Painful Urination (Dysuria): Causes and Treatment

That burning, stinging sensation when you pee. It's unmistakable and impossible to ignore. Each bathroom trip fills you with dread because you know it's going to hurt.

Painful urination - medically called dysuria - is one of the most common reasons people see a doctor. It's usually caused by infection (bladder, kidney, or sexually transmitted), but sometimes points to other issues like kidney stones, chemical irritation, or inflammation.

The good news? Most causes are easily treatable once identified. Let's figure out what's causing your pain and how to get relief.

What It Feels Like

Dysuria typically manifests as:

Burning: Most common description. Feels like fire or acid passing through your urethra as you pee. Can be mild discomfort or intense, eye-watering pain.

Stinging: Sharp, prickling sensation.

Aching: Dull pain in urethra, bladder area, or pelvis during or after urination.

Where you feel it:

• Opening of urethra (external dysuria)
• Inside urethra as urine passes
• Deep in bladder or lower pelvis (internal dysuria)

When you feel it:

• Beginning of urination
• Throughout the stream
• After finishing
• Constantly (with some conditions)

Associated symptoms often include:

• Urinary frequency (need to go often)
• Urgency (sudden, intense need to pee)
• Blood in urine
• Cloudy or foul-smelling urine
• Lower abdominal or pelvic pain
• Discharge from urethra or vagina

Common Causes

Urinary Tract Infection (UTI) - Most Common

Symptoms: Burning during urination, frequency, urgency, cloudy/smelly urine, lower abdominal pain. Maybe blood in urine.

Who gets them: Much more common in women (shorter urethra makes it easier for bacteria to reach bladder).

Treatment: Antibiotics. Symptoms usually improve within 1-2 days.

Why the burning? Bacteria irritate and inflame the bladder lining and urethra. Acidic urine passing over inflamed tissue causes the burning sensation.

Sexually Transmitted Infections (STIs)

Common STIs causing dysuria:

• Chlamydia (most common bacterial STI)
• Gonorrhea
• Herpes simplex virus (painful sores on genitals)
• Trichomoniasis
• Mycoplasma genitalium

Symptoms: Burning urination plus abnormal discharge (thick, yellow-green, foul-smelling), genital sores or lesions, pain during sex, testicular pain (men), pelvic pain (women).

Important: Many STIs are asymptomatic, especially in women. Get tested if you're sexually active and have dysuria.

Treatment: Antibiotics for bacterial infections, antivirals for herpes.

Kidney Stones

Symptoms: Severe flank pain (back/side), pain radiating to groin, blood in urine, nausea/vomiting, burning if stone is in lower ureter near bladder.

Why the burning? Stone scrapes and irritates the urinary tract as it moves. Secondary inflammation causes pain.

Treatment: Pain management, hydration for small stones. Procedures to break up or remove larger stones.

Chemical Irritation

Causes:

• Soaps, bubble baths, feminine hygiene products
• Spermicides
• Douches
• Scented toilet paper
• Detergents (residue on underwear)
• Personal lubricants

Symptoms: Burning externally (vulva, penis tip) rather than deep inside. May have redness, irritation, itching.

Treatment: Stop using the offending product. Symptoms usually resolve within days.

Vaginitis or Vaginal Infection (Women)

Types:

• Yeast infection (Candida)
• Bacterial vaginosis
• Trichomoniasis (STI)

Symptoms: Abnormal vaginal discharge, itching, odor, burning when urine touches irritated vulva (external dysuria).

Treatment: Antifungal for yeast, antibiotics for bacterial vaginosis or trichomoniasis.

Urethritis (Inflammation of Urethra)

Causes: Infection (STI, UTI) or non-infectious (irritation, trauma, autoimmune).

Symptoms: Burning during urination, discharge from urethra, frequency.

Treatment: Depends on cause - antibiotics if infectious, treat underlying condition if non-infectious.

Prostatitis (Men)

Symptoms: Painful urination, pelvic/genital pain, difficult or painful ejaculation, flu-like symptoms if acute bacterial.

Types: Acute bacterial (sudden onset, severe), chronic bacterial, chronic pelvic pain syndrome.

Treatment: Antibiotics for bacterial types, alpha blockers, pain management, pelvic floor therapy.

Other Causes

• Kidney infection (pyelonephritis) - burning plus fever, back pain, nausea
• Bladder stones
• Interstitial cystitis (chronic bladder inflammation)
• Atrophic vaginitis (post-menopause - low estrogen thins vaginal tissue)
• Medications (cyclophosphamide chemotherapy can cause bladder inflammation)
• Recent catheter use
• Genital herpes outbreak

When to See a Doctor

See a doctor if you have:

• Painful urination lasting more than 24-48 hours
• Burning with abnormal discharge
• Blood in urine
• Fever or back/side pain
• Pain severe enough to interfere with daily activities
• Recurrent dysuria
• Pregnant (UTIs during pregnancy need prompt treatment)
• Diabetes or immunocompromised (infections can become serious quickly)

Don't delay if:

• You're sexually active (could be STI)
• You're a man with dysuria (less common, more likely to indicate serious issue)
• Symptoms worsen despite home care

Diagnosis

Urinalysis: First step - checks for infection, blood, white blood cells.

Urine culture: Identifies specific bacteria and which antibiotics will work.

STI testing: Urine test or swab for chlamydia, gonorrhea, trichomoniasis. Blood test for herpes, HIV, syphilis.

Pelvic exam (women): Checks for vaginal infection, discharge, lesions.

Genital exam (men): Checks for discharge, lesions, prostate tenderness.

Imaging: Ultrasound or CT if kidney stones suspected.

Treatment

Treatment depends on the cause:

For UTI:

• Antibiotics (nitrofurantoin, trimethoprim/sulfamethoxazole, etc.)
• Symptoms improve within 1-2 days
• Phenazopyridine (AZO) for pain relief while antibiotics work

For STI:

• Antibiotics for chlamydia, gonorrhea, trichomoniasis, mycoplasma
• Antivirals for herpes
• Partner notification and treatment essential

For kidney stones:

• Pain management (NSAIDs work well)
• Hydration
• Medications to help stone pass (alpha blockers)
• Procedures if stone is large

For chemical irritation:

• Stop using offending product
• Use fragrance-free, gentle products
• Symptoms resolve on their own

For yeast infection:

• Antifungal cream or pill
• Available over-the-counter or prescription

For prostatitis:

• Antibiotics if bacterial
• Alpha blockers to relax bladder neck/prostate
• Pain management

Home Remedies for Symptom Relief

While you're waiting for treatment to work:

Hydration: Drink plenty of water. Dilutes urine, making it less irritating. Also helps flush bacteria.

Avoid bladder irritants: Skip caffeine, alcohol, spicy foods, acidic foods until healed.

Heat: Heating pad on lower abdomen can ease discomfort.

Urinate when you need to: Don't hold it - creates environment for bacteria to multiply.

Skip irritants:

• No bubble baths or scented products on genitals
• Use fragrance-free detergent
• Avoid tight clothing

Cranberry: May help prevent UTIs (evidence is mixed), but doesn't treat active infection. Cranberry juice or supplements won't hurt to try.

Baking soda: Some people find relief from drinking baking soda dissolved in water (neutralizes acidic urine). Check with doctor first.

Prevention

For UTI prevention:

• Stay hydrated
• Urinate after sex
• Wipe front to back (women)
• Don't hold urine when you need to go
• Avoid douches and feminine sprays

For STI prevention:

• Use condoms consistently
• Get tested regularly if sexually active
• Limit number of sexual partners
• Honest communication with partners about STI status

For chemical irritation:

• Use gentle, fragrance-free products
• Skip bubble baths
• Avoid spermicides if they cause irritation

The Bottom Line

Painful urination is usually caused by infection - either UTI or STI. Both are treatable with appropriate medication. Don't try to tough it out or hope it goes away on its own. Untreated infections can lead to complications.

See a doctor for diagnosis and treatment. Be honest about sexual activity - your doctor needs accurate information to diagnose correctly. And if you're sexually active, get tested for STIs even if you think it's "just a UTI."

Most cases resolve quickly with proper treatment. Within days you'll be back to normal, pain-free urination.

References

1. Cleveland Clinic - Dysuria (Painful Urination): Treatment, Causes & Symptoms
2. NCBI StatPearls - Dysuria medical overview
3. Medical News Today - Painful urination (dysuria): Causes, treatment, and more
4. AAFP - Dysuria: What You Should Know About Burning or Stinging with Urination
5. WebMD - Dysuria (Painful Urination): 8 Causes
6. GoHealth Urgent Care - Most common reasons why it burns when you pee