Dysuria

Dysuria: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses

Dysuria (painful or difficult urination) is commonly accompanied by urinary frequency, urgency, or hesitancy. This symptom usually reflects lower urinary tract infection (UTI) — a common disorder, especially in women.

Dysuria also results from lower urinary tract irritation or inflammation, which stimulates nerve endings in the bladder and urethra. The onset of pain provides clues to its cause. For example, pain just before voiding usually indicates bladder irritation or distention; whereas pain at the start of urination typically results from bladder outlet irritation. Pain at the end of voiding may signal bladder spasms; in women, it may indicate vaginal candidiasis.

History

If the patient complains of dysuria, have him describe its severity and location. When did he first notice it? Did anything precipitate it? Does anything aggravate or alleviate it?

Next, ask about previous urinary or genital tract infections. Has the patient recently undergone an invasive procedure, such as cystoscopy or urethral dilatation, or had a urinary catheter placed? Also, ask if he has a history of intestinal disease. Ask the female patient about menstrual disorders and use of products that irritate the urinary tract, such as bubble bath salts, feminine deodorants, contraceptive gels, and perineal lotions. Also ask her about vaginal discharge and pruritus.

Physical assessment

Ask the patient to void before beginning your examination. Inspect the urethral meatus for discharge, irritation, and other abnormalities. Then percuss over the kidneys. Costovertebral angle tenderness indicates kidney inflammation. Percuss the bladder. Start at the symphysis pubis and percuss upward. You should hear tympany; a dull sound signals retained urine. Then palpate the kidneys. Normally, they aren’t palpable unless they’re enlarged. If the kidneys feel enlarged, the patient may have hydronephrosis, cysts, or tumors. You won’t be able to palpate the bladder unless it’s distended. (See Palpating the kidneys.) A pelvic or rectal examination may be necessary.

Medical causes

Appendicitis

Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney’s point, anorexia, nausea, vomiting, constipation, slight fever, abdominal rigidity and rebound tenderness, and tachycardia.

Bladder cancer

In bladder cancer, a predominantly male disorder, dysuria throughout voiding is a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.

CULTURAL CUE:Bladder cancer is twice as common in White males as in Black males. It’s relatively uncommon in Asians, Hispanics, and Native Americans.

Cystitis

Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, low-grade fever. With chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. With viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and fever.

Diverticulitis

Inflammation near the bladder may cause dysuria throughout voiding. Other effects include urinary frequency and urgency, nocturia, hematuria, fever, abdominal pain and tenderness, perineal pain, constipation or diarrhea and, possibly, an abdominal mass.

Paraurethral gland inflammation

Dysuria throughout voiding occurs with urinary frequency and urgency, diminished urine stream, mild perineal pain and, occasionally, hematuria.

Prostatitis

Acute prostatitis commonly causes dysuria throughout or toward the end of voiding. Dysuria may be accompanied by a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, fever, chills, fatigue, myalgia, nausea, vomiting, and constipation.

With chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects include urinary frequency and urgency; diminished urine stream; perineal, back, and buttocks pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.

Pyelonephritis (acute)

More common in females, acute pyelonephritis causes dysuria throughout voiding. Other features include persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.

Reiter’s syndrome

With Reiter’s syndrome, a predominantly male disorder, dysuria occurs 1 to 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.

Urethral syndrome

Occurring in sexually active women, urethral syndrome mimics urethritis. Dysuria throughout voiding may occur with urinary frequency, diminished urine stream, suprapubic aching and cramping, tenesmus, and lower back and unilateral flank pain. In the absence of pyuria, symptoms usually resolve without intervention.

Urethritis

Primarily found in sexually active males, urethritis causes dysuria throughout voiding. It’s accompanied by a reddened meatus and copious, yellow, purulent discharge (gonorrheal infection) or white or clear mucoid discharge (nongonorrheal infection).

Urinary obstruction

Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (With complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features include diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.

Vaginitis

Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.

Other causes

Chemical irritants

Dysuria may be caused by contact with irritating substances, such as bubble bath salts and feminine deodorants; it’s usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes. Other findings include urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.

Drugs

Dysuria can result from monoamine oxidase inhibitor use. Metyrosine can also cause transient dysuria.

Special considerations

Monitor the patient’s vital signs and intake and output. Administer prescribed drugs, and prepare him for such tests as urinalysis and cystoscopy.

Geriatric pointers

Be aware that elderly patients tend to underreport their urinary-related symptoms, even though older men have an increased incidence of nonsexually related UTIs and postmenopausal women have an increased incidence of noninfectious dysuria. Although the kidneys typically aren’t palpable unless enlarged, you may be able to palpate both kidneys in an elderly patient because of decreased muscle tone and elasticity.

Patient counseling

Encourage the patient to increase his fluid intake to 3.2 qt (3 L))/day, unless contraindicated. Explain the importance of frequent urination. Show the female patient how to perform proper perineal care and tell her to avoid tub baths, especially bubble baths, and vaginal deodorants. Explain the importance of taking the full course of prescribed antibiotics, even if symptoms subside.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

More About Bladder Cancer

• Back to disease: Bladder Cancer: Introduction
• Next Book Extract About Bladder Cancer: Urethral discharge (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• More Book Extracts: All Online Books for Bladder Cancer

More Medical Textbooks Online about Bladder Cancer

Review other book chapters online related to Bladder Cancer:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

 » Next page: Urethral discharge (Signs & Symptoms: A 2-in-1 Reference for Nurses)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Urethral discharge (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Urinary hesitancy (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Urinary urgency (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Dysuria (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
• Bladder distention (Nursing: Interpreting Signs and Symptoms)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City