Painful Urination (Dysuria)

Painful Urination (Dysuria)

Dysuria means you feel pain or a burning sensation when you urinate. Men and women of any age can experience dysuria, but it’s more common in women. Urinary tract infections are commonly associated with dysuria. Treatment depends on the cause.

People at a higher risk of dysuria include:

• Pregnant women
• Men and women with diabetes
• Men and women with any type of bladder disease

Symptoms of dysuria

Symptoms of painful urination can vary between men and women, but both genders usually describe it as burning, stinging, or itching. Burning is the most commonly reported symptom.

Pain can occur at the start of urination or after urination. Pain at the start of urination is often a symptom of a urinary tract infection. Pain after urination can be a sign of a problem with the bladder or prostate. In men, pain can remain in your penis before and after urination too.

Symptoms in women can be internal or external. Pain outside your vaginal area may be caused by inflammation or irritation of this sensitive skin. Internal pain can be a symptom of a urinary tract infection.

Causes

There are many causes of dysuria. Doctors can’t always identify the cause.

WOMEN: Painful urination for women can be the result of:

• Bladder infection (cystitis)
• Vaginal infection
• Urinary tract infection
• Endometritis and other causes outside the urinary tract, including diverticulosis and diverticulitis
• Inflammation of the bladder or urethra (urethritis). Your urethra is the tube that begins at the lower opening of your bladder and exits out of your body. Inflammation is usually caused by an infection.
• The inflammation may also be caused by sexual intercourse, douches, soaps, scented toilet paper, contraceptive sponges, or spermicides.

MEN: Painful urination for men may be the result of:

• Urinary tract infection and other infections outside the urinary tract, including diverticulosis and diverticulitis.
• Prostate disease
• Cancer

Painful urination for men and women may be the result of a sexually transmitted infection (STI) or the side effect of medications. Chemotherapy cancer drugs or radiation treatments to the pelvic area may inflame the bladder and cause painful urination.

Care and Treatment

Treatment for dysuria depends on the cause of your pain/burning sensation. The first step in your treatment is to determine if your painful urination is caused by infection, inflammation, dietary factors, or a problem with your bladder or prostate.

Urinary tract infections are most commonly treated with antibiotics. If your pain is severe, you may be prescribed phenazopyridine. Note: this medication turns your urine red-orange and stains undergarments.

Inflammation caused by irritation to the skin is usually treated by avoiding the cause of the irritant.

Dysuria caused by an underlying bladder or prostate condition is treated by addressing the underlying condition.

There are several steps you can take to reduce the discomfort of painful urination, including drinking more water or taking an over-the-counter aid (such as Uristat® or AZO®) to treat painful urination. Other treatments need prescription medications.

If you have frequent urinary tract infections, your provider can help find the cause.

Prevent dysuria

• Drink more water. Drink two to three liters of water a day.
• If you wear a urinary incontinence pad, change it as soon as it gets soiled.
• After you (a woman) urinate, take some additional new tissue and wipe away any urine from the inside of your vaginal lips.

Ayurvedic Perspective on Painful Urination (Mutrakrichchra)

Ayurveda classifies painful urination (Mutrakrichchra) into eight types:

1. Vataja
2. Pittaja
3. Kaphaja
4. Sannipataja
5. Abhighataja
6. Shakrud
7. Ashmari
8. Sharkara

• Vataja Mutrakrichchra: Small, painful urination; tearing sensation in the scrotum, penis, and bladder.
• Pittaja Mutrakrichchra: Turmeric-colored or bloody urine with a scalding sensation; burning feeling in the scrotum, penis, and bladder.
• Kaphaja Mutrakrichchra: Slimy, colorless, cool urine; horripilation; heaviness in the scrotum, penis, and bladder.
• Sannipataja Mutrakrichchra: Variously colored urine, frequent urination with difficulty and pain; warm or cold sensation; feeling of sinking into darkness.
• Abhighataja Mutrakrichchra: Painful, obstructive uropathy after injury or trauma to the urinary system; similar to Vataja Mutrakrichchra.
• Shakrud Pratighata Mutrakrichchra: Fecal retention leads to reversed movement of Apan Vayu; causes abdominal distension, pain, and urinary retention.
• Sharkaraja Mutrakrichchra: Kapha particles transformed by Pitta and broken up by Vayu; precordial pain, rigor, colicky flank pain, impaired digestion, fainting, and dysuria. Pain subsides when Sharkara (gravel) is passed.

Treatment: Similar to Ashmari (stones) and Mutraghata (urinary obstruction).

Treatment in Purva Rupa (Prodromal Stage):

Snehana (oleation), Swedana (sudation), Vamana (emesis), Virechana (purgation) are advised.

Ayurvedic formulations:

• Varunadi kashaya
• Gokshuradi kashaya
• Chandraprabha vati
• Cystone tablets
• Crush tablets
• Clacurosin tablets
• Hazrulyahood bhasma, etc.

Panchakarma chikitsa:

• Virechana: Tilvak ghrita, etc.
• Basti: Especially Uttarbasti (enema given through urethra)
• Niruha basti: Ardha vishishta kwath of Shyamadi gana with Gomutra (cow urine)
• Anuvasanam: Peetadaru siddha taila (oil)

Shalya Karma Chikitsa (Surgical Procedures)

Purva Karma (Pre-operative procedures):

• Snehana & Swedana 7 days before operation
• Virechana 2 days before operation
• Abhyanga & Sweda on the day of operation
• Laghu bhojana (light meal) 1 hour before operation
• Bali-mangala & Swastivachana (auspicious rituals)
• Aashawasan (counseling & assurance)

Lithotomy position is used for the procedure.

Pradhana Karma (Main Procedure):

Nabhi Snehana (oleation of umbilicus) is done. The procedure involves manual manipulation to bring the Ashmari (stone) within reach for removal.

Paschat Karma (Post-operative procedures):

1. Basti shodhana (enema therapy)
2. Tub bath
3. Application of Lodhra, Yashti, Manjishta, Haridra & Goghrita (from the 4th day onwards)
4. Agnikarma (cauterization) after 1 week

Specific Treatments for Different Types of Mutrakrichchra:

• Vataja: Shavadamshtradi taila or ghrita orally, Anuvasana basti and Uttar basti.
• Pittaja: Ghee or milk processed with Trina panchmula, Utpala, Kakoli, and Nygrodha gana orally and for urethral irrigation. Basti with the same medicated fat. Laxatives with milk and grape/sugarcane juice.
• Kaphaja: Taila and Yava processed with Surasa, Ushaka, Musta, and Varuna.
• Abhighataja: Treatment for immediate wound management.
• Shakrud Pratighataja: Vatahara treatment, Swedana, Avagaha (sitz bath), Basti, Churna kriya (powder formulations).