Dysuria

oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

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.

NEW - log your activity

  • Notes Add notes to any clinical page and create a reflective diary
  • Track Automatically track and log every page you have viewed
  • Print Print and export a summary to use in your appraisal
Click to find out more »

See also the separate articles Genitourinary History and Examination (Male) and Genitourinary History and Examination (Female).

History

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:
  • 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.

Examination

May not be required for simple situations, eg if the history suggests uncomplicated lower UTI. If relevant, examine for:

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.

See also the separate articles Childhood Urinary Tract Infection, Urinary Tract Infection in Adults and Imaging of the Urinary Tract.

Further reading & references

  1. Kurowski K; The woman with dysuria. Am Fam Physician. 1998 May 1;57(9):2155-64, 2169-70.
  2. Roberts G, Hartlaub PP; Dysuria in men. American Family Physician, Sep 1999
  3. 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.

Original Author:
Dr Naomi Hartree
Current Version:
Last Checked:
20/04/2011
Document ID:
2081 (v21)
© EMIS