of symptoms in which the patient suffers from conjunctivitis in addition to urethritis (Conjunctivitis) and joint inflammation (arthritis) Suffer. It is one of the autoimmune diseases. Occasionally conjunctivitis also occurs in connection with chlamydial infections, if these are transmitted from the genital area to the eye in the event of an infection or are transmitted to the child at birth.
therapy
Depending on the underlying cause, painful urination must be treated urgently, as further complications can occur if appropriate therapy is neglected.
Inflammatory processes caused by bacteria in the urinary bladder, urethra or renal pelvis are usually treated with a suitable antibiotic. In order to be able to choose the most effective antibiotic, the exact determination of the germs is essential. In most cases, preparations like Amoxicillin or Co-trimoxazole prescribed.
The treatment usually covers a period of 5 - 7 days and should definitely be continued until the end. If the patient independently discontinues the antibiotic, the symptoms may worsen again and the bacterial pathogens may develop resistance.
In the event of abnormalities or intolerances, the attending physician should be consulted again for this reason.
In order to alleviate the pain when urinating as quickly as possible, it is advisable to support the treatment by increasing drinking behavior. Water and / or unsweetened tea are particularly suitable. In this way, the bacterial pathogens are flushed out of the urinary tract more quickly and the symptoms improve quickly.
With causes such as bladder or urethral stones, a Endoscopy (Mirroring). As part of this procedure, the urinary bladder and urethra can be examined and small stones removed without extensive surgical intervention. In the case of larger stones, these must be smashed before removal. A special ultrasound probe is inserted for this purpose.
An operation is only necessary in special cases.
If there is a sexually transmitted disease that causes pain when urinating, targeted treatment must be in place. Pain relievers can be taken to directly relieve pain when urinating.
Painful urination in woman
The most common cause of painful urination in women is cystitis.
The type of pain is very characteristic: a burning sensation that gets stronger towards the end of the toilet and pulls into the abdomen, combined with a persistent urge to urinate that does not go away afterwards.
Cystitis is a common disease in women due to the short urethra, only about 3 cm long, and the proximity to the rectum with all the bacteria.
Often you can get them with plenty of fluids of about 3 liters / day and herbal remedies, such as B. Bubble tea, cranberry juice or angocin from the pharmacy, without antibiotics.
Warmth also relieves symptoms. If the pain has not passed after a few days, a visit to the doctor is necessary. A urine sample is then given and examined for signs of inflammation and the presence of bacteria.
In the case of recurrent bladder infections, it is advisable to go to the toilet as a preventative measure no later than 15 minutes after intercourse. This flushes out any bacteria that may have been introduced before they can settle in the bladder.
If the pain is less typical of a bladder infection, but only burns superficially, other diseases are also possible.
If the labia or genital area are inflamed or injured, the urine may be irritating and burn.
This is typical, for example, with fungal infections of the genitals with Candida albicans.
It burns and itches permanently, and it gets worse on contact with urine.
Infections with the herpes virus or other sexually transmitted diseases can also sting while urinating. The decisive factor is the pain characteristics in order to distinguish between a conventional cystitis and another infection that burns when it comes into contact with the urine.
Read more on the topic: Painful urination in woman
During pregnancy
Pain when urinating is also possible during pregnancy. By the second to third trimester, the child is large enough that the bladder may also be affected.
Due to the scarcity of space in the abdomen, the pregnant woman feels a frequent need to urinate. However, it can happen that the child lies down completely on the bladder and squeezes it. The mother notices this through stabbing pain.
The stretching of the uterine ligaments, which hold the uterus in the abdomen, during pregnancy can also be painful when urinating, as the muscles of the pelvic floor work here. However, cystitis must always be considered during pregnancy. Pregnant women are automatically classified as complicated bladder infections because the infection can more easily reach the renal pelvis through enlarged ureters. In any case, a urine culture should be created and treated with an antibiotic despite pregnancy, e.g. Nitrofurantoin or fosfomycin. However, antibiotics from the quinolone class must not be used.
Urethritis during pregnancy can, depending on the pathogen, pose a risk to the child. Untreated colonization of the urethra with chlamydia or gonococci during birth can lead to conjunctivitis (Conjunctivitis) with the child.
Read more on the topic: Infections in pregnancy, Antibiotics in pregnancy as well Painful urination during pregnancy
As a sign of pregnancy
Pain when urinating is not a sign of pregnancy.
If you suspect you are pregnant and notice painful urination, it is most likely due to a bladder infection or an infection with a sexually transmitted disease.
Unprotected sexual intercourse is of course the basis of both pregnancy and the acquisition of such an infection. If the pain is persistent and also occurs when urinating, if there is possibly a positive pregnancy test, then the rare case of an extra-uterine pregnancy must also be considered. This means that the embryo is not in the uterus as intended, but somewhere else, e.g. has nested in the fallopian tubes, ovary or even in the abdominal cavity. This causes severe pain and, in rare cases, can mimic the symptoms of a urinary tract infection. In this case, however, the pain is permanent and more or less independent of urination. This is an emergency and should be presented to a doctor immediately.
Read more on the topic: Signs of pregnancy
After birth
Painful urination after having a baby is a relatively common phenomenon. There is a lot of raw force and pressure on the ureter and bladder at birth. The tissue is squeezed and, as a natural process, after this type of injury, stores water.
This process is called edema formation, and this edema can narrow the urethra. This makes it difficult to drain urine, which can lead to the urine collecting in the bladder and filling it painfully.
With such disorders of urination after the birth, a cystitis must also always be excluded. This is always an option, even after the birth. To make matters worse, the female body is sensitive after the hard work of childbirth and the abdomen is already hurting anyway. Often it is no longer possible to differentiate between pain in the bladder when the urine is stagnated and physical pain after birth, which is why particular attention must be paid to urination. Such phenomena are often observed after births with epidural anesthesia (epidural anesthesia) or surgical vaginal birth.
Pain when urinating in men
Male urination pain is usually a more serious matter. There are three possible reasons for a man.
The most common cause of painful urination in women, cystitis, can affect men too. However, anatomically speaking, men have a much longer urethra than women. Pathogens such as bacteria or fungi have to make it the long way from the outside world through the urethra in the male member to the mouth of the same in the bladder in order to cause inflammation.
That is why cystitis is automatically considered a complicated form in men and should always be presented to a doctor. If the pain is then a bladder infection, this is treated with an antibiotic or, in rarer cases, an antifungal agent (against fungi) treated. If this therapy is neglected, it is possible that the infection continues through the ureters and into the kidneys, causing inflammation of the renal pelvis, which if left untreated can even be fatal.
Another common cause of painful urination can be sexually transmitted diseases. The most common pathogens here are for example chlamydia or gonococci (gonorrhea). Unlike women, these bacteria cause inflammation of the urethra itself, which then hurts when urinating.
As an accompanying symptom, cloudy discharge from the mouth of the urethra on the male member may also be noticed. Especially if you had unprotected sexual intercourse with a partner a few days to weeks beforehand, you should consider this possibility as the cause of the pain.
The diagnosis is secured with a urethral swab. Here, too, antibiotic therapy should not be missed, as these pathogens can also continue to rise. However, they then nestle not in the kidneys, but in the testicles and epididymis, where they can cause complications such as inflammation and, in the worst case, infertility in men.
The third, but relatively rarer reason for painful urination is small kidney or urinary stones. These waste products of calcium oxalate or other minerals are formed in the kidney and can migrate down the ureter. If the stones are small enough, they slide through to the bladder, but the passage through the urethra can be painful for men. Here, too, the formation of kidney stones should be treated, as larger stones can get stuck in the ureter and cause terrible pain as part of renal colic.
Read more about this under: Acorn burns
diagnosis
As mentioned earlier, micturition pain can be triggered by a number of causes. The quality and the exact location of the pain cannot always be used to delimit the possible diseases.
For this reason, special investigation methods help to find the cause.
The direct examination of the urine is probably the most important measure in the diagnostic process when such symptoms occur. This method can be used to detect possible pathogens, such as bacteria or fungi, in the urine. Performing such a urine sample is easy and does not take much time. A thin measuring stick with different fields is dipped into the urine for a short time (so-called U-Stix). After a few seconds, a color change in the individual fields can be seen and compared with a table. In this way, for example, the pH of the urine can be determined. Metabolic products of typical intestinal bacteria (nitrite) can be verified in this way. In addition, the urine stix enables the detection of tiny amounts of red and / or white blood cells in the sample material.
If a sexually transmitted pathogen is suspected, however, this test method is not sufficient. In these cases, a blood sample and a smear must also be taken and examined in the laboratory. A so-called blood culture can be produced from the blood sample to cultivate the possible pathogens.
In addition to the examination measures already described, an ultrasound examination of the urinary tract and bladder can provide information about the underlying disease if there is pain when urinating. In addition, in some cases, a cystoscopy (Cystoscopy) or it may be necessary to take an X-ray after administration of contrast medium. In men, it is also advisable to consider having the attending physician scan the prostate. During this examination, the doctor inserts a finger into the anal region and tries to feel the prostate gland a bit above the rectum.
Furthermore, the patient's blood should be checked for specific protein levels and so-called prostate-specific antigens (PSAs) to be examined.
Summary
Painful urination can have different causes, but must urgently clarified by a doctor become. In the most cases there is one for the painful urination relatively harmless and good reason to treat.
