What is Dysuria?
Dysuria is pain, burning, or discomfort experienced during urination, representing a symptom rather than a disease itself. 1, 2, 3
Clinical Definition and Characteristics
- Dysuria is defined as a feeling of pain, burning, or discomfort that occurs during the act of urination 2, 3, 4
- It is a symptom, not an independent disease, and accompanies a wide range of urological conditions of both infectious and non-infectious origin 4, 5
- The symptom results from excessive bladder muscle contraction and peristaltic activity of edematous and inflamed urethral mucosa 6
Common Etiologies
Infectious Causes
- Urinary tract infection (UTI) is the most frequent cause of dysuria, though empiric antibiotic treatment is not always appropriate 2, 3
- Coliform organisms, notably Escherichia coli, are the most common pathogens in urinary tract infections causing dysuria 3
- Sexually transmitted infections, including cervicitis and urethritis, can present with dysuria 2
- Mycoplasma genitalium should be tested if persistent urethritis or cervicitis occurs with negative initial testing 2
Non-Infectious Causes
- Genitourinary inflammation due to various non-infectious reasons 7
- Bladder irritants, skin lesions, and chronic pain conditions 2
- Noninfectious inflammation or trauma, neoplasm, calculi, hypoestrogenism, interstitial cystitis, or psychogenic disorders 3
Clinical Context and Presentation
- Dysuria is one of the classic symptoms of cystitis, along with urgency and suprapubic pain 8
- In McGeer's criteria for UTI diagnosis, dysuria is specifically listed as a urogenital symptom that may indicate UTI 8
- Recent onset of dysuria, especially when accompanied by frequency, incontinence, or urgency, meets criteria for prescribing antibiotics for UTI 8
Population-Specific Considerations
Women
- Dysuria is more common in women than in men, occurring more often in younger women due to greater frequency of sexual activity 3
- Vaginal discharge decreases the likelihood of urinary tract infection, and other causes including cervicitis should be investigated 2
Men
- Older men are more likely to experience dysuria due to increased incidence of prostatic hyperplasia with accompanying inflammation and infection 3
- Lower urinary symptoms in males require specific evaluation 2
Special Populations
- In frail or comorbid older individuals, dysuria should be evaluated in context with other symptoms 7, 8
- In children, dysuria can indicate UTI but may present differently than in adults 7, 6
Critical Clinical Pitfall
Equating all cases of dysuria to urinary infection is incorrect 6, 5 - many physicians commonly equate dysuria with UTI and treat empirically without adequate evaluation, which represents undertreatment for many patients and inappropriate treatment for others 5