Burning Urine – Sensation During, After Urination (Men, Women)
What is Dysuria?
Dysuria is the term for painful urination and can vary from mild discomfort to a burning sensation or severe pain when urinating. The pain may be felt in the bladder or urethra during urination or could extend across the entire perineum. It is not uncommon for the pain to persist throughout the day and exacerbate upon urination. Dysuria often results in hesitancy as a person is anxious to commence with voiding due to the prospect of pain upon urination.
Usually it is not the change in chemical composition of urine that causes the burning sensation. The already inflamed lining of the urinary tract are further irritated by the passage of urine during urination. Contraction of the muscular linings of the lower urinary organs further contributes to the pain and discomfort. The burning sensation may continues after urination as the inflammation persists for minutes or even hours afterwards.
Causes of Burning Urination
The pain upon urination is usually due to inflammation of the urethra and/or bladder. In most cases, this is due to infections of the genitourinary system and is commonly accompanied by other symptoms like urging, incontinence, hematuria, cloudy urine and fever. Discharge may also be present and could related to a sexually transmitted diseases (STD’s).
Non-infectious causes of dysuria may be acute or chronic in nature. Apart from inflammatory disorders of the urinary tract, there may be inflammation of surrounding structures in the perineum, including the prostate (men), vagina, cervix or uterus (women) or colon. Pain extending from the upper abdomen may indicate renal (kidney) causes of dysuria which is commonly associated with kidney stones.
Infectious Causes of Dysuria
Bacterial causes are by far the most common infectious cause of dysuria and the infection progresses rapidly. Protozoal and fungal infections also need to be considered but the onset of symptoms due to infection by these microorganisms may be more gradual. Parasitic infections like schistosomiasis (bilharzia) are a common cause of dysuria in endemic areas.
- Cervicitis (cervix)
- Often due to a sexually transmitted disease (STD).
- Cervical discharge may be present.
- Cystitis (bladder)
- Constant dull ache in the perineum, aggravated by bending forward.
- Tenderness over the region of the bladder upon applying pressure.
- Frequent urination and urging along with changes in the urine (blood in the urine, cloudy urine, foamy urine and/or strong smelling urine).
- Epididymo-orchitis (testes, duct)
- Swelling and tenderness of the testes and tubules leading to the vas deferens.
- Hematospermia (blood in the semen) may be evident.
- Pain upon intercourse, ejaculation.
- Prostatitis (prostate gland)
- Prostate enlargement and tenderness.
- Hesitancy, straining and/or dribbling may be present.
- Urging and frequent urination.
- Urethritis (urethra)
- Often related to sexually transmitted infections.
- Offensive smelling discharge and itching of the external genitalia.
- Visible swelling of the penis may be evident in men.
- Dyspareunia (pain upon intercourse) may be more pronounced in men with urethritis.
- Vulvovaginitis (vulva, vagina)
- Offensive smelling vaginal discharge often present.
- Swelling and redness the vulva/labia may be evident.
- Itching of the vulva/vagina.
- Pain upon intercourse may also occur along with slight bleeding after intercourse (post-coital) which is not related to menses.
Non-Infectious Causes of Dysuria
- Allergic reaction to latex condoms, lubricants, spermicides, soap, toilet paper, tampons and sanitary pads.
- Benign prostatic hyperplasia (men).
- Urinary stones.
- Foreign body in the bladder, urethra.
- Interstitial cystitis.
- Atrophic urethritis particularly in post menopausal women.
- Urethral stricture.
- Dehydration resulting in concentrated urine which irritates the urethra.
- Drugs like NSAID’s, gout medication, steroid drugs, chemotherapeutic agents.
- Radiation treatment (radiation cystitis).
- Sexual abuse often accompanied by swelling and pain of the vulva (vulvitis).
- Spondyloarthropathies like reactive arthritis (Reiter’s syndrome), Bechet’s syndome.
- Tumors of the bladder, prostate (men). Rectal cancer, uterine and ovarian cancer should also be considered either due to pressure on the bladder or secondary spread (metastases).
Signs and Symptoms Associated With Burning Urine
The presence of other signs and symptoms that often accompany may provide an indication of the cause. This includes :
- Blood in the urine (hematuria) – urine may appear dark yellow, brown, orange or red depending on the quantity of blood in the urine.
- Urgency to urinate
- Vesical tenesmus – sensation of incomplete emptying of the bladder after passing urine
- Urinary incontinence – involuntary expulsion of urine varying from a few drops to complete emptying of the bladder
- Frequent urination
- Post-micturition dribble – passage of small quantities of urine after urinating
- Difficulty urinating – straining, hesitancy
- Discharge – urethra and vagina (women)
- Urine abnormalities – cloudy urine, foamy urine, strong-smelling urine (sometimes offensive odor)
- Blood in the semen (hematospermia) in men
- Pelvic and lower abdominal pain
Causes of Burning Urine
The causes of burning urine can be broadly divided into infectious and non-infectious causes. There are a number of causes of burning urine but most cases are due to urinary tract infections. Urethritis affects both men and women, but as the infection progresses, it may inflame the bladder (men and women) and/or prostate gland (men).
Infectious Causes of Burning Urine
Most infectious cases of burning during or after urination are due to a bacterial infection. It is often an ascending infection meaning that the microorganisms gains entry via the external meatus, infects and inflames the urethra and the infection progresses up the urinary tract.
Less frequently, the infectious agent reaches the urethra or bladder from higher up the urinary tract (ureters or kidney), neighboring sites (like the rectum) or distant sites in the body. In the latter two cases, the spread is via the direct infiltration, blood stream or lymphatic system.
The common pathogens responsible are discussed under :
While bacteria are the most common causes, at times viruses, protozoa and even fungi may be the cause of the infection. Parasites like schistosomes (schistosomiasis) may also cause burning during and after urination but are more commonly seen in endemic areas.
An offensive smelling discharge or urine with an infection and swollen groin lymph nodes are usually indicative of an infection. Infection of surrounding structures in the pelvis/perineum may also cause burning during and after urination although the urinary tract itself is not involved.
- Urethritis (urethra)
- Inflammation of the urethra often related to sexually transmitted infections – gonorrhea, chlamydia, syphilis and genital herpes
- Offensive smelling discharge and itching of the external genitalia.
- Swelling of the penis, particularly the tip.
- Pain during intercourse (men, women) or ejaculation (men).
- Cystitis (bladder)
- Constant dull ache/pain in the pelvis/perineum, sometimes just below the umbilicus (belly button) when the bladder is full, and may radiate to the flanks or back.
- Frequent urination, urging and sometimes incontinence.
- Fever is more frequently seen with cystitis than urethritis.
- Prostatitis (prostate gland)
- Difficulty passing urine – hesitancy, straining and/or dribbling
- Urgency to urinate
- Frequent urination
Other infectious conditions that lead to burning urine :
- Vulvovaginitis (vulva and/or vagina in women)
- Cervicitis (cervix in women)
- Epididymo-orchitis (testes, epididymis in men)
Non-Infectious Causes of Burning Urine
- Trauma
- Post-operative (pelvic surgery)
- Circumcision
- Urethral catheter
- Vigorous sexual activity
- Foreign body
- Chemical irritation and allergies
- Latex condoms
- Lubricants
- Spermicides
- Soap and bubble baths
- Cologne
- Toilet paper
- Tampons or sanitary pads
- Urethra
- Urethral stricture (narrow urethra)
- Urinary stones
- Atrophic urethritis (post-menopausal women)
- Bladder
- Bladder stones
- Interstitial cystitis
- Radiation cystitis
- Bladder cancer
- Cystocele (fallen bladder in women)
- Prostate Gland
- Benign prostatic hypertrophy (BPH)
- Prostate cancer
- Non-infectious prostatitis
- Medication
- NSAIDs
- Gout medication
- Chemotherapeutic drugs
- Systemic, Autoimmune and Metabolic
- Reactive arthritis (Reiter’s syndrome)
- Behcet’s syndrome
- Dehydration
Last updated on August 22, 2018.
