Painful urination indicates pathological processes in the bladder or urethra. Pain and pain are accompanied by inflammatory pathologies (urethritis, cystitis), STDs, urolithiasis, tumors, and injuries to the genitourinary organs, and foreign bodies. Pain may occur before micturition, during urination, or after urination. The urological examination includes urinalysis, endoscopic (ureteroscopy, cystoscopy), and X-ray diagnostics (cystography, urethrography, CT). Treatment is aimed at eliminating the cause of painful urination (antibiotic therapy, FTL - for infections, surgery - for KSD, neoplasms, injuries).
General characteristics
Painful urination - pain, cramps, severe discomfort, or burning sensation associated with the micturition process. They may appear before the start or in the first phase of urination, persist throughout the entire period of urine separation, disturb at the final stage or after its completion.
As a rule, the symptom is combined with other dysuric disorders: pollakiuria, nocturia, imperative urges. There may be episodes of incontinence, cloudy urine, or micro- or macrohematuria. In some diseases, pathological discharge from the urethra or vagina, a violation of the general condition, an increase in body temperature, and signs of intoxication are observed.
Causes of painful urination
Urological diseases
In the vast majority of cases, pain during micturition is provoked by pathologies of the urinary tract. The cause is more often the defeat of the lower sections, and less often the symptom is observed in diseases of the kidneys.
- Urethritis. They are found mainly in men, due to the significant length of the urethra. Nonspecific inflammation is provoked by conditionally pathogenic flora, develops against the background of hypothermia, after accidental sexual contacts, medical procedures. Secondary urethritis is observed with the spread of microbes from neighboring organs, characterized by a smoothing of symptoms.
- cystitis. They are the leading urological cause of disorders in women. Often develop during pregnancy and menopause. Along with the usual acute and chronic process, patients sometimes experience postcoital cystitis. In men, the disease is rarely diagnosed, it becomes a consequence of other pathologies of the urogenital area. Non-infectious variants are especially distinguished - radiation and interstitial cystitis.
- Urine crystallization. Painful missions appear due to the formation of crystals that injure the urethral mucosa. They are observed with salt diathesis, which can be primary or secondary (for example, with gout), sand in the kidneys, and urolithiasis. Along with dysuric disorders, hematuria, and renal colic are possible.
- Foreign bodies and trauma. Traumatic injuries are observed in representatives of both sexes, more often occur with intense impact, and can be combined with pelvic fractures. Painful urination is typical of an incomplete rupture of the urethra. The cause of foreign bodies in the urethra, as a rule, is sexual experimentation (more often in men) or curiosity (in young children, and people with mental illness).
- Volumetric formations. Paraurethral cysts form only in women. Polyps, benign neoplasias, and urethral cancer can be diagnosed in people of either sex. For cysts and benign tumors, a slow progression of symptoms is typical, a rather favorable course. In cancer, changes rapidly increase, and complications arise due to local spread and metastasis of the neoplasm.
Venereal diseases
In men, infection with STI pathogens is accompanied by the development of specific urethritis. In women, inflammation of the urethra is complemented by signs of acute vaginitis. In both cases, a chronic process is possible, the spread of infection to neighboring organs. Painful urination worries patients with the following pathologies:
- Gonorrhea. The incubation period is 5-10 days. The discharge is thick, copious, and creamy.
- Trichomoniasis. Manifests 5-14 days after infection. Discharge is mucopurulent, yellowish, or greenish.
- Chlamydia. Debuts, on average, after 3 weeks. Symptoms are mild or moderate, and Reiter's syndrome may develop.
- Ureaplasmosis. The first manifestations occur after 3 or more weeks. In women, the course is often asymptomatic, in men, along with pathological secretions, there is pain during sexual intercourse.
- Mycoplasmosis. The duration of the incubation period varies from 2 weeks to 2 months. Manifestations are often mild.
Along with the listed diseases, in men, the cause of pain during micturition can be candidal urethritis, which occurs as a result of infection with fungi upon contact with a sick partner.
Painful urination
Andrological diseases
Most often, painful micturitions are potentiated by diseases of the prostate gland. The symptom is combined with a weakening of the jet, and strangury. With progression, acute retention and incontinence are possible. The symptom is observed with prostatitis, sclerosis, and prostate cancer. In addition, pain during urination is sometimes observed with balanoposthitis, especially with acute catarrhal inflammation.
Gynecological pathologies
In women of the older age group, incontinence during menopause can become a triggering factor for painful urination. In the initial stages, pollakiuria, pain, and burning in the urethra during micturition are detected. Subsequently, increasing incontinence is added to the listed symptoms. Incontinence combined with soreness is also characteristic of total female hypospadias, but in this case, the symptoms are present from birth. In some women, pain during urination appears against the background of acute vaginitis.
Diagnostics
Diagnostic measures are usually carried out by a urologist. Patients with diseases of the reproductive system are referred to a gynecologist. At the initial stage of the examination, the specialist establishes the moment of occurrence of urination disorders, the nature of unpleasant sensations (burning, cramps, etc.), and their relationship to a particular period of micturition (at the beginning, at the end, throughout), the dynamics of development over time.
During an external examination, the doctor reveals anatomical defects, signs indicating the presence of inflammation, and other changes. The additional examination plan includes procedures such as:
- Gynecological examination. Essential for all women with painful urination. Allows you to assess the condition of the vulva, vagina, and cervix, detect signs of pathological changes or exclude gynecological diseases.
- Ultrasonography. Informative for urethritis, cystitis, trauma, foreign objects in the urethra, urolithiasis, and prostate pathologies. Most often, an ultrasound of the urethra and bladder is performed. Women may be shown an ultrasound of the pelvic organs, and men - an ultrasound of the prostate. If nephrolithiasis is suspected, an ultrasound of the kidneys is recommended.
- Beam methods. In case of traumatic injuries to the urethra, retrograde urethrography is performed. Plain films and excretory urography are prescribed for patients with suspected KSD. The most informative study for urolithiasis is CT of the kidneys. In some chronic cystitis, cystography is performed to clarify the nature of the inflammation.
- Endoscopic techniques. With foreign bodies, stones, and traumatic injuries to the urethra, ureteroscopy is performed. Patients with recurrent cystitis in remission are prescribed cystoscopy to assess morphological changes and obtain biopsy material. With renal colic, chromocystoscopy is indicative. Patients with hypospadias undergo video colposcopy.
- Laboratory tests. If sexual infections are suspected, PCR, ELISA, microscopy, or microbiological examination are performed. The presence of nonspecific inflammation is evidenced by leukocyturia, bacteriuria, erythrocyturia, and proteinuria according to OAM. Patients with prostate pathologies require a PSA test. The histological or cytological analysis is necessary to establish the morphological features and level of differentiation of tumors.
Urological diagnostics
Treatment
Conservative therapy
Therapeutic tactics are determined by the etiology of a painful urination. In most cases, drug therapy is indicated, sometimes non-drug methods are useful. The list of therapeutic measures may include:
- Antimicrobial agents. Nonspecific cystitis and urethritis are treated with antibiotics. For specific infections, an antifungal, antitrichomonas, or antibacterial drug is selected, taking into account the type of pathogen.
- Other medicines. The most commonly used NSAIDs and eurosceptics. In some diseases, the appointment of antispasmodics, analgesics, sedatives, immunocorrectors, and drugs with a hemostatic effect is required. With renal colic, the lumbar zone is irrigated with chloroethyl, blockades are performed with local anesthetics.
- local therapy. In some cases, intravesical installations are recommended. Physiotherapeutic methods include ultrasound, electropuncture, thermal procedures, acupuncture, via dynamic therapy, and electrical stimulation. Patients with incontinence are shown physiotherapy exercises, sometimes special pessaries are required.
Surgery
In diseases accompanied by painful urination, the following operations are performed:
- ICD: contact and remote crushing of stones in the kidneys, ureter, or bladder, open interventions to remove stones from different parts of the urinary system.
- Injuries, foreign objects: suturing of the urethra, plastic surgery to restore the urethra, removal of a foreign body using endoscopic equipment or traditional access.
- Prostate diseases: TUR, prostate brachytherapy, radical prostatectomy, bilateral orchiectomy in patients with hormone-dependent tumors.
- Women's diseases: sling techniques, pelvic floor reconstruction, plastic surgery of the vagina and lower urinary tract.