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Dysuria is the symptom of painful micturition. It is a very common presentation in primary care. Treatment depends on identifying the underlying cause. There are related articles on Lower Urinary Tract Symptoms in Men and Lower Urinary Tract Symptoms in Women.
- Abdominal causes: dysuria can occur with emergency causes of abdominal pain such as appendicitis and ectopic pregnancy (due to irritation of nearby urinary structures).
- Urinary tract causes:
- Urinary tract infection (UTI):
- Interstitial cystitis
- Obstruction: prostatic enlargement, urethral stricture.
- Kidney stones in the bladder or urethra.
- Malignancy, eg carcinoma of the bladder or urethral tumours.
- Genital causes:
- Other disease:
- Drugs, eg cyclophosphamide, allopurinol, danazol, tiaprofenic acid, and possibly other non-steroidal anti-inflammatory drugs.
- Chemical irritants: allergic or irritant reaction to soaps, vaginal lubricants, spermicides, contraceptive foams and sponges, tampons and toilet paper.
- Mechanical irritation, eg from a poorly fitting contraceptive diaphragm or vaginal ring pessary.
- Radiation or chemical exposure.
Depending on the situation, possible questions are:
- Pain symptoms:
- Onset and duration of dysuria.
- Is there abdominal pain? If it is present, consider abdominal pain causes, eg appendicitis and ectopic pregnancy.
- Radiation of pain (eg to loin or back, suggesting upper urinary tract pathology).
- Other symptoms:
- Fever, rigors or malaise - suggest pyelonephritis.
- Haematuria - occurs with infection, stones, neoplasms and renal disease.
- Urethral or vaginal discharge - consider genital tract infection.
- Odour - suggests bacterial infection.
- Pruritus - common with genital candidiasis.
- Frequency and urgency - indicate bladder irritation.
- Urine volume and flow - is there obstruction?
- Medical history:
- Possible pregnancy.
- Past history: previous UTI, other genitourinary disease, pelvic surgery or irradiation, other general illness, medication.
- Recent sexual history; method of contraception; bear in mind the possibility of child sexual abuse.
- Occupation: exposure to dyes and solvents is a risk factor for bladder cancer.
May not be required for simple situations, eg if the history suggests uncomplicated lower UTI. If relevant, examine for:
- Fever, tachycardia and loin tenderness (pyelonephritis).
- Abdominal/pelvic tenderness, guarding, masses or adnexal tenderness; enlarged bladder.
- Vaginal discharge, candidiasis, genital herpes simplex or vaginitis.
- An enlarged prostate may be felt on rectal examination.
- If child sexual abuse is suspected, specialist assessment is required.
Consider the appropriate level of investigation for the clinical picture, or whether to treat empirically. Investigations are generally required for children and men with dysuria, but not always for women (see below).
Possible investigations for dysuria
Depending on the clinical picture, these include:
- Urine dipstick, microscopy and culture (see below).
- Considering whether a pregnancy test is needed.
- Investigation for sexually transmitted infection(STI) - or referral to an STI clinic.
- Ultrasound of the urinary tract, pelvis or abdomen if there is suspicion of obstruction or masses.
- Plain kidney, ureters and bladder (KUB) X-ray if renal tract stones are suspected.
- Urodynamic studies.
- Urine cytology.
- Further tests, eg cystoscopy, require a specialist setting.
Further reading & references
- Kurowski K; The woman with dysuria. Am Fam Physician. 1998 May 1;57(9):2155-64, 2169-70.
- Roberts G, Hartlaub PP; Dysuria in men. American Family Physician, Sep 1999
- Urinary tract infection (lower) - men, Clinical Knowledge Summaries (January 2010)
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Naomi Hartree
Dr Colin Tidy