Painful urination

Disease Description (Causes and Symptoms)

Dysuria is a symptom involving discomfort such as pain or a burning sensation during urination. Major causes include

• Lower urinary tract infection (cystitis) — particularly common in women
• Urethritis (including bacterial and sexually transmitted infections: gonorrhea, chlamydia, etc.)
• Prostatitis (in men) and urination problems associated with benign prostatic enlargement
• Bladder stones, bladder cancer, and mechanical irritation of the urinary tract (such as from a catheter)
• Inflammatory diseases of the urinary tract or pelvis (such as vaginitis)
• Bladder dysfunction caused by neurological problems (such as spinal cord injury or multiple sclerosis)

Pathophysiologically, pain occurs due to inflammation or irritation of the urinary tract mucosa. Accompanying symptoms may include urinary frequency, nocturia, urinary urgency, a feeling of incomplete emptying, difficulty urinating (delayed urination or a weak urine stream), and hematuria. If it occurs after sexual intercourse or is accompanied by discharge (urethral discharge), a sexually transmitted cause should be suspected.

Treatment Methods

• Principle: Identify the cause (urinalysis/culture, sexually transmitted infection testing, and, if necessary, imaging or a digital rectal examination, etc.), then treat according to the cause.
• Antibiotic treatment: Since most cases of dysuria are caused by bacterial urinary tract infections or urethritis, antibiotics targeting the causative organism are used.
  • Uncomplicated urinary tract infection (women): Depending on local antibiotic resistance rates, nitrofurantoin, fosfomycin, or TMP‑SMX (when resistance is low) are often recommended.
  • Urethritis (sexually transmitted): If gonorrhea is suspected, ceftriaxone plus treatment for accompanying chlamydia (doxycycline or azithromycin) may be considered.
  • Prostatitis (acute): Long-term treatment over several weeks with an appropriate antibiotic (such as a jolliquinone-class antibiotic) may be necessary.
• Symptomatic treatment: Adequate fluid intake, pain relievers (NSAIDs), maintaining cleanliness after urination, and avoiding irritants (fragrances and cleansers).
• Procedures/surgery: Surgical treatment may be necessary when the cause is a structural problem such as stones, tumors, anatomical abnormalities, or a vesicovaginal or enterovesical fistula.
• Indications for hospitalization: Systemic symptoms caused by high fever or a urinary tract infection, suspected pyelonephritis or sepsis, inability to urinate (urinary retention), etc.
• Lifestyle management precautions: Use condoms during sexual intercourse, urinate after sexual intercourse, maintain personal hygiene, and appropriately manage underlying conditions such as diabetes.

Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)

Items to prepare

• A list of currently used medications (including prescription and nonprescription medications and supplements)
• Copies of previous test results (recent urinalysis, culture and blood test results, imaging findings, etc.), if available
• A record of when the symptoms began and how they have changed (when they started and in which situations they become worse)
• Information about genital symptoms (discharge, bleeding, etc.) and recent sexual activity and contraceptive methods
• A record of accompanying symptoms such as fever, back pain, fatigue, and changes in urine color

Items to ask the doctor in advance (examples of questions to use during the visit)

• Is a urinalysis or urine culture necessary? When will the results be available?
• What medication can I take immediately (by prescription), and what are the expected side effects?
• Do I need to be hospitalized? What symptoms mean that I should go to the emergency room immediately?
• Do I need testing for sexually transmitted infections? What accompanying tests are needed?

Examples of General Questions to Ask the Doctor

• What is the most likely cause of this pain?
• What are the expected side effects of the medication you prescribed, and how long should I take it?
• What lifestyle changes should I make to prevent recurrence?
• If additional tests (such as cultures or imaging) are needed, when will they be performed and what tests will they be?
• If symptoms remain or recur after treatment, which specialist should I see (urology, obstetrics and gynecology, infectious diseases, etc.)?

Examples of Disease-Specific Questions

• For women (in cases of recurrent dysuria): "What additional tests do you recommend to find the cause of recurrent cystitis? Are tests for urinary tract anatomical abnormalities or bladder function necessary?"
• For men (when a prostate-related cause is suspected): "Are a digital rectal examination or prostate-specific tests (such as a prostate tissue biopsy or prostate-specific antigen test) necessary to diagnose prostatitis? How long should antibiotic treatment last?"

Additional Emergency Signs (Immediate Emergency Treatment Required)

• High fever (>38℃) and chills, with flank pain (suspected pyelonephritis)
• Complete inability to urinate (urinary retention)
• Altered consciousness, low blood pressure, or difficulty breathing (suspected sepsis)
• Heavy hematuria or uncontrollable bleeding

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