Pain or burning when peeing is a common symptom that both men and women can experience. It’s often the first sign of a urinary tract infection (UTI), especially if accompanied by an urge to urinate frequently. However, several other conditions can also cause pain or discomfort when urinating. Identifying the cause is important to get proper treatment.
What is the urethra?
The urethra is the tube that carries urine from the bladder to outside the body. Both men and women have a urethra, but the structure is different.
In women, the urethra is a short tube, about 1.5 inches long on average, that opens into the vestibule of the vagina. In men, the urethra runs through the prostate gland, penis, and ends at the urethral meatus (the opening at the tip of the penis). The male urethra is 8 to 10 inches long on average.
The main function of the urethra is to transport urine from the bladder and out of the body. When the bladder is full, nerves send signals to the brain triggering the urge to urinate. The brain then sends signals back to relax the muscles around the bladder and simultaneously contract the bladder to squeeze urine out. At the same time, the muscles around the urethra relax allowing the urine to flow out.
What causes pain when urinating?
There are several possible causes for urethral pain or burning during urination, including:
Urinary tract infections (UTIs)
UTIs are the most common cause of painful urination. UTIs occur when bacteria, often from the gastrointestinal tract, enter the urethra and infect the bladder and urethra. The infection causes inflammation and irritation of the lining of the urinary tract.
Women are at greater risk for UTIs than men due to having a shorter urethra. Sexual intercourse increases the risk of UTIs in women because bacteria near the anus can get pushed into the urethra. Using a diaphragm or spermicide as birth control also increases UTI risk.
Other UTI risk factors include:
– Family history
– Kidney stones
– Catheter use
– Suppressed immune system
Typical UTI symptoms include:
– Burning with urination
– Increased frequency and urgency of urination
– Cloudy, bloody, or foul-smelling urine
– Pelvic pain or pressure
– Low grade fever (less than 101 ̊F)
UTIs are easily treated with antibiotics prescribed by a doctor. Symptoms typically improve within a few days of starting antibiotics.
Urethritis refers to inflammation or infection of the urethra. It has similar symptoms as a UTI, including painful urination and abnormal discharge.
Urethritis is commonly caused by sexually transmitted infections (STIs) like chlamydia and gonorrhea. It can also be caused by irritation from soaps, feminine hygiene sprays, or sexual lubricants.
Treatment depends on the cause. Bacterial STIs can be cured with antibiotics. If the cause is irritation, avoiding the source of irritation allows the urethra to heal.
Interstitial cystitis (IC)
Interstitial cystitis (IC) is a chronic bladder condition causing bladder pressure, pelvic pain, and increased urinary frequency and urgency. Pain during urination is also common. The cause is unknown but may involve chronic inflammation of the bladder lining.
IC treatments aim to relieve symptoms and include medications, nerve stimulation, bladder instillations, and dietary changes like avoiding spicy food and alcohol.
Urethral strictures are scars or stiff tissue in the urethra that narrow the urethral opening. This obstruction restricts urine flow, which can cause painful urination, straining, weak stream, and increased frequency.
Strictures can form after injury, surgery, or infection. Enlarged prostate is a common cause in older men. Treatment may include stretching the opening with urethral dilators or surgery.
Kidney stones are hard deposits of minerals that form inside the kidneys. Small stones can pass down through the ureters and urethra unnoticed. However, larger stones can block urine flow and cause severe pain, including painful urination.
Kidney stones often require surgery or other procedures for removal. Pain medications, alpha blockers to relax the ureter muscles, and drinking lots of fluids may help pass a stone more quickly.
Prostatitis means inflammation of the prostate gland. This can be due to bacterial infection or non-bacterial causes. Symptoms include pelvic pain, painful urination, and difficulty emptying the bladder fully.
Antibiotics are used for bacterial prostatitis. Non-bacterial prostatitis may be treated with pain relievers, physical therapy, stress management, and avoiding anything that can irritate the prostate further.
Urethral syndrome involves recurring UTI-like symptoms without evidence of an actual infection. The cause is unknown but may relate to muscle spasms or inflammation in the urethra.
Symptoms flare up and subside unpredictably. Like IC, treatments focus on relieving symptoms since there is no identified infection to cure. This may include urinating after sex, cotton underwear, and avoiding potential irritants.
When to see a doctor
It’s important to see a doctor if you experience any persistent urethral pain or burning with urination. While UTIs are the most common cause, the wide range of possible conditions means an accurate diagnosis is essential.
See a doctor right away if you have these red flag symptoms:
– Fever over 101 ̊F
– Inability to urinate at all
– Blood in the urine
– Lower back pain
– Nausea and vomiting
Prompt evaluation and treatment can greatly reduce the risk of the infection spreading to the kidneys (pyelonephritis) and causing permanent damage.
Schedule an appointment with your doctor if you have any degree of burning urination that lasts more than a day or two, especially if accompanied by increased frequency and urgency to urinate. While waiting for your appointment, take these self-care steps:
– Drink plenty of water and urinate when you feel the need to. Avoid holding it.
– Take over-the-counter pain medication like acetaminophen or ibuprofen for discomfort.
– Avoid sexual intercourse which could introduce additional bacteria.
– Wipe front to back gently after using the toilet.
– Consider urinating in the shower or tub to avoid stinging.
When to go to the emergency room
Seek emergency care if you have severe pain, inability to urinate, very bloody urine, or other concerning symptoms along with painful urination. This could indicate a serious infection or obstruction requiring urgent treatment.
Go to the ER or call 911 if you experience:
– High fever over 103°F
– Shaking and chills
– Signs of dehydration from reduced urination like dizziness, dry lips and mouth, fainting, or rapid heart rate
– Severe flank pain that radiates to the groin
– Nausea and repeated vomiting preventing you from keeping liquids down
What are the exams and tests for painful urination?
The evaluation for painful urination may include:
Medical history: Your doctor will ask about your symptoms, any past urinary conditions, recent sexual activity, and lifestyle factors that could increase your risk of infection.
Urinalysis: A urine sample is checked under a microscope and tested for signs of blood, bacteria, and other abnormalities. This is typically the first test done.
Urine culture: A urine sample is allowed to incubate in the lab to test for growth of bacteria. This can identify the type of bacteria causing an infection.
Cystoscopy: A cystoscope (thin tube with a camera) is inserted in the urethra to view the inside of the urethra and bladder. This helps identify inflammation, obstructions, and bladder cancer.
Imaging tests: An ultrasound, CT scan, or MRI may be used to get images of the urinary tract if obstruction or other structural problems are suspected.
Urodynamics: These are specialized tests to evaluate bladder function and pressure during urination and filling. It can assess nerve control and muscle function of the bladder.
STI tests: Blood tests and urine tests check for sexually transmitted infections like chlamydia and gonorrhea if urethritis is suspected.
How is painful urination treated?
Treatment depends on the underlying cause of the symptoms:
Antibiotics, usually taken for 3-7 days, are used to clear bacterial infections. Symptoms should start improving within a few days of starting antibiotics. It’s important to finish the entire course prescribed.
Bacterial STIs are treated with appropriate antibiotics to both cure the infection and prevent transmission to others. Any sexual partners should also be notified and treated.
Since there is no cure for interstitial cystitis, treatments focus on managing symptoms. Common options include avoiding bladder irritants, NSAID pain relievers, urinary antiseptics, nerve stimulation, and medications to reduce bladder inflammation.
Narrowed urethral openings are treated by urethral dilation to stretch the scar tissue. Short strictures can be incised through endoscopic surgery. Reconstruction surgery may be needed for longer strictures.
Pain management is important while passing a stone. Some stones require surgical removal or breaking up the stone with ultrasound shock waves (lithotripsy). Drinking more fluids may help prevent recurrence.
Antibiotics for 4-6 weeks are used for bacterial prostatitis. Non-infectious types are treated with anti-inflammatories, sitting in warm baths, muscle relaxants, and stress reduction.
What are home remedies to soothe urethral pain and burning?
While waiting to see a doctor and get an accurate diagnosis, you can try these self-care tips at home to soothe urethral irritation:
– Drink plenty of water and herbal teas like chamomile to flush out bacteria and irritants.
– Avoid coffee, alcohol, acidic drinks, and spicy food which can sting.
– Take over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil).
– Apply a warm compress to the urethral opening to reduce discomfort.
– Consider urinating in a warm bath, especially for women, to prevent burning.
– Wipe gently and avoid scented toilet paper or wipes, which contain chemicals irritating to the urethra.
– Take warm baths to provide general relief for the pelvic region.
– Wear loose, breathable cotton underwear and avoid tight clothing around the groin area.
– Avoid sexual activity while symptoms are active to prevent more irritation and bacteria spreading.
– Try stress-reduction techniques like meditation, yoga, or deep breathing if your pain seems worsened by stress.
– Apply aloe vera gel externally for its soothing properties.
While these remedies may temporarily calm symptoms, seeking proper medical treatment is still important to identify and properly treat the underlying cause.
How can I prevent urethral irritation and infections?
Some key prevention tips include:
– Urinate as soon as you feel the urge and empty the bladder fully to avoid bacteria growing in residual urine.
– Wipe front-to-back after using the toilet to avoid spreading fecal bacteria toward the urethra.
– Stay well-hydrated to produce more urine, which helps flush out bacteria.
– Consider urinating shortly after intercourse to flush out any bacteria that may have entered.
– Avoid potentially irritating soaps, douches, creams, lubricants near the urethral opening.
– Take showers instead of baths, which can expose the urethra to more bacteria.
– Wear breathable cotton underwear and avoid overly tight clothing.
– Practice safe sex by using condoms to prevent STIs that could cause urethritis.
– Promptly treat any suspected infections and finish the full course of any prescribed antibiotics.
– Manage medical conditions like diabetes that increase infection risk.
– Consider taking D-mannose supplements, cranberry tablets, or probiotics that make urine more acidic to discourage bacterial growth.
When should I consider seeing a urologist?
It’s a good idea to see a urologist if you have:
– Recurrent UTIs with no clear cause
– Painful urination that persists despite antibiotic treatment
– Other urinary symptoms that don’t respond to initial treatments
– Blood in the urine
– Difficulty fully emptying the bladder
– Other structural problems suspected like strictures or stones
– Possible neurological problems affecting bladder function
– Symptoms in men, who are less prone to UTIs, indicating a potentially different cause
A urologist specializes in treating conditions involving the urinary tract and genitals. They can perform specialized tests like cystoscopy to thoroughly evaluate the urethra and bladder. Based on the results, they may provide treatments like surgery for urethral strictures or kidney stones that general doctors do not perform.
Getting a urological perspective is wise before symptoms become chronic or start severely interfering with your quality of life.
Pain or burning during urination is extremely common but rarely life-threatening on its own. While uncomfortable, try not to panic. There are many potential causes, and various effective treatments are available once the underlying problem is identified through proper medical diagnosis. While waiting to be evaluated, home remedies can provide some symptom relief. Being aware of prevention strategies can also help reduce your risk of developing urinary problems in the first place. Reach out to your doctor or urologist if symptoms are severe or do not resolve within a few days with self-care. With the right treatment plan, most causes of painful urination can be cured or well managed so symptoms no longer interfere with daily life.