Painful Urination

Pain on urination is a fairly common problem. It usually results from an infection somewhere in the urinary tract. 

Causes

Common causes of painful urination are- 

  • Urinary tract infection (UTI) (commonest cause) 
  • Urethritis caused by gonorrhea or chlamydia (through sexual intercourse) 
  • Prostatitis (especially in recurrent infections)
  • Interstitial cystitis   
  • Contact dermatitis (extremely rare in these organs) 
With previous bladder or kidney infections, a more detailed history and physical are needed, and extra laboratory studies may be necessary. If urinary infections become recurrent, then the doctor needs to investigate for problems like urinary tract obstruction, urethral stricture, prostatitis and prostatic enlargement.

A urinalysis commonly reveals white blood cells (WBC) and/or red blood cells (RBC). Testing may start with an office urine dipstick. Based on those results, a urine culture may be ordered.
A urine culture (clean catch) or catheterized urine specimen may reveal bacteria in the urine. A urine culture that is positive for more than 2 weeks even with treatment indicates chronic or recurrent UTI. 
An abdominal ultrasound or KUB (abdominal X-ray) may be needed to evaluate the status of the renal system (kidneys, ureters, and bladder).

Treatment

An antibiotic is prescribed for urinary tract infection. Normally bactrim works well, but sometimes ciprofloxacin is required if the bacteria are resistant to bactrim. E.coli is the bacteria responsible for most episodes of UTIs, but sometimes bugs like chlamydia or mycoplasma may be the culprits. Many times they are contracted through sexual intercourse. They typically require longer treatment with antibiotics such as doxycycline.

Phenazopyridine hydrochloride (pyridium) may be used to reduce the burning and urgency associated with cystitis. Pain medications may also be added. In addition, acidifying medications, such a ascorbic acid may be recommended to decrease the concentration of bacteria in the urine. Increasing the intake of fluids may allow urination to flush out the bacteria from the bladder. It is best to avoid coffee, alcohol, and spicy foods.