Painful urination indicates pathological processes in the bladder or urethra. Pains and cuts are accompanied by inflammatory pathologies (urethritis, cystitis), STDs, urolithiasis, tumors and injuries of the genitourinary organs, foreign bodies. Pain may occur before the start of the injection, during urination or after it ends. Urological examination includes urine tests, endoscopic (urethroscopy, cystoscopy), X-ray diagnostics (cystography, urethrography, CT). Treatment is aimed at eliminating the cause of painful urination (antibiotic therapy – for infections, surgery – for UTS, neoplasms, injuries).
General characteristics
Painful urination – pain, pain, severe discomfort or burning associated with the process of miction. They may appear before 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. Episodes of incontinence, turbidity of urine, micro- or macrohematuria are possible. In some diseases, pathological discharge from the urethra or vagina, a violation of the general condition, an increase in body temperature, signs of intoxication are observed.
Causes of painful urination
Urological diseases
In the vast majority of cases, painful sensations during the injection are provoked by pathologies of the urinary tract. The cause is more often the lesion of the lower parts, less often the symptom is observed in kidney diseases.
- Urethritis. They are found mainly in men, due to the considerable length of the urethra. Nonspecific inflammation is provoked by conditionally pathogenic flora, develops against the background of hypothermia, after accidental sexual intercourse, medical procedures. Secondary urethritis is observed during the spread of microbes from neighboring organs, characterized by smoothness of symptoms.
- Cystitis. They are the leading urological cause of the disorder in women. They often develop during pregnancy and during menopause. Along with the usual acute and chronic process, postcoital cystitis is sometimes observed in patients. In men, the disease is rarely diagnosed, it becomes a consequence of other pathologies of the genitourinary sphere. Non-infectious variants are particularly distinguished – radiation and interstitial cystitis.
- Crystallization of urine. Painful infections occur 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, renal colic are possible.
- Foreign bodies and injuries. Traumatic injuries are observed in representatives of both sexes, more often occur with intense exposure, can be combined with pelvic fractures. Painful urination is typical for incomplete rupture of the urethra. The cause of foreign bodies of the urethra, as a rule, are sexual experiments (more often in men) or curiosity (in young children, people with mental illnesses).
- Volumetric formations. Paraurethral cysts form only in women. Polyps, benign neoplasia and urethral cancer can be diagnosed in people of any gender. For cysts and benign tumors, a slow progression of symptoms is typical, a fairly favorable course. In cancer, changes increase rapidly, complications arise due to the 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, the chronization of the process, the spread of infection to neighboring organs are possible. Painful urination worries patients with the following pathologies:
- Gonorrhea. The incubation period is 5-10 days. The discharge is thick, abundant, creamy.
- Trichomoniasis. Manifests 5-14 days after infection. The discharge is mucopurulent, yellowish or greenish.
- Chlamydia. Debuts, on average, after 3 weeks. The symptoms are minor or moderate, the development of Reiter’s syndrome is possible.
- Ureaplasmosis. The first manifestations occur after 3 or more weeks. In women, it often proceeds with little symptoms, in men, along with pathological secretions, soreness is noted during sexual contacts.
- Mycoplasmosis. The duration of the incubation period varies from 2 weeks to 2 months. Manifestations are more often non-intensive.
Along with the listed diseases, in men, candidiasis urethritis, which occurs as a result of infection with fungi in contact with a sick partner, can become the cause of painful sensations during mycosis.
Andrological diseases
Most often, painful infections are potentiated by prostate diseases. The symptom is combined with a weakening of the jet, stranguria. With progression, acute delay and incontinence are possible. The sign is noted in 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 trigger factor for painful urination. At the initial stages, pollakiuria, pain, burning in the urethra during miction 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. Some women have pain when urinating 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 determines the moment of occurrence of urination disorders, the nature of unpleasant sensations (burning, pain, etc.), their relationship to a particular period of infection (at the beginning, at the end, throughout), the dynamics of development over time.
During an external examination, the doctor identifies anatomical defects, signs indicating the presence of inflammation, and other changes. The additional examination plan includes such procedures as:
- Gynecological examination. It is necessary 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. It is informative for urethritis, cystitis, injuries, foreign objects in the urethra, urolithiasis, prostate pathologies. Ultrasound of the urethra and bladder is most often performed. Women can be shown ultrasound of the pelvic organs, men – ultrasound of the prostate. If nephrolithiasis is suspected, ultrasound of the kidneys is recommended.
- Radiation methods. In case of traumatic injuries of the urethra, retrograde urethrography is performed. Patients with suspected UTS are prescribed survey images and excretory urography. The most informative study in urolithiasis is considered to be a CT scan of the kidneys. In some chronic cystitis, cystography is performed to clarify the nature of inflammation.
- Endoscopic techniques. In case of foreign bodies, concretions and traumatic injuries of the urethra, urethroscopy 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 a video colposcopy.
- Laboratory tests. If sexual infections are suspected, PCR, ELISA, microscopy or microbiological examination are performed. The presence of nonspecific inflammation is indicated by leukocyturia, bacteriuria, erythrocyturia and proteinuria according to BT. Patients with prostate pathologies require the determination of PSA. Histological or cytological analysis is necessary to establish morphological features and the level of differentiation of tumors.
Treatment
Conservative therapy
Therapeutic tactics are determined by the etiology of 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, anti-trichomonas or antibacterial drug is selected, taking into account the type of pathogen.
- Other medications. NSAIDs and uroseptics are most often used. In some diseases, the appointment of antispasmodics, analgesics, sedatives, immunocorrectors, drugs with hemostatic action is required. With renal colic, the lumbar zone is irrigated with chloroethyl, blockades are performed with local anesthetics.
- Local therapy. In some cases, intravesical instillations are recommended. Physiotherapeutic methods include ultrasound, electropuncture, thermal procedures, acupuncture, diadinamotherapy, electrical stimulation. Patients with incontinence are shown physical therapy classes, sometimes special pessaries are required.
Surgical treatment
In diseases accompanied by painful urination, the following operations are performed:
- UTS: contact and remote crushing of kidney stones, ureter or bladder, open interventions to remove concretions 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: 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.
