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Updated 11 February 2013

Dysuria

Dysuria is a symptom: an unpleasant burning, tingling or painful sensation of the perineum or urethra felt during or just after passing urine.

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Definition and description
Dysuria is a symptom: an unpleasant burning, tingling or painful sensation of the perineum or urethra felt during or just after passing urine. It is a common complaint, especially amongst women, and is often accompanied by frequency (the need to empty the bladder abnormally often) and heamaturia (obvious or apparent blood in the urine).

Causes and associated problems
Two main categories are implicated in dysuria:

  • 1. Inflammation/infection of the urethra or bladder base (trigone) – this applies to men and women

  • 2. In women, vaginal and labial inflammation can cause pain on contact with the urinary stream.

The commonest causes of dysuria are:

  • Urinary tract infection – urethritis and cystitis in women, and urethritis (gonorrhoea, Chlamydia) and prostatitis in men;

  • Vaginitis, including candidiasis;

  • Urinary retention; or

  • Sexually transmitted conditions such as gonorrhoea.

Some conditions predispose to the development of urinary tract infections and dysuria, such as:

  • Diabetes;

  • Anatomical problems, for example duplex ureter; and
  • Neurological problems, such as paraplegia.

Diagnosis
The diagnosis of dysuria is made on the history, describing the symptoms. In small children, the mother may report a change in the number of nappies used daily, excess irritability of the child, fever, a different smell to the child’s urine, diarrhoea or constipation.

The underlying cause must be found and treated. The first step is to test a “clean catch” sample of urine (not always possible in a baby) for dipstick testing in the rooms. This test detects the presence of pus, blood and nitrates in the urine, all of which indicate an infection. In complicated or recurrent cases, or those associated with, for instance, diabetes, culture of the urine is advised to identify the specific organism and its antibiotic sensitivity. In suspected sexually transmitted diseases like gonorrhoea, a smear may be taken of the urinary opening for cytology, culture and sensitivity.

Cytology mat be needed if there is a suspicion of malignancy.

If examination reveals any associated conditions, such as diabetes or neurological problems, appropriate blood tests and/or scans will need to be done. Once identified, these predisposing causes must also be treated to avoid developing recurrent or complicated cystitis. Pregnancy and diabetes have a high risk for dysuria due to infection, and patients with these conditions need thorough investigation.

Treatment
Treatment is aimed at relieving symptoms, as well as treating the underlying cause.

  • Urinary analgesics and alkalinisers are useful for providing immediate relief until the definitive treatment takes effect.

  • The patient is encouraged to keep up a good fluid intake to increase urine output and “flush away” bacteria and debris.

  • Antibiotics are used where urinalysis shows evidence of infection. The choice of antibiotic will be guided by the patient’s individual profile (is she diabetic, for instance, or is she pregnant?)

  • Predisposing factors such as poor glucose control in diabetics, or overuse of vaginal spermicides must be corrected.

Outcome
With swift and correct management, the outcome is good, and complications like pyelonephritis can be avoided.

Attending to predisposing factors will avoid recurrent dysuria and cystitis developing.

(Dr AG Hall)

 
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