Burning or pain during urination may be felt at the opening of the urethra or, less often, over the bladder (in the pelvis, the lower part of the abdomen just above the pubic bone). Burning or pain during urination is an extremely common symptom in women, but it can affect men and can occur at any age.
(See also Overview of Urinary Tract Symptoms.)
Causes of Pain or Burning With Urination
Burning or pain during urination is typically caused by inflammation of the urethra or bladder. In women, inflammation in the vagina or in the region around the vaginal opening (called vulvovaginitis
Common causes
Overall, the most common causes of burning or pain during urination are
Bladder infection (cystitis)
Infection of the urethra (urethritis) due to a sexually transmitted infection (STI)
Evaluation of Pain or Burning With Urination
Not every person who has pain or burning during urination needs to see a doctor right away. The following information can help people decide how quickly a doctor's evaluation is needed and help them know what to expect during the evaluation.
Warning signs
In people who have pain or burning during urination, certain symptoms and characteristics are cause for concern. They include
Fever
Pain in the back or side (flank pain)
Nausea and vomiting
A recent history of insertion of a bladder catheter or other instrument
Immune system disorders
Repeat episodes (including frequent childhood infections)
A known urinary tract abnormality
When to see a doctor
People with immune system disorders and pregnant women with warning signs should see a doctor that day (or in the morning if symptoms develop overnight) because complications of a urinary tract infection can be serious in such people. Other people with warning signs should see a doctor in 1 or 2 days, as should those whose symptoms are particularly bothersome. For people without warning signs who have mild symptoms, a delay of 2 or 3 days is not harmful.
Women with frequent bladder infections may recognize characteristic symptoms that suggest another episode.
What the doctor does
Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What they find during the history and physical examination often suggests a cause of the burning or pain during urination and the tests that may need to be done (see table Some Causes and Features of Painful Urination).
Doctors may ask whether similar symptoms have occurred in the past. Doctors ask about symptoms that may accompany the pain and provide clues to the cause. For example, doctors may ask whether
The urine is bloody, cloudy, or foul smelling
Any discharge is noticed
There has been any recent unprotected intercourse
Potential irritants have been applied to the genitals
A bladder catheter has recently been inserted or another urinary tract procedure has been done
Women are asked whether they might be pregnant.
In women, the physical examination usually includes a pelvic examination and the taking of samples of cervical and vaginal fluid to check for STIs. In men, the penis is examined for presence of a discharge, and doctors do a digital rectal examination to examine the prostate.
Doctors can sometimes get clues to the cause based on where symptoms are most severe. For example, if symptoms are most severe just above the pubic bone, a bladder infection may be the cause. If symptoms are most severe at the opening of the urethra, urethritis may be the cause. In men with a penile discharge, urethritis is often the cause. If burning affects mainly the vagina and the woman has a discharge, vaginitis may be the cause. Cervical discharge suggests cervicitis.
Doctors may also review the person's dietary history to check for food or drink that may cause symptoms.
Some Causes and Features of Painful Urination
Cause | Common Features* | Tests |
|---|---|---|
Infections† | ||
Cystitis (bladder infection) | Usually in women and girls A frequent and urgent need to urinate Getting up at night to urinate Sometimes blood in the urine or foul-smelling urine | A doctor's examination Usually urinalysis and urine culture |
Epididymo-orchitis (infection of an epididymis and a testis) | Tenderness and swelling in a testis Possibly frequent urination or a discharge from the urethra Sometimes fever or nausea | A doctor's examination Sometimes urinalysis Sometimes STI testing |
Prostatitis (infection of the prostate) | A tender prostate detected during a digital rectal examination Often fever, difficulty starting urination, frequent urination, the need to urinate during the night, and burning or pain during urination Sometimes blood in the urine Often symptoms of a long-standing blockage in the urinary tract (including a weak urine stream, difficulty passing urine, or dribbling at the end of urination) | Urinalysis and urine culture |
Urethritis (infection of the urethra), typically due to an STI | Usually a visible discharge from the urethra in men Sometimes a discharge from the vagina in women In people who have recently had unprotected intercourse | STI testing |
Vulvovaginitis (infection of the vulva and vagina) | A discharge from the vagina Often redness in the genital area | A doctor's examination, including examination of a sample of the discharge under a microscope |
Cervicitis (infection of the cervix) | Often a cervical discharge History of unprotected intercourse | STI testing |
Disorders that cause inflammation | ||
Connective tissue disorders that cause inflammation (such as reactive arthritis or Behçet syndrome)‡ | General or bodywide symptoms (including body pain and joint pain) that develop before urination becomes painful Sometimes sores on the skin, mouth, eyes, or genital area, including inside the vagina | STI testing Sometimes blood tests to check for these connective tissue disorders |
Contact with a substance that irritates the area or causes an allergic reaction (such as a spermicide, lubricant, or latex condom) | Sometimes redness in the genital area In people who have been exposed to a substance that could cause irritation or an allergic reaction | Only a doctor's examination |
Interstitial cystitis (inflammation of the bladder without infection) | More common among women A frequent and urgent need to urinate Long-standing symptoms | Urinalysis and urine culture Examination of the interior of the bladder using a flexible viewing tube inserted through the urethra (cystoscopy), usually including removal of a sample of tissue for examination (biopsy of the bladder) |
Other disorders | ||
Atrophic vaginitis or urethritis (thinning of tissues in the vagina or urethra) | In postmenopausal women Vaginal dryness Often pain during intercourse A discharge from the vagina Changes in the interior of the vagina (it becomes smooth and pale) | Only a doctor's examination |
Tumors (usually bladder, prostate, or urethral cancer) | Long-standing symptoms, such as a weak urine stream or difficulty starting urination Usually blood in the urine | If bladder cancer is suspected, cystoscopy If prostate cancer is suspected, a blood test to measure PSA levels If the PSA level is elevated, biopsy of the prostate |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Infectious organisms that commonly cause painful urination include sexually transmitted organisms (such as those that cause gonorrhea, chlamydial infection, and trichomoniasis) and bacteria that are not sexually transmitted, mostly Escherichia (E.) coli. | ||
‡ This cause is rare. | ||
PSA = prostate-specific antigen; STI = sexually transmitted infection. | ||
Testing
Doctors do not always agree on the need for tests for certain adult women who have symptoms that suggest a bladder infection. Some doctors do urine tests, whereas others treat without doing any testing. All doctors do tests when the diagnosis is unclear. The first test is usually urinalysis. In many cases, doctors also do a urine culture to identify organisms causing infection and determine which antibiotics would be effective.
For women of childbearing age who are not known to be pregnant, a pregnancy test is done. Testing for STIs is often done, for example, for men who have a discharge from the penis and for many women who have a vaginal discharge.
Cystoscopy and imaging of the urinary tract may be needed to check for anatomic abnormalities or other problems, especially if antibiotics have not been effective. People who are male, older, or pregnant may need closer attention and a more thorough investigation.
Treatment of Pain or Burning With Urination
Key Points
Although bladder infections are a common cause, many other disorders may cause painful urination.
Burning or pain during urination may be a sign of a sexually transmitted infection (STI).
Doctors may decide to treat women with an antibiotic and see whether symptoms resolve rather than do testing.
