Difficulty in Urinating- Passing Urine is Hard: Causes, Symptoms, Diagnosis, Prevention & Treatment

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Difficulty in Urinating or passing urine is hard is termed as dysuria. Dysuria is pain or discomfort felt during or immediately after passing urine or burning sensation felt on the urethral meatus or the suprapubic region. Pain occurring while passing the urine suggests a urethral site of disease while pain after passing urine suggests a pathology in the bladder. Dysuria is common in females and older males.
Dysuria is caused by the irritation of the trigone of the urinary bladder or urethra, which causes difficulty in starting urination or burning sensation during or after micturition. It occurs due to infection of the lower urinary tract. It is very important to visit a doctor if you are suffering from the difficulty in passing urine as there are numerous causes of the infections/Diseases causing dysuria.

Causes of Dysuria (Difficulty in Urinating)

The causes of dysuria are as follows:

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  • Urinary tract infection ( most common cause of dysuria  in female)
  •  Benign prostatic hyperplasia (Enlargement of prostate) and prostatic carcinoma ( common in old age males)
  • Renal stones.
  • Inflammation of the urinary bladder.
  • A sexually transmitted disease like Gonorrhea, Syphilis.
  • Inflammation of the prostate (Prostatitis).
  • Inflammation of Urethra (Urethritis).
  • Uses of some chemical irritants like soaps and toilet paper may also lead to dysuria.

Among these causes, Urinary tract infection is the most common cause of difficulty in urinating in females.Urinary tract infection is common in females because they have a short urethra, Urethra is in close proximity to the anus. An absence of prostatic secretions which are present in males and minor trauma of urethra during sexual intercourse.

Symptoms of Difficulty in Urinating

Symptoms of dysuria depend upon the cause of the dysuria. There may be other symptoms in addition to pain during micturition, such as the discharge of blood or pus in the urine. These additional features should be noticed by the people suffering from the painful micturition are mentioned below:-
1. Frequent passage of urine.
2. Intense desire to pass urine at short intervals.
3. Blood in urine.
4. Passage of white cloud-like urine.
5. Discharge from the urethra.
6. Redness around the opening of the urethra.
7. Pain in the upper back region.
8. Fever, Sweating, Nausea, Vomiting.
9. Passage of foul smelling urine.
Dysuria is a symptom of an underlying disease these associated symptoms help in finding the cause of difficulty in micturition.
You should visit your doctor as soon as possible if difficulty in micturition is accompanied by the discharge from your penis or vagina. If you notice the passage of blood or red color of urine, If it lasts for more than one day despite the intake of large amounts of fluids or if you have a fever.

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Diagnosis of Difficulty in Urinating

The most important thing in diagnosing the cause of difficulty in micturition is the history of the patient. A doctor will ask you questions such as:- 
When did you first noticed the difficulty in micturition?
Does the pain start during micturition or after you stop urinating?
Did you notice the color changes in the urine?
Do you feel pain in the lower back region?
Do you pass the normal amount of urine?
A doctor may also ask you about the unprotected sexual intercourse as the sexually transmitted disease may also cause difficulty in micturition. Along with history, the following examinations are needed.

  • Urine examination:- Routine examination of urine is the simplest investigation culture of urine for 72 hours is done routinely to find out the causative organism.
  • Ultrasonography uses sound waves to see the picture of the urinary system. It may be done to rule out causes other than the infection of the urine. 
  • A pelvic exam or examination of the vaginal fluids may be needed in some women and girls who have a vaginal discharge.pelvic examination is done by palpating the organs it helps in finding the gynecological causes of dysuria.
  • In males having discharge, urethral swabs should be taken for culture.
  • Cystoscopy involves the use of the camera to visualize the bladder as well as the urinary passage.It helps to find out the cause of dysuria.

Prevention of difficulty in Urinating (Dysuria)

Since there are so many causes of dysuria preventive measures may not prevent dysuria completely,  but the following preventive measures may help in preventing dysuria in most cases.
1. Drink plenty of water (in an amount more than 2-3 liters in a day).
2. Do not hold urine:- Passage of urine frequently without holding for long times helps in removal of organisms which causes urinary tract infection thus reducing dysuria.
3. Women should wipe the genitalia from front to back to reduce the movement of organisms into the urinary tract.
4. Use of cotton underwear.
5. Avoid staying in wet clothes such as a bathing suit.
6. Avoid smoking and drinking alcohol
7. Avoid consumption of caffeine and spicy foods which worsens the symptoms.
8. Maintain good personal hygiene.
9. Consumption of cranberry juice may be effective.
10. Emptying of bladder before and after sexual intercourse helps in removal of organisms from the urinary tract.
11. Double micturition emptying bladder then attempting to pass urine after 10-25 minutes is effective in patients having frequent dysuria.

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Treatment of difficulty in Urinating

 Treatment of difficulty in passing urine depends upon the diagnosis. If it is due to urinary tract infection then a single regimen antibiotic such as ciprofloxacin, Ofloxacin, Cefixime may be enough.

In males having an enlarged prostate, the patient should take drugs with the anticholinergic property.Alpha blockers, such as alfuzosin, Doxazosin, Tamsulosin has moderate benefits. They relax the smooth muscles of the bladder and decreases the block of urine flow. Drugs such as finasteride and data steroid may help in the reduction of the enzyme (5 alpha reductase enzymes) which is responsible for the enlargement of the prostate) or may even opt for surgery if the symptoms are severe.

Sexually transmitted diseases should be treated according to the cause. Treating modalities may range from a single regimen of the antibiotics to lifelong drugs (in cases such as HIV).

    Surgical treatment is suggested in patients having stones in the urinary bladder, ureter, and urethra. Surgical treatment is also needed if medical treatment of Benign prostatic hyperplasia fails or you are suffering from prostatic carcinoma. 

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