What medications are used to treat dysuria (urinary pain)?

From the Guidelines

For urinary pain, phenazopyridine is the most effective over-the-counter medication, typically taken at 100-200mg three times daily for no more than 2 days. This medication directly soothes the urinary tract lining but doesn't treat infections. It will turn urine orange-red, which is normal.

Key Considerations

• Ibuprofen (200-400mg every 6-8 hours) or acetaminophen (500mg every 6 hours) can also help reduce inflammation and discomfort.
• Drinking plenty of water helps dilute urine and reduce burning.
• If urinary pain persists beyond 2 days, is accompanied by fever, blood in urine, or back pain, see a doctor immediately as these symptoms suggest a urinary tract infection requiring antibiotics, such as those recommended by the Infectious Diseases Society of America, including fluoroquinolones, nitrofurantoin monohydrate/macrocrystals, trimethoprim-sulfamethoxazole, fosfomycin trometamol, or pivmecillinam 1.

Treatment Approach

• Phenazopyridine works by numbing the urinary tract mucosa but only masks symptoms rather than addressing underlying causes, so proper diagnosis is essential for persistent symptoms.
• The choice of antimicrobial agent should be individualized and based on patient allergy and compliance history, local practice patterns, local community resistance prevalence, availability, cost, and patient and provider threshold for failure 1.
• It's crucial to consider the potential for collateral damage and in vitro resistance prevalence when making treatment choices, as highlighted in the 2010 guideline update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases 1.

From the FDA Drug Label

Phenazopyridine HCl is indicated for the symptomatic relief of pain, burning, urgency, frequency, and other discomforts arising from irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, endoscopic procedures, or the passage of sounds or catheters The answer is phenazopyridine (PO), which is used for the symptomatic relief of urinary pain.

• It provides symptomatic relief of pain, burning, urgency, and frequency
• The use of phenazopyridine should not delay definitive diagnosis and treatment of causative conditions 2

From the Research

Urinary Pain Medication

• Urinary tract infections (UTIs) can cause significant pain and discomfort, and treatment options are available to alleviate these symptoms 3.
• Phenazopyridine is a medication that has been shown to be effective in reducing pain and discomfort associated with uncomplicated lower urinary tract infections 3.
• A study published in 2020 found that phenazopyridine significantly improved symptoms of uncomplicated cystitis, including pain during urination and increased frequency of urination, within 6 hours of taking the medication 3.
• The medication was well-tolerated, with no serious adverse events reported, and can be recommended as an addition to etiological therapy for patients with acute uncomplicated cystitis 3.
• Other studies have discussed the importance of early diagnosis and appropriate therapy for UTIs, including the use of antibiotics, to prevent complicated conditions such as urosepsis 4, 5, 6.
• The diagnosis of UTIs can be made based on clinical presentation, including symptoms such as dysuria, frequency, and urgency, and can be confirmed by urinalysis 5, 6, 7.