Dr. MJ Bazos MD, Patient Handout
Painful Urination

Why does it sometimes hurt when I urinate?

Painful urination can be caused by several things. A common cause is a urinary tract infection (sometimes also called a bladder infection). Urination may hurt if your bladder is inflamed. This may occur even if you don't have an infection. Certain drugs, like some used in cancer chemotherapy, may inflame the bladder. Something pressing against the bladder (like an ovarian cyst) or a kidney stone stuck near the entrance to the bladder can also cause painful urination.
Painful urination can have other causes, such as vaginal infection or inflammation. You may feel pain when urine passes over the inflamed tissue. If the urethra is inflamed, you could feel pain as the urine passes through it. (The urethra is the tube that carries urine from your bladder.) You might be sensitive to chemicals in certain products, such as douches, vaginal lubricants, soaps, scented toilet paper, or contraceptive foams or sponges. If it hurts to urinate after you've used these products, you're probably sensitive to them.

What will I need to tell my doctor?

You should tell your doctor if you've had urinary tract infections before (including when you were a child), how many you've had and how they were treated. Tell your doctor about any other medical conditions you have, such as diabetes mellitus or AIDS, because these could affect your body's response to infection. Tell your doctor about any known abnormality in your urinary tract, or if you are or might be pregnant. Tell your doctor if you've had any procedures or surgeries on your urinary tract or if you were recently hospitalized (less than 1 month ago) or stayed in a nursing home.

What type of tests will I need to have done?

Your doctor will usually be able to tell what's causing your pain by your description of the pattern of urination and symptoms, along with a physical exam. Testing your urine (urinalysis) can also help your doctor identify what type of infection you have. Usually, a sample of your urine is taken in your doctor's office and sent to a lab to check for infection.
If your doctor thinks your pain may be from vaginal inflammation, he or she may wipe the lining of your vagina with a swab to collect mucus. The mucus will be looked at under a microscope to see if it has yeast or other organisms. If your pain is from an infection in your urethra, your doctor may swab it to test for bacteria. If an infection can't be found, your doctor may suggest other tests, such as pressure measurements within the bladder or cystoscopy (a way to look at the bladder lining with a very thin tube inserted through the urethra).

How are urinary tract infections treated?

If you are a healthy adult woman (who is not pregnant) or man, 3 days of antibiotic pills will usually cure your urinary tract infection. It's important that you tell your doctor if you have symptoms such as back pain and fever (especially a fever over 101°F, which could mean that the infection has spread into your kidneys). It's also important that you take the antibiotic exactly as your doctor has said, since skipping pills could make the treatment less effective and may allow a kidney infection to develop.
If you are having 3 or more urinary tract infections each year, your doctor may want you to begin a preventive antibiotic program. A small dose of antibiotics taken after you have sexual intercourse may help reduce infections that occur after intercourse. A small dose of an antibiotic taken every day helps to reduce infections not associated with intercourse.

What can I do if I keep getting urinary tract infections?

Some women get these infections over and over again, and they may get some relief from preventive efforts. There are changes you can make in your habits that can help. For example, drinking 12 ounces of cranberry or blueberry juice every day may decrease your chance of getting an infection. If you tend to get urinary tract infections after sexual intercourse, going to the bathroom right after intercourse may lessen your risk.
Frequent urinary tract infections may be caused by changes in the bacteria in the vagina. Antibacterial vaginal douches, spermicides and certain oral antibiotics may cause changes in vaginal bacteria. Avoid using these items, if possible. Menopause can also cause changes in vaginal bacteria that increase your risk for urinary tract infection. Taking estrogen usually corrects this problem, but may not be for everyone. Ask your doctor if estrogen replacement therapy is right for you.