What Causes Painful Urination? (Dysuria)

Pelvic Floor Doctor

Medically Reviewed By Dr. Amanda Olson,DPT, PRPC

When most people experience painful urination, a Urinary Tract Infection (UTI) is the first thing that comes to mind. However, there are actually a number of infections or other conditions that can cause painful urination--some a lot more serious than others.

Let’s take a look at some of the potential causes of pain or a burning sensation during urination.

Infections That Cause Painful Urination

Urinary Tract Infection & Urethritis

One reason why UTIs come to mind as one of the first causes of painful urination is that they’re incredibly common. In fact, UTIs may be the most common bacterial infection; almost half of those with vaginas will experience at least one UTI in their lifetimes (Foxman, 2002).

Of these infections, about 40% will recur within one year (Arnold, Hehn, & Klein, 2016). 

There are many different components of the urinary tract that can become infected such as the kidneys, urethra, and bladder--but a UTI is typically an infection of the bladder (and is therefore synonymous with bladder infection).

This is in contrast to urethritis, a type of urinary tract infection that causes inflammation of the urethra. Urethritis is also fairly common; up to 4 million Americans will get Urethritis each year, though this condition is more common in people with penises (Young, Toncar, & Wray, 2020). 

Vaginitis

While a UTI is an infection of the urinary tract, vaginitisdescribes a group of infections of the vagina. Yeast infections are probably the most common form of vaginitis; almost everyone with a vagina will experience a yeast infection at some point (Denning et al, 2018).

Yeast infections are one source of pain or discomfort during urination, along with itchiness and thick, white discharge (Johnson, 2020).

Many sexually transmitted infections (STIs) also fall under vaginitis, including chlamydia, gonorrhea, and trichomoniasis. 

  • Of these, chlamydiais the most common… and also one of the most dangerous to be left untreated, as it can lead to long-term damage of internal and external sex organs. It can be accompanied by vaginal itching or pain during urination (Cleveland Clinic, 2015).
  • Gonorrhea(“The Clap”) can also be accompanied by pain during urination, though it is more common in those with penises than those with vaginas, and vaginal gonorrhea is more likely to be asymptomatic (CDC, 2014).
  • In opposition to gonorrhea, trichomoniasis(“trich”, pronounced “trick”) is more common in those with vaginas, and again causes pain during urination. Only about 30% of cases of trichomoniasis are accompanied by symptoms (Johnson, 2019).

Pelvic Inflammatory Disease (PID)

We’ve covered UTIs (infection that usually occurs in the bladder), urethritis (infection and inflammation of the urethra), and different forms of vaginitis (infection and inflammation of the vagina).

However, the reproductive organs of those assigned female at birth--the cervix, fallopian tubes, uterus, and ovaries--can also become infected, leading to a dangerous condition called Pelvic Inflammatory Disease (PID).

PID typically happens when gonorrhea or chlamydia are left untreated and their infections reach the internal organs. The symptoms are usually pain in the abdomen or pelvis, pain while urination, fever, and fatigue.

If you are having painful urination combined with any of these symptoms, please seek immediate medical attention(Das, Ronda, & Trent, 2016). 

Other Sources of Painful Urination

Interstitial Cystitis (IC)

We mentioned above that a UTI is typically an infection of the bladder. Sometimes, these bladder infections can lead to inflammation of the bladder, which is known as cystitis. When these bladder infections are recurring, they could be evidence of a condition known as Interstitial Cystitis (IC).

Interstitial Cystitis is relatively rare, only impacting 3-6% of those with vaginas (Interstitial Cystitis Association, 2020). Its symptoms--including painful urination--overlap with symptoms of chronic UTI, making it difficult to diagnose. 

Obstructions

Another particularly painful source of pain while urinating is urinary obstructions which block the flow of urine outside your body; this is commonly known as obstructive uropathy.

Obstructive uropathy can have many causes including injuries, blood clots, a tumor, or kidney stones. This condition also frequently comes with fever symptoms. The longer obstructive uropathy goes untreated, the more damage can be done to the kidneys; treatment can include a stent, surgery, or--in the case of kidney stones--patience and a lot of water to help you pass the stone quickly (Rishor-Olney & Hinson, 2021).

Irritants

Several irritants--both external and internal--can also cause painful urination. Spicy foods or drinks, caffeine, and any food you are allergic to can cause painful urination, as can certain medications.

Using scented detergents or other scented products on your genitals can also cause irritation that would lead to painful urination.

Painful Urination Symptoms to Look For

Some of the conditions we’ve mentioned are very serious and can cause long-term harm; others, like kidney stones, might pass on their own in a few days. Your vaginal discharge is one of the most important things to pay attention to and note to your doctor.

Note whether it looks or smells “off”. It could be cloudy, milky, discolored, or have an off smell. One particular cause for concern is if your discharge or urine contain blood.

You will also want to get immediate medical attention if your pain while urination coincides with other severe abdominal pain or fever. These can both be signs that your infection has spread to your internal organs, which can cause serious damage if left untreated.

Conclusion

Many of these conditions can be prevented by practicing proper hygiene and safe sex. Make sure you and any partner you’re planning to be intimate with are tested regularly for STDs, whether you have symptoms or not. Also, use caution when inserting anything into your vagina; be sure both your hands and the item you are inserting are clean.

If you’re experiencing painful urination, it’s vital that you write down a list of all other symptoms you may be experiencing. Be sure your doctor tests your condition to be sure you have the right diagnosis and the right treatment. Left untreated, many of these conditions can become chronic and do serious damage to your organs. 

References

  1. Foxman B. (2002). Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. The American journal of medicine, 113 Suppl 1A, 5S–13S. https://doi.org/10.1016/s0002-9343(02)01054-9 
  2. Arnold, J. J., Hehn, L. E., & Klein, D. A. (2016). Common Questions About Recurrent Urinary Tract Infections in Women. American family physician, 93(7), 560–569. https://pubmed.ncbi.nlm.nih.gov/27035041/ 
  3. Young, A., Toncar, A., & Wray, A. A. (2020). Urethritis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK537282/ 
  4. Denning, D. W., Kneale, M., Sobel, J. D., & Rautemaa-Richardson, R. (2018). Global burden of recurrent vulvovaginal candidiasis: a systematic review. The Lancet Infectious Diseases, 18(11), e339-e347. https://doi.org/10.1016/S1473-3099(18)30103-8 
  5. Cleveland Clinic (2015). Chlamydia Symptoms, Treatment, Prevention & Complications. https://my.clevelandclinic.org/health/diseases/4023-chlamydia 
  6. Centers for Disease Control and Prevention [CDC], Division of STD Prevention (2014). Gonorrhea - CDC Fact Sheet. https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm 
  7. Johnson, T.C. (Ed.) (2019). Trichomoniasis (Trich). WebMD. https://www.webmd.com/sexual-conditions/guide/trichomoniasis 
  8. Das, B. B., Ronda, J., & Trent, M. (2016). Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infection and drug resistance, 9, 191–197. https://doi.org/10.2147/IDR.S91260 
  9. Interstitial Cystitis Association (2020). 4 to 12 Million May Have IC. https://www.ichelp.org/about-ic/what-is-interstitial-cystitis/4-to-12-million-may-have-ic/
  10. Rishor-Olney, C. R., & Hinson, M. R. (2021). Obstructive Uropathy. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/32644347/