Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2004;69(1):149-150

Why does it sometimes hurt when I urinate?

Painful urination can be caused by several things. A common cause is a urinary tract infection (also called a UTI or bladder infection). Urination may hurt if your bladder is inflamed. Inflammation can happen even if you do not have an infection. Some medicines can inflame the bladder. Something pressing against the bladder (like a cyst) or a kidney stone stuck near the opening to the bladder also can cause painful urination.

Painful urination can have other causes, such as an infection or inflammation in the vagina or in the prostate gland. You may feel pain when urine passes over the inflamed tissue. If the urethra is inflamed, you would feel pain as the urine passes through it. (The urethra is the tube that carries urine from your bladder out of your body.)

You might be sensitive to chemicals in certain products, such as douches, soaps, scented toilet paper, personal lubricants, or contraceptives like foams, sponges, and the sperm killer nonoxynol–9. If it hurts to urinate after you have used these products, you are probably sensitive to them.

What will I need to tell my doctor?

You should tell your doctor if you have had UTIs before (including when you were a child), how many you have had, and how they were treated. Tell your doctor about any other medical conditions you have, such as diabetes or AIDS, because these could affect your body's response to infection. Tell your doctor if you know about any abnormality in your urinary tract, or if you are pregnant or might be pregnant. Tell your doctor if you have had unsafe sex or anal sex. Tell your doctor if you have had any procedures or surgeries on your urinary tract, if you were recently hospitalized, or if you recently stayed in a nursing home.

What kind of tests will I need to have done?

Your doctor usually will be able to tell what is causing your pain by the way you describe your pattern of urination and your symptoms, along with a physical exam. Testing your urine (called urinalysis) can help your doctor see what kind of infection you have. Usually, a sample of your urine is taken at the doctor's office and sent to a lab to check for 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 is looked at under a microscope to see if it has yeast or other organisms. If your pain is from an infection in your urethra, your doctor may swab it to test for bacteria. Your doctor may examine your prostate gland if your pain might be caused by an enlarged or infected prostate gland.

If an infection cannot be found, your doctor may suggest other tests, such as pressure measurements within the bladder or cystoscopy (a way to look at the bladder lining with a very thin tube put into the urethra).

How are UTIs treated?

If you are a healthy adult woman (who is not pregnant) or man, antibiotic pills usually will cure your UTI. It is important that you tell your doctor if you have symptoms such as back pain and fever (especially a fever higher than 101°F, which could mean that the infection has spread to your kidneys). It is important that you take the antibiotic exactly as your doctor tells you to, because skipping pills could make the treatment less effective and allow a kidney infection to develop.

If you are having three or more UTIs each year, your doctor may want you to begin a preventive antibiotic program. A small dose of antibiotics taken after you have sex may help reduce infections that occur after having sex. A small dose of an antibiotic taken every day helps reduce infections not associated with sex.

What can I do if I keep getting UTIs?

Some people, mostly women, get these infections over and over again, and they may get some help from preventive efforts. For example, drinking cranberry juice every day may decrease your chance of getting an infection. If you tend to get UTIs after having sex, going to the bathroom right after sex may lessen your risk.

Frequent UTIs may be caused by changes in the bacteria in the vagina. Antibacterial vaginal douches, spermicides, and certain oral antibiotics may cause changes in vaginal bacteria. Avoid using these items, if possible. Menopause also can cause changes in vaginal bacteria that increase your risk for UTIs. Using estrogen usually corrects this problem, but it is not right for everyone. Ask your doctor if estrogen therapy is right for you.

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