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 Overview of Urinary Tract Symptoms Kidney and urinary tract disorders can involve one or both kidneys, one or both ureters, the bladder, or the urethra, and in men, the prostate, one or both testes, or the epididymis. Problems... read more .)
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 Vulvitis Vulvitis is inflammation of the vulva. When both the vulva and vagina are inflamed, the disorder is called vulvovaginitis. The vulva is the area surrounding the opening of the vagina and containing... read more ) can be painful when exposed to urine. Inflammation that results in burning or pain is usually caused by infection but sometimes by noninfectious conditions. Sometimes acidic foods (for example, citrus fruits) and certain drinks (for example, alcohol and caffeine) act as irritants and cause burning or pain during urination.
Overall, the most common causes of burning or pain during urination are
Infection of the urethra ( urethritis Urethritis Urethritis is infection of the urethra, the tube that carries urine from the bladder out of the body. Bacteria, including those that are sexually transmitted, are the most common cause of urethritis... read more ) due to a sexually transmitted infection Overview of Sexually Transmitted Infections (STIs) Sexually transmitted (venereal) diseases are infections that are typically, but not exclusively, passed from person to person through sexual contact. Sexually transmitted infections may be caused... read more (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.
In people who have pain or burning during urination, certain symptoms and characteristics are cause for concern. They include
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 a day or two, 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 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 Urethritis Urethritis is infection of the urethra, the tube that carries urine from the bladder out of the body. Bacteria, including those that are sexually transmitted, are the most common cause of urethritis... read more is often the cause. If burning affects mainly the vagina and the woman has a discharge, vaginitis Vulvitis Vulvitis is inflammation of the vulva. When both the vulva and vagina are inflamed, the disorder is called vulvovaginitis. The vulva is the area surrounding the opening of the vagina and containing... read more 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.
Doctors do not always agree on the need for tests for certain adult women who have symptoms that suggest a bladder infection Bladder Infection Cystitis is infection of the bladder. Usually, bacteria are the cause of cystitis. A frequent need to urinate and pain or burning while urinating are the most common symptoms. Doctors can often... read more . 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 STDs 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
The cause is treated. Often the cause is an infection, and antibiotics provide relief in a day or two. If pain is severe, doctors may give phenazopyridine for a day or two to relieve discomfort until antibiotics start to work. Phenazopyridine turns the urine a red-orange color and may stain undergarments.
Although bladder infections are a common cause, many other disorders may cause painful urination.
Burning or pain during urination may be a sign of an STI.
Doctors may decide to treat women with an antibiotic and see whether symptoms resolve rather than do testing.