Dysuria

Dysuria is the term used to describe pain or burning that occurs during urination, either at the beginning or at the end of micturition.

Symptoms and Causes

Dysuria is pain during urination, which patients perceive as mild discomfort, burning, or stinging sensations, depending on the case. It may be caused by a wide variety of conditions and affects both men and women, although it is more common among females.

According to the duration of symptoms, three types of dysuria are distinguished:

Acute dysuria: appears suddenly and resolves within no more than one week.
Chronic dysuria: persists continuously for more than two weeks.
Intermittent dysuria: appears and disappears sporadically. Symptoms usually last for two or three days and resolve spontaneously, but recur after several weeks.

The prognosis of dysuria varies according to the underlying cause. Nevertheless, in most cases, it resolves within a few days when appropriate treatment is followed.

Symptoms

The characteristic symptoms of dysuria are:

Pain, burning, or stinging during urination. It may occur at different stages of micturition:
- Initial dysuria: discomfort occurs at the beginning of micturition, often causing difficulty initiating urination.
- Terminal or post-micturition dysuria: discomfort is perceived after urination, together with the sensation that the bladder has not been completely emptied.
- Straining dysuria: because urination is difficult, the patient must strain to initiate or maintain micturition.
Increased urinary frequency.
In cases of nocturnal dysuria, patients awaken during the night because of the need to urinate.
Hematuria: the presence of blood in the urine, indicating infection.
Malodorous urine.
Vesical tenesmus: the sensation of incomplete bladder emptying.
Pelvic pain or a sensation of pressure.
Urethral discharge: passage of thick or watery white, yellow, or greenish fluid as a sign of a sexually transmitted infection.

When any of the following symptoms occur in addition, emergency medical attention is recommended:

Fever or chills.
Nausea or vomiting.
Lower back pain.
Weakened immune system.
Recurrent episodes.

Causes

The causes of dysuria are highly varied and are divided into two main groups:

Infectious Dysuria: Occurs as a consequence of bacteria, viruses, fungi, or parasites entering the body.
- Urinary tract infection (UTI):
  - Cystitis: inflammation of the bladder.
  - Urethritis: inflammation of the urethra.
  - Vaginitis: inflammation of the vagina and frequently the vulva.
- Sexually transmitted infections (STIs):
  - Chlamydial infection: caused by the bacterium Chlamydia trachomatis.
  - Gonorrhea: caused by the bacterium Neisseria gonorrhoeae, also known as gonococcus.
  - Trichomoniasis: caused by infection with the parasite Trichomonas vaginalis.
  - Genital herpes: caused by the herpes simplex virus.
- Prostatitis: inflammation or irritation of the prostate gland.

Non-Infectious Dysuria: Not related to any type of infection.
- Nephrolithiasis: calculi or stones in the urinary tract (bladder or kidney).
- Irritating substances: the use of products containing chemical components, such as spermicides, lubricants, or intimate hygiene products, may cause itching and burning.
- Urethral stenosis: narrowing of the urethra, the duct that carries urine outside the body.
- Medical procedures, such as urethral catheterization or urinary catheter placement.
- Diabetes or autoimmune diseases: although they do not directly cause dysuria, they may increase the likelihood of developing it.

Risk Factors

The risk of dysuria increases in the following situations:

Sex: female anatomy facilitates the entry of bacteria into the urethra because it is shorter and located closer to the anus.
Age: more common among older men as a consequence of natural prostate enlargement.
Pregnancy: hormonal changes and increased pressure on the urethra favor the development of infections.
Inadequate hydration, which impairs proper elimination of bacteria because of insufficient fluid intake.
Poor hygiene: women are advised to wipe from front to back after urination and defecation.
Voluntarily delaying urination: holding urine for prolonged periods increases the risk of bacterial proliferation.
Use of irritants, such as soaps that disrupt the vaginal flora or spermicides.
Having undergone urinary catheterization or using a urinary catheter.
High-risk sexual activity.
Diabetes.
Renal cysts, congenital malformations, or bladder stones that prevent complete bladder emptying.

Complications

When the condition causing dysuria is not treated promptly, complications may occur, such as:

Pyelonephritis: a severe bacterial infection of the urinary system that spreads to the kidneys.
Kidney damage.
Sepsis: if the infection reaches the bloodstream, it spreads throughout the body and becomes life-threatening.

Which specialist treats dysuria?

In milder cases, dysuria is managed within the specialty of Family and community medicine. When patients present with greater severity or warning signs, they are referred to Urology.

Diagnosis

The diagnosis of dysuria is established through clinical assessment, usually supplemented by specific tests to determine the cause:

Medical history: the patient's medical history, lifestyle, and reported symptoms are reviewed.
Urinalysis and urine culture: detects leukocytes (an indication of inflammation or infection), nitrites (a sign of bacterial presence), or blood. In addition, assessment of urine density and pH helps determine whether lithiasis is present. Urine culture is used to identify the causative pathogen and determine the most effective antibiotic.
Ultrasound: provides images of the urinary system and is used to identify structural abnormalities or urinary calculi.
STI testing: culture or PCR detects the presence of microorganisms in urine.

Treatment

Treatment of dysuria should be individualized according to the underlying condition. The most common approaches include:

Analgesics to relieve symptoms while the underlying cause is addressed.
Antibiotics.
Antiviral agents.
Antifungal agents.
Lithotripsy: a procedure used to fragment urinary calculi and facilitate their elimination. It may be performed in two ways:

Extracorporeal lithotripsy: shock waves are used.
Intracorporeal lithotripsy: a catheter with a laser tip is inserted through the urethra until the calculus is reached.