From the Guidelines
Dysuria in elderly females is most commonly caused by urinary tract infections (UTIs) and atrophic vaginitis due to decreased estrogen levels after menopause. The causes of dysuria in this population can be multifaceted, including:
- Urinary tract infections (UTIs), which occur when bacteria enter the urinary tract and multiply 1
- Atrophic vaginitis, a condition characterized by thinning and inflammation of vaginal tissues due to decreased estrogen levels after menopause 1
- Sexually transmitted infections like chlamydia, gonorrhea, or herpes, which can cause painful urination
- Interstitial cystitis, a chronic bladder condition characterized by bladder pressure and pain, may present with dysuria
- Bladder or urethral stones, which can irritate the urinary tract
- Bladder cancer, though less common, should be considered in cases with persistent symptoms or blood in urine
- Certain medications, particularly some antibiotics and chemotherapy drugs, may cause dysuria as a side effect
- Urethral diverticulum, a pouch that forms along the urethra, can lead to infection and pain
- Pelvic organ prolapse, where pelvic organs descend into the vagina, can alter urinary flow and cause discomfort
- Diabetes, which can increase susceptibility to UTIs and cause dysuria due to elevated sugar levels in urine promoting bacterial growth
According to the European Association of Urology guidelines on urological infections, post-menopausal and elderly women with a history of UTI before menopause, urinary incontinence, atrophic vaginitis, cystocele, high postvoid residual urine volume, and blood group antigen secretory status are at increased risk of developing UTIs 1. Therefore, it is essential to consider these factors when evaluating dysuria in elderly females.
From the Research
Causes of Dysuria in Elderly Female
- Dysuria, or painful urination, can be caused by various factors in elderly females, including:
- Urinary tract infections (UTIs) 2, 3, 4
- Sexually transmitted infections 3, 4
- Vaginitis 3, 4
- Medication use 3
- Urethral anatomic abnormalities 3
- Local trauma 3
- Interstitial cystitis/bladder pain syndrome 3
- Genitourinary syndrome of menopause (GSM), which includes symptoms of urgency, frequency, dysuria, and recurrent UTIs 5
Risk Factors for Dysuria in Elderly Female
- Risk factors for recurrent symptomatic UTI include:
- Menopause hormone therapy may also play a role in the development of urinary symptoms, including dysuria 5
Diagnosis and Evaluation of Dysuria in Elderly Female
- The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection 2
- A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI 2
- Urinalysis and urine culture are essential for evaluating dysuria in elderly females 2, 3, 4
- Clinical decision rules may increase the accuracy of diagnosis with and without laboratory analysis 4