Why does it hurt when you pee?

Distressed woman with closed eyes, head tilted down, and right hand covering side of upper face and head.

Today's hot topic is: Why does it hurt when you pee?

This is a common concern that women have when meeting with their gynecologist or primary care provider. Painful urination can be very bothersome and get in the way of a woman’s daily life, so it can be helpful to know some common causes and remedies. This blog post will give you an overview of the various causes of painful urination along with helpful tips for prevention. 

In general, you may experience pain with urination when your bladder is inflamed; however, inflammation can occur even if you don't have a urinary tract infection. Some causes of inflammation include medications and chemicals contained in products such as toilet paper, personal lubricants and other feminine hygiene products. These external factors may cause irritation in the outer female genital area, the vulva, which can eventually lead to painful urination when the urine passes over the inflamed tissue.

Sexually transmitted infections such as chlamydia, gonorrhea, trichomonas, and genital herpes can all cause the urethra to become inflamed, causing you to feel pain during urination. The urethra is a tubular structure that transports urine that's stored in the bladder out of the body. When looking at the vulva, the opening of the urethra sits just above the opening to the vagina and underneath the clitoris. Yeast infections and bacterial vaginosis may cause inflammation of the urethra as well. Additional symptoms include vaginal discharge, and in the case of genital herpes, you can develop blisters and sores on the vulva. As you can imagine, urine passing through and over those areas can be very painful!

On the subject of external vulvar conditions that can cause painful urination, insufficient lubrication during sexual activity can lead to abrasions and tears of the vaginal tissue. A burning sensation is possible as urine passes over those areas. It is very important to allow time for personal lubrication prior to vaginal intercourse to reduce friction and avoid pain and trauma. If additional lubrication is needed during sexual activity, use water based lubricants. These small abrasions will usual heal on their own, but can cause temporary discomfort and pain. 

Low estrogen levels can cause various bladder symptoms like the need to urinate more frequently, the inability to control urination, painful urination, and increased urinary tract infections. Estrogen is a hormone that develops and maintains the reproductive organs in women. During perimenopause and menopause, your estrogen levels drop dramatically. This can cause your tissues to weaken. These changes in the urinary tract make it more vulnerable to infection. Along with the urinary tract changes, thinning of the vaginal tissue, called vaginal atrophy, is another sign of low estrogen and is accompanied by itching, burning, and vaginal discharge. If you are approaching menopause, which we call perimenopausal, or are postmenopausal, where you have gone through menopause and are no longer having a monthly period, estrogen replacement therapy can be helpful to treat the symptoms of atrophy.

As discussed above, painful urination can be caused by a myriad of things; however, the most common cause is a urinary tract infection (UTI). More than half of women will experience at least one UTI at some point in life. A UTI occurs when bacteria travels into the urethra. Over time, bacteria can multiply and cause overgrowth which eventually makes the urine acidic. This acidity causes a burning sensation as the urine leaves the bladder through the urethra when you pee. Additional symptoms of a UTI can be an urge to urinate often, dribbling or not very much urine coming out, abdominal pain or pressure, urine with a bad odor, cloudy urine, and/or blood in the urine. 

An interesting fact is that women get UTIs up to 30 times more often than men do, mainly because of the size and location of the female urethra. A woman’s urethra is much shorter which makes it very easy for bacteria to travel into the bladder. A woman’s urethra is also closer to both the vagina and the anus. This is convenient for bacteria to travel into the urethra as the anus is the main source of germs that cause urinary tract infections. 

Pregnancy can also increase the risk of getting a urinary tract infection. Pregnancy hormones not only alter the bacteria in the urinary tract, but as you advance in pregnancy the uterus grows and presses on the bladder. The new position of the uterus makes it difficult to fully drain the bottom of the bladder when urinating and creates a reservoir for bacteria to grow.

Other risk factors for UTIs can include having diabetes, a weakened immune system, and low defense to infection in general. Severe diabetes can also cause nerve damage, disturbing the connection between the brain and the bladder, and making it difficult for you to realize that your bladder is full. Additionally, large kidney stones can block the flow of urine and cause infections. Also, if you've recently had surgery and had a urinary catheter placed, you may have an increased risk of developing a UTI due to bacterial growth on the catheter tubing near the urethra. Overall, the key to preventing urinary tract infections is emptying your bladder regularly and staying well hydrated to lower all chances of bacterial growth. 

Urinary tract infections are treated with antibiotics. You should start to feel better in one to two days, but it's really important that even though you feel better, you finish your entire course of the antibiotics. If the infection is not treated properly, it can travel up to your kidneys, which is then called pyelonephritis. Developing a fever and back pain can be warning signs that the infection has risen up to your kidneys. On rare occasions, the infection can actually get into your bloodstream which can be very dangerous and life-threatening. If treated right away, a urinary tract infection is not likely to cause any damage to your urinary tract. Women who get two UTIs in 6 months or three UTIs in 1 year are considered to have recurrent UTIs. When this happens, it is very important to consult your doctor to identify any underlying causes and get treated as soon as possible to avoid additional complications.

What can you do to prevent a urinary tract infection? 

  1. Urinate after sex: Sexual activity is a high-risk activity that can get bacteria from the vagina and anus to the urethra and eventually into the bladder. So, the activity of urinating immediately after sexual activity is very important for people who are sexually active. Oftentimes, if you're noticing that you are getting UTIs after sexual activity, we can provide you with an antibiotic that you can regularly take after sexual activity. 
  2. Wipe from front to back: Stay vigilant with your bathroom hygiene. A rule of thumb is to always wipe from front to back after using the bathroom. 
  3. Stay hydrated: Staying hydrated flushes your bladder and helps reduce the chance of you getting a urinary tract infection. A trick to help you know that you're well hydrated is when your urine is clear or just a tinge of yellow. 
  4. Empty your bladder regularly: We often become engrossed in our work and other activities and end up holding a full bladder for hours. This ultimately increases our chances of developing a UTI. It is very important to always urinate when you feel you need to. Try not to go without urinating for longer than three or four hours, because the longer the urine stays in the bladder the more time the bacteria has to grow and cause a UTI. 
  5. Cranberry supplements: Consuming cranberry juice has been suggested to help prevent frequent UTIs. One of the theories regarding the effectiveness of cranberry is that it helps to prevent bacteria from attaching to the cells of the bladder, which will ultimately help reduce the chance of the bacteria growing in the bladder and causing an infection. Although studies have shown inconclusive results, I am of the mindset that cranberry supplementation helps more than it hurts. However, I would advise you to use the pill form and purchase cranberry tablets to help avoid excess calories and sugar found in many cranberry juices. 

Although a urinary tract infection (UTI) is the most common reason to have painful urination, there are various other causes of this distressing symptom. A thorough medical history, exam, and laboratory testing helps determine whether a UTI, or one of the other conditions discussed, is the cause of your symptoms. An accurate diagnosis is key for effective treatment. It is important for you to partner with your doctor to evaluate all the reasons why you may be experiencing occasional or recurrent episodes of painful urination to adequately diagnose and develop the best treatment option for you.

 

Follow Desert Star Family Planning on Instagram and Facebook for Dr. Taylor’s LIVE series “Well Woman Wednesdays” where she discusses hot topics in women’s health Wednesdays at noon. Dr. DeShawn Taylor M.D. is a board-certified Gynecologist and Family Planning Specialist who is the owner of Desert Star Family Planning clinic in Phoenix, Arizona. She is accepting new patients and would love to partner with you in your health and wellness. Please visit www.desertstarfp.com or call 480-447-8857 to learn more and schedule an appointment. 

This content is also available via video on Instagram and Facebook.

Author
DeShawn Taylor, MD Dr. DeShawn Taylor, MD, MSc, FACOG, is a gynecology physician, clinical professor, and reproductive rights advocate, who founded and owns Desert Star Family Planning clinic, as well as Desert Star Institute for Family Planning, a nonprofit organization in Phoenix for which she is the president and CEO.

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