What Causes Painful Urination (Dysuria)?

Most people will experience dysuria, or painful urination, at least once in their life. It may hurt at the end when you pee because of a urinary tract infection (UTI) or sexually transmitted infection (STI). Other causes of painful urination include cystitis, irritation of the genital area, or, rarely, bladder cancer.

Painful urination could be a sign of many different conditions, some of which require treatment. A healthcare provider can assess your symptoms, administer diagnostic tests, and recommend treatment.

1. Urinary Tract Infection (UTI)

Anyone can get a UTI, but this infection is most common in females. The infection occurs when bacteria make their way into the urethra, or the tube through which urine flows out of the body. The bacteria can then infect any other part of the urinary tract, including the bladder, kidneys, or ureters.

The bacterial overgrowth makes urine acidic, which creates a burning sensation when you pee. A UTI can also cause symptoms like:

• Feeling tired or shaky
• Fever
• Foul-smelling, cloudy, or red urine
• Pain in the back or sides
• Pressure in the lower abdomen
• A strong urge to urinate frequently

Antibiotics are the standard treatment for UTIs. You may be able to treat mild symptoms by drinking a lot of fluids, taking a pain reliever, or using a heating pad.

2. Sexually Transmitted Infections (STIs)

Chlamydia, genital herpes, gonorrhea, and trichomoniasis (trich) can all make it hurt to pee. Other signs you might have an STI include:

• Abdominal pain
• Abnormal vaginal odor or discharge from the vagina or penis
• Anal bleeding, itching, or soreness 
• Blister or sores in or around the mouth
• Fever
• Frequent urination
• Genital sores or warts
• Itching or redness near the genitals

In-office or at-home STI tests can help identify the cause of your symptoms. Treatment depends on the specific infection. A healthcare provider can guide you toward the right option, which might include antibiotics or antiviral medications.

3. Bacterial Vaginosis (BV)

Bacterial vaginosis (BV) is the most common vaginal infection in women aged 15 to 44. This infection is more common in sexually active people than those who have never had vaginal sex. It has to do with an imbalance between the healthy and harmful bacteria that naturally reside in the vagina.

Douching and having sex with a new partner or with multiple partners seems to increase a person's risk of BV. It can hurt to pee, your vulva and vagina might itch, and your discharge may appear thin and white or grayish. Some people with BV also notice a strong vaginal odor.

BV can increase the risk of contracting certain STIs. It's worth getting diagnosed and treated, even if your symptoms are on the milder side. Treatment typically involves antibiotics.

4. Cystitis

Cystitis, or inflammation of the bladder, can trigger a wide range of causes. Cystitis is caused by a bacterial infection in many cases, but not all. Many irritants can also upset the bladder lining. This can lead to inflammation and, ultimately, pain when you pee.

Resolving cystitis may include some medications and treatments, such as antibiotics. The fix is simple if a product is the source of bladder inflammation and painful urination: Steer clear of the offending irritant. You'll need to discuss options to manage this side effect with a healthcare provider if cystitis is the result of medical treatment.

Bladder inflammation can be long-lasting and hard to treat. This is called interstitial cystitis (IC), which is also known as painful bladder syndrome.

It can hurt for people with IC for the bladder to simply fill with urine, which usually means peeing provides relief. Some people might also often have chronic pelvic pain and pain during sex. Treatments, including diet and lifestyle changes, medication, and physical therapy, may be needed to ease symptoms.

5. Irritant Contact Dermatitis

Irritant contact dermatitis causes the skin to become inflamed, red, or sore after contact with substances like detergents, fabric softeners, or soaps. You may develop a rash near the genital area if you use an irritant near or on it. This condition can also cause burning or pain when you urinate and itching.

One of the best ways to treat irritant contact dermatitis is to avoid substances that cause symptoms. You may rinse the genital area with water to get rid of the irritant. Moisturizers, creams, or ointments keep the skin moist and repair itself. A healthcare provider might also prescribe a topical corticosteroid.

6. Kidney Infection

A UTI may have moved into the kidneys if it hurts when you pee, and you've got blood in your urine and back pain. Kidney infections, or pyelonephritis, occur when a UTI travels to either or both of these filtering organs. Other symptoms of a kidney infection include fever, chills, and abdominal pain.

A healthcare provider will likely need a urine sample to diagnose you with a kidney infection. Antibiotics are the first line of treatment. Symptoms usually start to improve after a few days of treatment.

A kidney infection can be severe if it's left untreated. You might have to get bed rest and receive fluids through an IV at the hospital.

7. Kidney or Bladder Stones

These stones are minerals in the urine that stick together and crystallize. They can settle in the kidneys or bladder. It's possible for stones to cause no symptoms and pass unnoticed when you pee. Urine flow can be blocked and painful if a kidney stone lodges in the wrong place or a bladder stone irritates the bladder lining.

A healthcare provider will likely recommend drinking a lot of water to help flush out the stones. Larger symptomatic stones may require medications or need to be removed surgically.

8. Medications

Certain medications—such as those that treat bladder cancer—can cause painful urination. These medications can cause irritation and inflammation of the tissue that lines the bladder.

It's important not to stop medications without talking to a healthcare provider first. They may adjust or change your prescription to avoid this side effect.

9. Ovarian Cysts

Ovarian cysts are fluid-filled sacs that develop in or on the ovaries and are most commonly benign (non-cancerous). They affect most people who ovulate during childbearing years and often go away without treatment.

Cysts typically don't cause symptoms unless they grow large, bleed, break open, or cause torsion (twisting). You may develop lower abdominal pain, which may cause painful urination. Other symptoms include bloating, pressure, and swelling.

A healthcare provider can surgically remove a cyst if it becomes too large, breaks open, or bleeds. They may prescribe birth control pills to help prevent future cysts.

10. Prostate Infection

The prostate is a gland located below the bladder in males that makes fluid that carries semen. Prostatitis, or inflammation of the prostate, can develop from a bacterial infection.

Painful urination can be a symptom of a prostate infection. Other symptoms might include:

• Body aches
• Fever or chills
• Foul-smelling or bloody urine
• Leaking urine
• Nocturia, or peeing too much at night
• Not being able to urinate, which is a medical emergency
• Pain in the abdomen, anus, penis, or scrotum
• A strong urge to urinate frequently
• Trouble controlling or starting urine flow

It's important to see a healthcare provider if you develop any of these symptoms. They can prescribe antibiotics to treat a bacterial infection.

11. Vaginal Tears

You might develop small abrasions that cause painful urination if you're not quite lubricated enough when having penetrative sex. You're more likely to deal with vaginal tears and painful urination if you've passed menopause. Hormone changes can thin the vaginal walls and the skin of the vulva, leading to tears.

A good lube can help you avoid this kind of pain. You'll have to wait a bit before having intercourse again if this is the cause of your discomfort. You might have painful urination until this area heals.

12. Bladder Cancer

Bladder cancer starts in the tissue that lines the bladder. It's the sixth most common type of cancer in the United States, making up 4% of all cases. Symptoms include painful or frequent urination, bloody urine, and lower back pain.

A healthcare provider can diagnose and stage bladder cancer. Treatment can include chemotherapy, radiation therapy, and surgery. Biologic therapy is another treatment that supports the immune system.

Differences in Males and Females

Both males and females can develop painful urination. The causes and symptoms may differ based on anatomical differences. UTIs, for example, most often affect females. This is because the urethra is shorter in females, making it easier for bacteria to infect the urinary tract.

Females can develop pelvic pain when they have an infection or irritation that causes painful urination. Males are more likely to develop pain in the prostate, penis, or scrotum.

When To Contact a Healthcare Provider

No matter the cause of your pain, always ensure you seek medical attention to address the problem and get relief. Pain when peeing can resolve on its own, but you won't know unless you get the correct diagnosis as soon as possible.

See a healthcare provider if you have:

• Abnormal drainage or discharge from your vagina or penis
  
• Blood in your urine
• A fever
• Painful urination during pregnancy
• Symptoms that last for more than one day
  

A Quick Review

It may hurt at the end when you pee for several reasons. Causes of painful urination, which is also called dysuria, include UTIs, STIs, and irritation of the genital area. Burning or pain when you pee can also be a sign of bladder cancer, but it's rare.

A healthcare provider can diagnose the cause of painful urination based on your symptoms and diagnostic tests. They can recommend treatment depending on the cause.