Dysuria is a urological symptom that expresses conditions such as burning and pain while urinating. It is a condition that affects both men and women. It is seen in children as well as adults. In this article, I will give general information about the “dysuria” symptom (complaint).

What does dysuria mean?

Dysuria means burning, aching, and pain while urinating. Dysuria is not a disease, it is a symptom of more than one disease. Dysuria should not be confused with frequent urination. Most patients with dysuria have frequent urination, but not every patient with frequent urination may have dysuria. It is a more common symptom in women than in men.

In whom is dysuria more common?

Dysuria is a common urological symptom of all genders and ages, including men and women. It is more common in women. The most important reason for this is anatomical factors. Since the urethra in women is shorter than in men, women are more prone to urinary tract infections than men. Therefore, dysuria is more common in females.

People at high risk for dysuria include:

• Pregnant women
• Sexually active women
• People with diabetes (diabetes)
• People with bladder problems
• Elderly male patients with enlarged prostate
• Older women (due to menopause)

What are the causes of dysuria?

Dysuria is seen in all genders, but it is more common in women. Dysuria is more common at certain ages depending on special conditions. Benign prostatic enlargement (BPH) in older men and menopause in women is one of the important causes of dysuria.

The causes of dysuria in women are:

• Bladder infections (cystitis): Since the female urethra is shorter than the male urethra, cystitis is more common in women.
• Vaginal infections: Since the genital system and urinary system are closely adjacent in women, an infection in the female genital system easily affects the urinary system and causes dysuria.
• Urinary tract infections: Urinary tract infections are more common in women due to the short urethra, which manifests itself with dysuria.
• Diverticulitis: Disorders such as endometriosis and diverticulitis may cause dysuria in women.
• Inflammations of the bladder: It is usually the result of urinary tract infection and is often accompanied by dysuria.
• Urethritis: Infections in the urethra cause dysuria.
• Women of sexually active age: Cystitis is common in women who are sexually active and have frequent intercourse, especially young women. This is because the urethra is shorter in women, so the infection can easily pass into the bladder.
• Chemical irritants: Substances used for birth control, spermicides, condoms cause dysuria by causing irritation in the urethra.
• Bladder cancer: The most important symptom of bladder cancer is painless hematuria (blood in the urine). Dysuria is also common in these patients. Especially in bladder disease called carcinoma in situ, the most important symptom (symptom) is dysuria.
• BCG therapy: Dysuria (painful, painful urination) is often seen in patients who are administered BCG into the bladder due to bladder cancer.
• Radiotherapy: If radiotherapy (radiation therapy) is applied in cancers adjacent to the bladder, such as bladder cancer, uterine cancer, bowel cancer, dysuria is frequently seen as a side effect of radiation in these people.
• Bladder stones: Bladder stones cause dysuria by causing irritation in the bladder mucosa.
• Ureteral stones: Especially stones in the part of the ureter inside the bladder (intramural ureter stones) manifest themselves with dysuria.
• Menopause: Since postmenopausal infection is common in women, dysuria is common in women who have entered menopause.
• Diabetes: Diabetes (diabetes mellitus) poses a risk for infection. Infection and therefore dysuria are common in diabetic patients.
• Food and beverages: Dysuria may occur due to the allergic effects of some foods and beverages.
• Endoscopic interventions: Dysuria may occur after endoscopic interventions of the urinary system (stone, cancer, diagnostic purposes).
• Catheter insertion: Catheter insertion into the urethra causes burning (dysuria) in the urethra, continues a little after the catheter is removed and disappears over time.

Causes of dysuria in men include:

• Urinary tract infections: The most important symptom (symptom, patient’s complaint) of kidney, ureter, bladder and urethra infections (urinary tract infection) is dysuria. Depending on the location and severity of the infection, sometimes high fever may also be seen.
• Bladder diverticulum and diverticulitis: If there is a bladder diverticulum and eventually a diverticula infection, dysuria may be seen in these individuals.
• Urethritis: Dysuria is often seen as a result of infection of the urethra
• Sexually transmitted diseases: In sexually transmitted diseases, dysuria, that is, painful urination, is usually seen with urethral discharge.
• Bladder stones: Just like in women, bladder stones cause dysuria in men as well.
• Bladder cancer: Bladder cancer is among the causes of dysuria. Dysuria is more common if the cancer is located in the bladder neck.
• Carcinoma in situ: dysuria is common in this type of bladder cancer.
• Radiotherapy: Radiation cystitis develops as a result of radiation therapy of the bladder and neighboring organs and this causes dysuria.
• Ureteral lower end stones: Stones located in the lower end of the ureter and the ureter in the bladder wall cause dysuria.
• Prostate diseases: Benign prostate enlargement 8BPH), prostate diseases such as prostate cancer cause dysuria if there is an infection.
• Prostatitis: Dysuria is seen in patients with acute and chronic prostatitis. Dysuria is seen in patients with acute and chronic prostatitis.
• Side effects of drugs: Dysuria can be seen as a side effect of drugs taken for cancer or other reasons.
• BCG therapy: Dysuria (painful, painful urine) is often seen in patients receiving BCG for bladder cancer.
• After prostate surgeries: Dysuria can be seen in the early stages after TUR-P, laser (HOLEP) surgeries of the prostate. It gets better day by day.

The most common causes of inflammation and irritation causing dysuria in men and women are:

There are some conditions that can cause dysuria in both men and women. These cause inflammation and irritation, leading to dysuria. We can list these situations as follows:

• Urinary system stones (kidney, ureter, bladder stones)
• Urethral irritation, especially in women, due to frequent intercourse
• Interstitial cystitis (painful bladder syndrome)
• Atrophic changes in the vagina in women in menopause
• Chemical irritants
• Side effects of some drugs and foods
• Cancers of the urinary system (especially bladder cancer)
• Irritation of tight clothing
• Some physical activities (such as horseback riding, cycling)

How is dysuria diagnosed?

Dysuria is not a disease. It is a symptom of many diseases. A systematic approach is required to diagnose the disease that may cause dysuria.

• Anamnesis: A detailed history should be taken from a patient who comes to the urology specialist with the complaint of dysuria. The patient’s lifestyle, medications, and surgeries are questioned.
• Examination: The patient undergoes a detailed genitor-urinary system examination to reveal the cause of dysuria. In older men, prostate examination should be performed for prostate enlargement.
• Laboratory tests: Urine microscopy, if necessary, urine culture is taken from the patients to determine whether there is an infection in the urinary tract. If sexually transmitted diseases are suspected, tests for this are done.
• Blood tests: Appropriate blood tests are taken to reveal a disease that may cause dysuria.
• Radiological diagnostic methods: Urinary and genital system USG, X-ray (x-ray), if necessary, further examinations such as MRI and CT are performed.
• Cystoscopy: Diagnostic cystoscopy is performed to reveal the causes of bladder dysuria. In order to be able to perform cystoscopy, there must be no active urinary tract infection.

The urologist will ask patients who come for dysuria!

The urologist asks some questions that will help in the diagnosis of the patients who come to him with the complaint of burning in the urine (dysuria).

Information such as the onset and frequency of dysuria can be asked to the patient:

• Whether the dysuria starts suddenly or gradually
• Whether it repeats or not
• Whether it is at the beginning or all of the urine
• Complaints that may accompany dysuria
• There may be fever (especially in upper urinary tract infections)
• Urethral discharge (usually urethral discharge is seen if urethritis is present)
• Flank pain (seen in kidney disorders)
• Pain in the lower part of the abdomen (may be in bladder diseases)

There may be problems with urination:

• Urinating drop by drop
• Difficulty starting to urinate
• Thin and bifurcated urination
• Needing to go again after urinating

Changes in the color and odor of urine:

• If there is a urinary tract infection, the urine may be cloudy
• Bloody urine (hematuria)
• Smelly urine

What can be done to prevent dysuria?

The Urologist gives some suggestions to the patients who come with the complaint of dysuria to prevent this complaint from recurring. We provide the following recommendations for our patients who have burning and pain while urinating:

• Increasing fluid intake: Increasing urine output by drinking at least 2-3 liters of water a day can prevent dysuria. This is especially important for people who live in hot areas and lose a lot of fluid through sweat.
• Paying attention to the use of pets: It is important for patients who use pets for different reasons to change these pads frequently and keep them dry.
• Attention should be paid to hygiene: Care should be taken to dry the vaginal lips.
• Avoiding irritants: It is necessary to be protected from irritant chemicals.

How is dysuria treated?

Instead of treating dysuria, the treatment of the disease causing this condition should be based. Because dysuria is not a disease by itself, it appears as a symptom of one or sometimes more than one disease. For this reason, it is essential to diagnose the disease that causes dysuria and to treat it accordingly. We give patients who apply to our clinic with the complaint of painful urination, undergo a general urological examination and give effective treatment accordingly.

The treatment approach in a patient with dysuria should be as follows:

• Urinary tract infection treatment: If there is a urinary tract infection, it is easily detected with a urine test and antibiotic treatment is started for it.
• Treatment of sexually transmitted diseases: Sexually transmitted diseases can be a cause of dysuria in both sexes. Appropriate treatment should be given to these patients.
• Inflammation treatment: If there is inflammation, the factors causing this condition should be eliminated.
• Treatment for the causative disease: The causes of dysuria should be investigated and effective treatment should be applied accordingly. If there are prostate diseases in older men, BPH should be treated as the cause. If the cause is cancer or bladder disease, they should be treated. Urinary system stones are the cause of dysuria. This condition must be investigated and treated. If women have gynecological disorders, treatment should be arranged for them.
• Lifestyle changes: If both sexes have eating habits that may cause dysuria, these should be changed.

In summary; Dysuria is a common symptom in urological diseases. This symptom is not a single disease, but a symptom of more than one disease or factor. The causative agent should be determined in the patient who comes with dysuria and special treatment should be applied for it. In addition, the recurrence of dysuria can be prevented with preventive measures or the quality of life of patients can be improved by reducing its severity.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY