Few symptoms prompt a trip to the doctor as quickly as pain during urination. That burning, stinging sensation is unpleasant enough that most people want answers and relief as soon as possible. If you’ve experienced this, you’re in good company: dysuria ranks among the most common complaints seen in general practice and urology clinics.

The medical term “dysuria” simply refers to pain, discomfort, or burning during urination. It’s not a diagnosis in itself, but rather a symptom that signals something else is going on in your urinary tract, reproductive system, or surrounding structures. The good news is that most causes are treatable. The key is figuring out what’s actually causing the problem.

Why does urination become painful?

The urinary tract wasn’t designed to hurt. Under normal circumstances, urine flows from the kidneys through the ureters to the bladder, where it’s stored until you’re ready to void through the urethra. When any part of this system becomes inflamed, infected, irritated, or obstructed, the result can be pain during what should be a routine bodily function.

Infections: the most common culprit

Urinary tract infections account for the majority of dysuria cases, particularly in women. The shorter female urethra and its proximity to the vagina and rectum make it easier for bacteria—usually Escherichia coli from the bowel—to reach the bladder. Once there, they multiply and trigger inflammation of the bladder lining (cystitis), producing that characteristic burning sensation 1.

Men get UTIs less frequently, but when they do, the infection may involve the prostate (prostatitis) or the tube running along the testicle (epididymitis). These require longer treatment courses and prompt medical attention.

Sexually transmitted infections deserve particular mention. Chlamydia and gonorrhoea often cause urethritis—inflammation of the urethra—along with discharge. Herpes simplex virus can produce extremely painful urination, sometimes to the point where people avoid voiding altogether. If you’re sexually active and develop dysuria with discharge or sores, STI testing should be part of your evaluation.

Beyond infection: other common causes

Not all dysuria comes from bacteria or viruses. Several other conditions can make urination uncomfortable:

Stones. Kidney stones and bladder stones cause intermittent sharp pain as they scrape along the urinary tract lining. You might notice blood in your urine alongside the burning.

Interstitial cystitis. Also called painful bladder syndrome, this chronic condition produces burning and urgency without any identifiable infection. It’s notoriously difficult to diagnose because standard urine tests come back negative. If you’ve been told repeatedly that “nothing is wrong” despite ongoing symptoms, interstitial cystitis is worth discussing with your doctor.

Hormonal changes. Postmenopausal women often develop burning urination from atrophic vaginitis. As oestrogen levels drop, the tissues of the vagina and urethra thin and become more fragile. This isn’t an infection, but it can mimic one.

Prostate enlargement. In older men, benign prostatic hyperplasia can compress the urethra, making urination difficult and sometimes painful. The incomplete emptying that results can also predispose to infections.

Chemical irritants. This one often gets overlooked. Bubble baths, scented soaps, douches, spermicides, and some lubricants can irritate the urethral opening. If your symptoms appear after introducing a new product, that’s worth noting.

Medications. Certain drugs, including some chemotherapy agents, can irritate the bladder lining. Haemorrhagic cystitis is a known complication of cyclophosphamide, for instance.

Accompanying symptoms matter

Dysuria rarely shows up alone. The additional symptoms provide crucial clues about what’s causing it:

Frequency and urgency alongside burning typically point to bacterial cystitis or overactive bladder
Fever and chills suggest the infection may have spread beyond the bladder, possibly to the kidneys (pyelonephritis)—this requires urgent medical attention
Discharge from the urethra or vagina raises suspicion for sexually transmitted infections
Blood in the urine (haematuria) can indicate stones, infection, or rarely, bladder cancer
Pain in the lower back or flank suggests kidney involvement
Pelvic or perineal pain in men may indicate prostate issues

Timing also helps. Pain at the very beginning of urination often suggests urethral problems, while pain that comes at the end of voiding typically points to the bladder or prostate.

Getting a diagnosis

Your doctor will start with a detailed history. Be prepared to discuss when symptoms began, whether you’ve had similar episodes before, your sexual history, and any new products you’ve used in the genital area. I know these questions can feel intrusive, but honest answers help narrow down the cause quickly.

Physical examination varies by sex. Women usually need a pelvic examination to check for vaginitis, urethral abnormalities, or prolapse. Men receive a genital exam and often a digital rectal examination to assess the prostate. Neither is particularly pleasant, but both provide valuable information.

The cornerstone test is a urinalysis. This simple urine sample can detect white blood cells (indicating inflammation or infection), red blood cells (suggesting bleeding), bacteria, and other abnormalities. If infection is suspected, a urine culture identifies the specific bacteria and which antibiotics will work against it 2.

For suspected STIs, separate testing is needed—typically nucleic acid amplification testing (NAAT) on urine or swab samples. Standard urine cultures don’t detect chlamydia or gonorrhoea.

When initial tests don’t explain ongoing symptoms, additional investigation may include:

Imaging (ultrasound or CT scan) to look for stones, structural abnormalities, or kidney involvement
Cystoscopy—a thin camera inserted through the urethra to directly visualise the bladder lining
Urodynamic testing to assess bladder function

Treatment options

Treatment depends entirely on what’s causing the dysuria. There’s no one-size-fits-all approach.

For bacterial infections

Antibiotics remain the standard treatment for UTIs. Common choices include trimethoprim-sulfamethoxazole, nitrofurantoin, and fosfomycin. The duration varies: uncomplicated cystitis in women may need only 3 days of treatment, while men with UTIs or prostatitis typically require 7-14 days or longer. Finish the full course even if you feel better after a day or two—stopping early risks incomplete eradication and antibiotic resistance.

Kidney infections (pyelonephritis) require more aggressive treatment, often with different antibiotics and sometimes intravenous administration if severe.

For sexually transmitted infections

Chlamydia is treated with doxycycline (100mg twice daily for 7 days) or sometimes azithromycin. Gonorrhoea requires an injection of ceftriaxone. Anyone diagnosed with an STI should inform recent sexual partners so they can be tested and treated too—otherwise you risk reinfection.

For interstitial cystitis

This is where things get more complicated. There’s no single effective treatment for interstitial cystitis. Most specialists use a stepwise approach 3:

Dietary changes: Avoiding bladder irritants like caffeine, alcohol, citrus fruits, and spicy foods helps some people significantly
Bladder training: Gradually increasing the intervals between voiding
Pelvic floor physiotherapy: Particularly useful if pelvic floor muscle dysfunction contributes to symptoms
Medications: Pentosan polysulfate sodium (Elmiron), amitriptyline, or antihistamines may provide relief
Bladder instillations: Various solutions can be instilled directly into the bladder during clinic visits

Atrophic vaginitis responds well to vaginal oestrogen therapy, available as creams, rings, or tablets. This is a local treatment, so the systemic risks associated with hormone replacement therapy don’t really apply.

For symptomatic relief

While waiting for the underlying cause to be addressed, several measures can ease discomfort:

Phenazopyridine (available over the counter in some countries) acts as a urinary analgesic. Fair warning: it turns your urine bright orange and can stain clothing
Drinking more water dilutes urine and may reduce irritation
Avoiding bladder irritants like coffee, alcohol, and fizzy drinks
Applying a heating pad to the lower abdomen

When to seek urgent care

Most dysuria, while unpleasant, isn’t an emergency. However, certain situations warrant immediate medical attention:

High fever (above 38.5°C/101.3°F)
Severe flank or back pain
Inability to urinate at all
Visible blood clots in urine
Confusion or altered consciousness
Pregnancy with urinary symptoms

Women who are pregnant should never delay evaluation of dysuria. Untreated UTIs during pregnancy carry real risks, including preterm labour and low birth weight.

Prevention: can you avoid this happening again?

For recurrent UTIs, several preventive strategies have evidence behind them:

Adequate hydration: Keeping urine dilute makes the bladder environment less hospitable to bacteria
Post-coital voiding: Urinating shortly after sex helps flush bacteria that may have been introduced
Wiping front to back: Reduces transfer of bowel bacteria to the urethra
Avoiding irritating products: Skip the bubble baths and scented feminine products
Cranberry products: The evidence is mixed, but some studies suggest cranberry may reduce UTI frequency. I wouldn’t bet the farm on it, but it’s unlikely to cause harm
Vaginal oestrogen: For postmenopausal women with recurrent infections, this addresses an underlying risk factor

For interstitial cystitis, identifying and avoiding personal triggers—whether dietary, stress-related, or otherwise—remains the cornerstone of management. Keeping a symptom diary can help identify patterns you might otherwise miss.

Final thoughts

Painful urination is your body’s way of signalling that something needs attention. Most of the time, the cause is straightforward and treatable. The key is getting an accurate diagnosis rather than just treating symptoms or assuming it’s “just a UTI.”

If your dysuria keeps coming back despite treatment, or if standard tests keep coming back normal, push for further investigation. Conditions like interstitial cystitis can take years to diagnose simply because they don’t show up on routine testing. You know your body better than anyone—if something feels wrong, it’s worth pursuing answers.

For more detailed information about specific conditions mentioned here, visit our dysuria condition page or explore related topics including urinary tract infections, interstitial cystitis, and chronic prostatitis.

References

Bent S, et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002;287(20):2701-10. PubMed
NHS. Urinary tract infections (UTIs). NHS Website
Hanno PM, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185(6):2162-70. PubMed