Painful urination is mainly caused by urinary tract infections (especially in women), but it can also be a sign of kidney stones, a sexually transmitted infection or even bladder cancer.
In men specifically, pain can occur due to prostatitis or prostate cancer, and in women, it may be related to cervicitis or pelvic inflammatory disease.
Anytime you feel pain with urination, especially if it lasts for more than one day, or if you experience other symptoms, you should consult a urologist for assessment and treatment as necessary.
What causes painful urination?
Pain with urination can occur with the following health conditions
1. Urinary tract infection
A urinary tract infection is one of the most common causes of painful urination and occurs due to the presence of bacteria in the urinary tract. UTIs are most common in women, as women’s urethras are shorter, making it more susceptible to bacteria entering and growing. In addition, UTIs are common during pregnancy due to decreased overall immunity, and due to the natural increase in protein in the urine, which facilitates bacteria growth and spread.
Generally, pain with urination is accompanied by other symptoms, like urinary urgency, urinating small amounts at a time, difficulty starting to urine, foul urine odor, and discomfort or burning with urination. See our online UTI symptoms checker, which can help to assess whether your symptoms may be related to a UTI.
What to do: UTI treatment should be oriented by a doctor, who will likely prescribe antibiotics like fosfomycin, nitrofurantoin, amoxicillin or ciprofloxacin. You are also advised to drink plenty of water or fruit juices while recovering to help to flush out any remaining bacteria.
You can also use home remedies for UTIs to complement your medical treatment.
2. Cystitis
Cystitis is a type of UTI that affects the bladder. It causes symptoms like frequent urination, a burning sensation, blood in the urine, fever, general malaise and cloudy or dark urine.
What to do: In this case, you should seek assessment to confirm a diagnosis and start treatment. Antibiotics are usually prescribed in accordance with the type of bacteria identified in the urine test.
3. Pyelonephritis
Pyelonephritis is a kidney infection that is normally caused by bacteria that migrated from the bladder. It causes kidney inflammation and leads to symptoms like fever, lower back pain, foul-smelling urine, loss of appetite and general malaise.
What to do: Treatment for pyelonephritis involves the use of antibiotics as prescribed by a doctor. Antibiotics should be taken even if there are no symptoms to prevent further complications.
4. Urethritis
Urethritis is a urinary infection that affects just the urethra. It is associated with symptoms like urinary frequency, itching and discharge from the urethra.
What to do: You should follow treatment as prescribed by a doctor to avoid complications like pyelonephritis.
5. Cervicitis or vulvovaginitis
Cervicitis or vulvovaginitis are uteral or vulvar inflammations that occur due to a fungal, viral or bacteria infection. These infections are associated with symptoms like yellow vaginal discharge, fever above 38ºC (or 100.4ºF) and vaginal bleeding.
What to do: It is important to identify the underlying cause of the cervicitis or vulvovaginitis so that the most appropriate treatment can be started. Treatment typically involves, antibiotics, antifungals or antivirals
6. Kidney stones
Kidney stones are a hard mass that can form anywhere along the urinary tract, which can block urinary flow. It is also common to experience lower back pain and blood in the urine. Learn more about the symptoms of kidney stones and what can cause them.
What to do: Elimination of kidney stones can be stimulated by drinking plenty of water and decreasing sodium intake. However, in more serious cases, the doctor may prescribe medications to help relieve symptoms, or may recommend surgery. See how chanca piedra tea can help to prevent future kidney stones from forming.
7. Bladder stones
Bladder stones can also cause painful urination, especially very large stones that block urinary flow. Symptoms typically include lower abdominal pain, cloudy urine, bloody urine, and in men, penile pain.
What to do: You should consult your doctor for assessment and testing to investigate the size of the stone and determine the best elimination method (through medication or through a surgical procedure)
8. Sexually-transmitted infections
Sexually-transmitted infections, or STIs, like gonorrhea, chlamydia or genital herpes, can occur in both men or women. In addition to painful urination, they are associated with symptoms like green or yellow discharge, burning and fever.
Learn more about the most common STIs and how they clinically present.
What to do: You should consult a doctor if you suspect you may have an STI. The doctor will order testing to identify the microorganism causing the infection, which will then guide the treatment plan. It is important to abstain from sex or use a condom during treatment, and to notify your sexual partner of your infection status so that they can seek testing and treatment.
9. Benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH) is characterized by an increased size in the prostate. It can cause painful urination, as well as difficulty urinating and urinary frequency. Some studies show that there is no relation between the size of the prostate and the severity or quantity of presenting symptoms. Family history, race and diet seem to play a role in the risk for this condition.
What to do: In this case, treatment should be oriented by a urologist, who will consider the man’s age, prostate size and symptoms when determining management. The doctor may prescribe medications to decrease symptoms and reduce prostate size, or surgery.
10. Prostatitis
Prostatitis is an inflammation of the prostate caused by a bacterial infection. It can cause pain or burning with urination, pain with ejaculation, or generalized penile, perineal or testicular discomfort.
What to do: You should consult a urologist for testing (e.g. a PSA test and ultrasound) to diagnose this condition and to start treatment. Treatment usually involves the use of antibiotics to eliminate the bacteria, and analgesics and anti-inflammatory to relieve other symptoms.
11. Prostate cancer
Prostate cancer is a type of cancer that is very common in men, especially after the age of 50. It may not present with symptoms in its initial stages, but as the cancer progresses, men often report symptoms like pain with urination or ejaculation, difficulty starting to urine, and the feeling of a heavy bladder, even after urinating.
What to do: You should consult a urologist for testing, which usually involves a prostate biopsy. This test can confirm a diagnosis and prompt treatment, like surgery, radiation therapy, hormone replacement therapy or chemotherapy.
It is important to keep up-to-date with prostate cancer screening, starting at 50 or at 45 if you have a positive family history of prostate cancer.
12. Pelvic inflammatory disease
Pelvic inflammatory disease is an inflammation that starts in the vagina and can eventually affect the cervix, uterus, fallopian tubes and ovaries. It can lead to symptoms like painful urination, vaginal discharge, bleeding or cramping outside of a period.
Pelvic inflammatory disease typically occurs as a result of an STI that was left untreated, like gonorrhea or chlamydia, but it can also occur due to labor, sex toys or endometriosis.
What to do: Treatment for pelvic inflammatory disease involves the use of prescription antibiotics, like azithromycin, levofloxacin or clindamycin, in oral or injectable form. You should avoid sexual contact during treatment to allow damaged tissue to heal.
13. Allergies
Painful urination can also happen as a result of an allergy to certain products, like tampons, wet wipes, douching products, soap, laundry detergent, scented toilet paper, lubricant or deodorant. These can cause irritation or alter vaginal pH, leading to an imbalance of the fungus and bacteria naturally present in the vagina. This increases a risk for yeast infections and UTIs.
In addition to painful urination, some women may also experience redness, intense vaginal itching or irritation.
What to do: It is important to identify the product triggering the allergy and to discontinue use immediately. You should consult your gynecologist for assessment and to possibly recommend more mild products to use instead. A yeast infection or UTI can be treated with antibiotics or antifungals.
14. Bacterial vaginosis
Bacterial vaginosis is a vaginal infection caused by Gardnerella vaginalis bacteria. This bacteria starts to grow and spread when the amount of good bacteria naturally found in the vagina starts to decrease. This infection leads to symptoms like painful urination, foul-smelling vaginal discharge and intense itching.
Learn more about the symptoms of bacterial vaginosis and what causes it.
What to do: You should consult a gynecologist to indicate treatment with antibiotics like metronidazole, clindamycin or secnidazole, which are available as vaginal tablets, oral pills or topical ointments.
15. Endometriosis
Endometriosis consists of the migration and implantation of endometrial tissue (the lining of the uterus) on other organs in the body. With this condition, it is most common for endometrial tissue to be found in the ovaries, fallopian tubes or intestines. It causes symptoms like inflammation, abdominal pain, intense cramping and pain during sex.
Although this is more rare, endometrial tissue can also implant within or on the bladder walls, leading to symptoms like painful urination, urinary frequency, pain with a full bladder, pelvic pain, lower back pain and urinary urgency.
Check-out the symptoms of endometriosis and how they may differ depending on the areas where endometrial cells have spread to.
What to do: You should consult a gynecologist to evaluate your pain and order testing, like a transvaginal ultrasound or transvaginal laparoscopy, to confirm a diagnosis. Treatment for endometriosis is generally done with birth control and/or surgery.
16. Bladder or uterine cancer
The growth of a tumor in the bladder or uterus can cause painful urination as well as constant pain, blood in the urine, weight loss for no apparent reason or excessive fatigue.
Find out more about other signs of cancer that you should report to your doctor.
What to do: If cancer is confirmed, the doctor may recommend surgery and medications, like immunosuppressants and hormone blockers. Read more about blood tests that doctors may order to help reach a cancer diagnosis.