Dysuria
Dysuria: Excerpt from Nursing: Interpreting Signs and Symptoms
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 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 and physical examination
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 the use of products that irritate the urinary tract, such as bubble bath salts, feminine deodorants, contraceptive gels, or perineal lotions. Also ask her about vaginal discharge or pruritus.
During the physical examination, inspect the urethral meatus for discharge, irritation, or other abnormalities. 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, a slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer.Bladder cancer, a predominantly male disorder, causes dysuria throughout voiding—a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
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, a 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 a fever.
Paraurethral gland inflammation.Dysuria throughout voiding occurs with urinary frequency and urgency, a diminished urine stream, mild perineal pain and, occasionally, hematuria.
Prostatitis.Acute prostatitis commonly causes dysuria throughout or toward the end of voiding as well as a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, a fever, chills, fatigue, myalgia, nausea, vomiting, and constipation. With chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects are urinary frequency and urgency; a diminished urine stream; perineal, back, and buttock pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute).Pyelonephritis causes dysuria throughout voiding. Other features include a 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.Reiter's syndrome is a disorder in which dysuria occurs 1 or 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 a low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
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 are a 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 with vaginitis. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants.Dysuria may result from 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 inhibitors. Metyrosine can also cause transient dysuria.
Nursing considerations
▪ Monitor the patient's vital signs and intake and output.
▪ Administer prescribed drugs.
▪ Prepare the patient for such tests as urinalysis and cystoscopy.
Patient teaching
▪ Explain the importance of increased fluid intake.
▪ Emphasize the importance of frequent urination.
▪ Teach the patient to perform perineal care.
▪ Discourage the use of bubble baths and vaginal deodorants.
▪ Discuss the importance of taking prescribed drugs as instructed.
▪ Explain to the patient his diagnosis and the treatment plan.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Urinary stones
More Medical Textbooks Online about Urinary stones
Review other book chapters online related to Urinary stones:
Medical Books Excerpts
- DYSURIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Dysuria
- "In a Page: Signs and Symptoms" (2004)
- [ read ]
- Dysuria
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- DYSURIA
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Dysuria
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysuria
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Dysuria
- "Field Guide to Bedside Diagnosis" (2007)
- [ read ]
- Bladder distention
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Dysuria
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Dysuria
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Dysuria
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- DYSURIA
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Urinary hesitancy (Nursing: Interpreting Signs and Symptoms)
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:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
