Am Fam Physician. 1998;57(9):2169-2170
See related article on dysuria.
Why does it sometimes hurt when I urinate?
If you have a vaginal infection or inflammation, you may feel pain when urine passes over the inflamed tissue. And if the urethra is inflamed, you could feel pain as the urine passes through it. (The urethra is the tube that carries urine from your bladder.) You might be sensitive to chemicals in douches, vaginal lubricants, soaps or scented toilet paper. You may also be sensitive to contraceptive foams or sponges. You'll find out if you're sensitive to these products if it hurts to urinate after you've used them.
Urination may hurt if your bladder is inflamed. This may occur even if you don't have an infection. Something pressing against the bladder (like an ovarian cyst) or irritation from a kidney stone that is stuck near the entrance to the bladder can also cause painful urination. Certain drugs, like some used in cancer chemotherapy or radiation treatments to the pelvic area, may inflame the bladder and cause painful urination.
What will I need to tell my doctor?
You should tell your doctor if you've had urinary tract infections before, how many you've had and how they were treated. How well you responded to that treatment is also important information. You should tell your doctor if you had urinary tract infections as a child. Your doctor should know about any other medical conditions you may have, such as diabetes mellitus or acquired immunodeficiency syndrome (AIDS), because these could affect your body's response to infection. Telling your doctor about any known abnormality in your urinary tract or the possibility that you're pregnant is also important. Tell your doctor if any procedures were done on your urinary tract or if you were recently hospitalized (less than one month ago) or stayed in a nursing home.
What type of tests will I need to have done?
Your doctor will usually be able to tell what's causing your pain by your description of the pattern of urination and symptoms, along with a physical exam. Testing your urine for white blood cells, red blood cells and chemical by-products can also help your doctor identify what type of infection you have. Usually, a sample of your urine is taken in your doctor's office and sent to a laboratory to check for a bacterial infection.
If your doctor thinks your pain may be from vaginal inflammation, he or she may wipe the lining of your vagina with a swab to collect mucus. The mucus will be looked at under a microscope to see if it has yeast and other organisms. If your pain is from an infection in your urethra, your doctor may swab it to look for white blood cells and test for bacteria. If an infection can't be found, your doctor may suggest other tests, such as pressure measurements within the bladder or cystoscopy (cystoscopy is a way to look at the bladder lining with a very thin tube inserted through the urethra).
What can I do to stop or prevent these symptoms?
Most women who get a urinary tract infection don't get another one and don't need to be on a prevention program. All they need is a few days of treatment with an antibiotic. Some women, however, get these infections over and over again, and they may get some relief from preventive efforts. Drinking 12 ounces of cranberry or blueberry juice every day decreases your chances of getting an infection. If you tend to get urinary tract infections after sexual intercourse, going to the bathroom right after intercourse or taking a single dose of an antibiotic may lessen your risk.
Frequent urinary tract infections may come from changes in the kinds of bacteria living in your vagina. These changes may make it easier for you to get a urinary tract infection. Antibacterial vaginal douches, spermicides and certain oral antibiotics may cause this change in vaginal bacteria. Avoid using these items, if possible, if you keep having urinary tract infections. Menopause can also cause changes in vaginal bacteria that increase your risk for urinary tract infection. Taking estrogen usually corrects this problem.
How are urinary tract infections treated?
If you are a healthy adult woman who is not pregnant, a treatment of three days of antibiotics taken by mouth is usually effective. It's important that you tell your doctor if you have symptoms such as back pain and fever (especially a fever over 101°F, which could mean that the infection has spread into your kidneys. It's also important that you take your antibiotics exactly as your doctor has prescribed, since skipped doses could make the treatment less effective and may allow a kidney infection to develop.
What if I still get urinary tract infections even after I take antibiotics?
Some women keep getting urinary tract infections, even after following preventive measures. If you are having three or more urinary tract infections each year, your doctor may want you to begin a preventive antibiotic program. A small dose of antibiotics taken after you have sexual intercourse will help reduce infections that occur after intercourse. A small dose of an antibiotic taken every day helps to reduce infections not associated with intercourse.