Frequent or Painful Urination

Frequent or painful urination at a glance

• Frequent or painful urination occurs when a person urinates more often than is normal for him or her and when urinating causes pain, burning or stinging.
• Painful or frequent urination is most often a symptom of another condition.
• Most treatments for these conditions treat the underlying condition or include behavioral changes a person can make to feel better.

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What is frequent or painful urination?

Urination is the process of passing liquid waste from the body in the form of urine. For most people, the bladder holds urine until it is convenient for them to use the toilet. Urination is normally painless.

Most people urinate four to eight times a day depending on fluid intake. Frequent urination is when a person needs to urinate much more often, experiences an urgent need to urinate or when a person urinates more frequently than is normal for him or her.

Painful urination (also called dysuria) is more common in women than in men. In both men and women it results in pain, discomfort, burning or stinging. Pain may be felt at the spot where urine leaves the body (urethra) or inside the body at the prostate (in men), bladder or behind the pubic bone at the lower part of the pelvis.

Frequent urination or painful urination can indicate another physical problem and should be evaluated by a physician.

Causes of frequent urination

Sometimes frequent urination and painful urination go together. In women, painful urination is most often a symptom of a urinary tract infection (UTI). UTIs often include an urgent need to urinate, uncomfortable, painful or burning sense when urinating, fever, and a painful or uncomfortable abdomen.

A variety of other problems can cause frequent urination, including:

• Diabetes. People who notice that they are urinating frequently, or an unusually large amount, should see a physician. These symptoms can indicate that a person has type 1 or type 2 diabetes. Increased urination is the way the body eliminates unused glucose (sugar).
• Diuretic medications. These eliminate excess fluid from the body. The drugs usually are prescribed to treat high blood pressure or other fluid buildup.
• Interstitial cystitis. This condition in which the walls of the bladder become inflamed can include frequent urination, an urgent need to urinate and pain in the bladder. Women experience about 80 percent of cases of interstitial cystitis.
• Overactive bladder (OAB) syndrome. Involuntary contractions of the bladder in OAB create sudden, uncontrollable urges to urinate. OAB often makes people need to use the bathroom during the night and might cause urinary incontinence or leaking. Up to one-third of men and 40 percent of women experience OAB.
• Most pregnant women notice they need to urinate often. This is because as the uterus grows, it pressures the bladder.
• Prostate problems. Men who experience an enlarged prostate, also known as benign prostatic hyperplasia (BPH), may have increased urinary frequency. As it enlarges, the prostate presses the urethra, which can block urine flow and irritate the bladder, causing it to contract more often. These contractions feel like a need to urinate.
• Stroke or other neurological diseases. After a stroke or other nerve damage, many people need to urinate more often. Neurological issues also can cause other bladder function problems.

Rarely, bladder cancer, bladder dysfunction and radiation therapy or other cancer treatment can cause issues with frequent urination.

Causes of painful urination

Several kinds of infection or inflammation can cause painful urination. These include:

• Urethritis and prostatitis. These two inflammatory conditions are the most frequent causes of painful urination in men.
• Vaginal infection, such as a yeast infection. Women who have a vaginal infection may notice vaginal odor, discharge and painful urination.
• Sexually transmitted infections. STIs such as chlamydia, genital herpes and gonorrhea can cause painful urination.
• Can be caused by:
  • Interstitial cystitis (see above).
  • Irritation of the urethra from sexual activity or activities like bicycling or horseback riding.
  • Irritation from douches, spermicides, bubble baths, soap or toilet paper with fragrance.
  • Side effects of certain medications, supplements and treatments.
  • Stones in the urinary tract.
  • Vaginal changes related to menopause (“vaginal atrophy”).
  • Tumor in the urinary tract.

Symptoms of frequent or painful urination

Frequent or painful urination can be a symptom of a variety of health conditions requiring treatment.

Symptoms of frequent urination that call for a visit to the physician as soon as possible include:

• Pain in the lower abdomen, side or groin
• Painful urination
• Blood in the urine, or red or dark brown urine. This can be a dangerous sign and should always be evaluated.
• A powerful urge to urinate
• Difficulty urinating, or trouble emptying the bladder completely
• Fever
• Discharge from the vagina or penis
• Loss of bladder control.

People should see a physician when urinary frequency increases with no obvious cause (such as drinking an unusual amount of fluids), especially if other symptoms are present.

Symptoms accompanying painful urination requiring medical attention are:

• Painful urination lasting more than one day
• Discharge from the penis or vagina
• Blood in the urine
• Fever
• For pregnant women, any painful urination.

Diagnosis of frequent or painful urination

The physician will study the symptoms (listed above) and take a complete medical history to determine the cause of the frequent or painful urination. He or she may order additional tests, such as:

• A laboratory examines and tests a urine sample to determine its contents and whether infection is present.
• Cystometry or Urodynamics. This measures the pressure within the bladder and assesses how well the bladder is working. This test allows physicians to understand if nerve or muscle problems may be interfering with bladder function.
• Using a thin, lighted instrument called a cystoscope, the physician can view inside the urethra and bladder to look for physical problems.
• Neurological tests. A physician might request tests to confirm or eliminate the possibility of a nerve disorder that affects bladder function.
• This imaging test uses sound waves to make a “picture” of the organs inside the body to check for issues affecting urinary function.

Preventing frequent or painful urination

Whenever possible, physicians treat frequent or painful urination by determining what underlying problem is causing the symptoms, and treating that problem. For example:

• If diabetes is the cause of a person’s frequent urination, the physician will work with the patient to control blood sugar to minimize the urinary issue.
• If a man’s frequent urination is due to benign prostatic hyperplasia (BPH) or prostatitis, the physician will treat that issue to relieve urinary symptoms.
• For women who have painful or frequent urination due to urinary tract infections, the physician will prescribe antibiotics or suggest other treatments to eliminate the infection.

Sometimes, behavioral treatments may also help alleviate symptoms of painful or frequent urination. These are activities the patient can do to minimize or eliminate symptoms for conditions such as OAB. Behavioral treatments might include:

• Avoiding fluid intake before bed. People need to stay hydrated, but avoiding drinking before bedtime can help stop overly frequent urination at night.
• Bladder retraining. Over time (about 12 weeks), the person makes an effort to wait longer between trips to the bathroom. This process helps the bladder hold urine longer so people do not experience frequent urination.
• Dietary changes. Physicians usually advise people to avoid foods that cause them to urinate more often. These foods may include alcohol, caffeine, carbonated beverages, chocolate, imitation sweeteners, spicy foods and tomato-based foods. Additionally, people should incorporate high-fiber foods into their diet. Constipation can make OAB worse.
• Kegel exercises. Men and women can do these exercises to strengthen the muscles around the urethra and bladder. Doing Kegel exercises three times a day, five minutes at a time, can strengthen the bladder and reduce frequent urination.

Lifestyle changes to treat & prevent painful urination

Treating the underlying cause often eliminates or reduces painful urination. People can also undertake lifestyle changes to prevent painful urination. Treatments include:

• Antibiotics to treat UTIs, prostatitis and some sexually transmitted infections
• Drugs to treat interstitial cystitis
• Using condoms during sex to protect against infections
• Avoiding scented detergents and toiletries that may cause infections
• Avoiding foods and drinks that can irritate the bladder, such as:
• Caffeine
• Alcohol
• Spicy food
• Artificial sweeteners
• Citrus and tomato products

Medical treatment for frequent & painful urination

Some conditions may require more aggressive treatment. Treatment options include:

• Botox injections. Some people respond to injections of Botox into the bladder muscles to relax them. This allows the bladder to store more urine, reducing frequent urination.
• Physicians might prescribe one of a variety of medications that improve bladder function.
• Several types of surgery are available. In the most common (and least invasive) procedure, a physician implants a small nerve stimulator just under the skin. These devices help improve muscle control to reduce accidents due to frequent urination.