I have burning suprapubic pain and a sensation of incomplete voiding despite a negative urine dipstick for infection; what are the possible causes and recommended evaluation?

Suprapubic Burning Pain with Incomplete Voiding and Negative UTI

You most likely have chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), interstitial cystitis/bladder pain syndrome (IC/BPS), or urethritis—all of which commonly present with suprapubic burning and sensation of incomplete voiding despite negative urine dipstick. 1

Most Likely Diagnoses

Your symptom pattern—burning suprapubic pain with difficulty emptying the bladder and negative UTI testing—points to three primary conditions:

• CP/CPPS characteristically causes pain in the suprapubic region, perineum, or tip of penis, with pain often worsened by urination and a common sensation of incomplete bladder emptying 1
• IC/BPS should be strongly considered when pain is perceived as bladder-related, as clinical characteristics overlap significantly with CP/CPPS 1
• Urethritis remains possible even with negative dipstick, as standard urinalysis may miss sexually transmitted infections 1

The sensation you describe as "can't push pee out like normal" is specifically recognized as incomplete bladder emptying, a hallmark symptom of CP/CPPS 1

Critical Next Steps for Diagnosis

You need specific testing beyond a basic urine dipstick:

• Obtain formal urinalysis and urine culture (not just dipstick) as basic laboratory testing 1
• If sexually active, get nucleic acid amplification testing on first-void urine for N. gonorrhoeae and C. trachomatis, as these cause urethritis that standard dipstick won't detect 1
• Consider urethral swab if urethral discharge is present (>5 white blood cells per high-power field indicates urethritis) 1

Why Your UTI Test Was Negative

A negative urine dipstick does not rule out urologic causes of your symptoms:

• Standard dipstick primarily detects bacterial cystitis, not CP/CPPS, IC/BPS, or sexually transmitted urethritis 1, 2
• CP/CPPS and IC/BPS are not infections—they are pain syndromes where routine urine tests are typically negative 1
• Sexually transmitted urethritis requires specific nucleic acid testing, not standard urinalysis 1

Additional Considerations

Pelvic floor muscle dysfunction may be contributing to your symptoms:

• Pelvic floor myofascial pain correlates significantly with difficulty emptying the bladder and lower urinary tract symptoms including suprapubic pain 3
• This dysfunction can cause the sensation of incomplete voiding even when the bladder empties adequately 3

If you have constipation, address this first—66% of patients with incomplete bladder emptying and constipation improve with constipation treatment alone 4

Red Flags Requiring Urgent Evaluation

Seek immediate medical attention if you develop:

• Fever or shock—suggests acute infection requiring hospitalization 4
• Inability to urinate at all—suggests urinary retention 4
• Blood in urine (though this can support diagnosis of IC/BPS or urethritis, gross hematuria needs evaluation) 4

Common Pitfalls to Avoid

• Don't dismiss your symptoms because the UTI test was negative—this is expected in CP/CPPS and IC/BPS 1
• Don't accept "pressure" being different from "pain"—many patients with CP/CPPS and IC/BPS describe pressure rather than pain, and both are equally significant 1
• Don't assume you need antibiotics—if cultures are negative and STI testing is negative, antibiotics won't help and may cause harm 1

What to Tell Your Doctor

Request evaluation specifically for:

• CP/CPPS and IC/BPS as primary differentials 1
• STI testing if sexually active (even if you think exposure is unlikely) 1
• Assessment for pelvic floor muscle dysfunction 3
• Evaluation of bowel function if constipation is present 4