What is the treatment approach for dysuria (painful urination) not caused by a urinary tract infection (UTI)?

Treatment of Dysuria When It's Not a UTI

For non-infectious dysuria, phenazopyridine is the recommended first-line treatment for symptomatic relief of pain, burning, and discomfort arising from irritation of the lower urinary tract mucosa. 1

Diagnostic Approach

• Distinguish between infectious and non-infectious causes through urinalysis and urine culture before initiating treatment 2
• Common non-infectious causes include:
  • Bladder irritants (caffeine, alcohol, spicy foods) 2
  • Skin lesions or dermatologic conditions 3
  • Medication-induced irritation 3
  • Urethral anatomic abnormalities 3
  • Interstitial cystitis/bladder pain syndrome 3
  • Trauma from procedures or foreign bodies 3

First-Line Treatment

• Phenazopyridine (100-200mg three times daily) provides symptomatic relief for pain and discomfort 1
  • Acts as a urinary analgesic to reduce pain, burning, and urgency
  • Treatment should not exceed 2 days without addressing the underlying cause 1
  • Note: Phenazopyridine turns urine orange-red and can stain clothing 1

Condition-Specific Treatments

For Dysfunctional Voiding

• Urotherapy (non-surgical, non-pharmacological approach) is highly effective 4:
  • Education about bladder/bowel function
  • Timed voiding schedules
  • Adequate fluid intake
  • Correct toilet posture with buttock and foot support 4
  • Management of constipation (critical component) 4

For Hypoestrogenism-Related Dysuria (Postmenopausal Women)

• Vaginal estrogen replacement is strongly recommended to prevent recurrent symptoms 5
• Available as creams, rings, or tablets for local application

For Interstitial Cystitis/Bladder Pain Syndrome

• Dietary modifications to avoid bladder irritants (caffeine, alcohol, acidic foods) 2
• Pelvic floor physical therapy for muscle relaxation 4

Non-Pharmacological Approaches

• Increased fluid intake to dilute urine and reduce irritation 5
• Warm sitz baths for symptomatic relief 3
• Avoidance of potential irritants:
  • Spermicides, douches, and scented hygiene products 5
  • Caffeine, alcohol, and acidic foods 2

Special Considerations

For Children

• Biofeedback techniques show high success rates for dysfunctional voiding 4
• Correct toilet posture is essential (feet supported, comfortable hip abduction) 4
• Management of constipation is particularly important in pediatric cases 4

For Elderly Patients

• May present with atypical symptoms such as altered mental status or functional decline 5
• Consider drug interactions and comorbidities when selecting treatments 5
• Avoid nitrofurantoin if creatinine clearance <30 mL/min 5

Treatment Pitfalls to Avoid

• Don't assume all dysuria is due to infection; treating with antibiotics inappropriately contributes to resistance 2
• Don't delay identifying and addressing the underlying cause while providing symptomatic relief 1
• Don't overlook constipation as a contributing factor, especially in children 4
• Don't discontinue bowel management programs too early; they may need to be maintained for months 4