What Causes Burning When You Urinate? Causes in Women and Men

Burning or stinging when passing urine (medically called dysuria) is one of the most common complaints seen in urology clinics. It is usually caused by a simple infection, but in some cases it can be the first sign of a different problem. In this article you will find the causes of burning, the tests that are done and the warning signs to look out for.

What causes burning when passing urine?

The main causes are:

• Bladder inflammation (cystitis): Burning comes with frequent urination, a sudden feeling of urgency, lower abdominal pain and sometimes blood in the urine.
• Kidney infection (pyelonephritis): When the infection reaches the kidney, fever, shivering and pain in the side appear.
• Inflammation of the urinary channel (urethritis): Mostly due to sexually transmitted infections; there may be a discharge.
• Prostatitis: Inflammation of the prostate gland in men; there may be pain in the perineum (the area between the scrotum and the anus), fever and difficulty passing urine.
• Stones: Ureteral stones close to the bladder and bladder stones can cause burning and a feeling of urgency.
• Urethral stricture: Can show itself as a thinner or split urine stream and burning.
• Irritants: Perfumed soaps, vaginal douches, spermicides and tight underwear can irritate the urinary tract.
• Bladder pain syndrome: Ongoing bladder pain and burning without infection.
• Urological procedures: Mild burning lasting a few days can be expected after a catheter, cystoscopy or stone surgery.

Why is burning when passing urine more common in women?

In women, the urethra is short and close to the anus, so it is easier for bacteria to reach the bladder. For this reason, the most common cause of burning in women is cystitis. Sex, pregnancy, the menopause, not drinking enough and constipation increase the risk.

Vaginal infections can also cause an external burning feeling when passing urine; in this case there is usually vaginal discharge and itching, and a gynaecological assessment is needed.

If infections recur several times a year, an underlying cause should be looked for and preventive measures planned. For details, see the urinary tract infection page.

What can burning when passing urine mean in men?

Urinary tract infections are less common in men than in women and are usually associated with an underlying cause. For this reason, burning in men should always be assessed. The main causes to consider are:

• Sexually transmitted urethritis in young men
• Prostatitis
• The bladder not emptying completely because of an enlarged prostate
• Urethral stricture
• Stones

If the urine flow has become weaker, if urine comes out drop by drop or if the stream splits, further assessment for a stricture or prostate problem is needed.

Why is burning when passing urine important in pregnancy and in children?

In pregnancy, changes in the urinary tract make it easier for an infection to spread to the kidneys. For this reason, burning when passing urine, frequent urination or lower abdominal pain during pregnancy should always be reported to a doctor. Even urinary infections without symptoms may need treatment in pregnancy; the medicines used are chosen to be suitable for pregnancy.

In children, urinary tract infections do not always appear with typical symptoms. In young children, an unexplained fever, restlessness, vomiting, loss of appetite and foul-smelling urine may be the only signs. In older children, burning, going to the toilet often and wetting again after being dry may be seen. In children with recurrent infections, structural causes such as urine flowing back up to the kidneys (vesicoureteral reflux) may be investigated.

In both cases, it is important not to start antibiotics before a urine culture is taken, and for treatment to be given under medical supervision.

Which tests are done?

• Urine test: Checks for inflammatory cells, bacteria and blood.
• Urine culture: Shows the bacterium causing the infection and which antibiotics it is sensitive to. This is important in men, in pregnant women, in recurrent infections and when there is no response to treatment.
• Tests for sexually transmitted infections: Done if there is a discharge or a risk.
• Ultrasound scan: Assesses the kidneys, the bladder, the prostate in men, and the urine left in the bladder after passing urine.
• Uroflowmetry and imaging if necessary: If the flow is weak, a stricture is looked for.

How is burning when passing urine treated?

Treatment depends on the cause. In bacterial infections, the antibiotic the doctor considers suitable should be taken for the full recommended course, even if the symptoms go away. Do not use old antibiotics you have at home on your own; the infection may not clear, and antibiotic resistance may develop.

To support treatment:

• Drink enough fluid during the day.
• Do not hold your urine for long periods; pass urine after sex.
• Women should wipe from front to back after using the toilet.
• Avoid perfumed soaps and vaginal douches.
• Prevent constipation.

For infections that recur several times a year, treating each episode may not be enough. In this case, an underlying stone, incomplete emptying of the bladder or a structural problem is looked for with urine cultures, ultrasound and further tests if needed. In post-menopausal women, local treatments recommended by the doctor and, in some patients, preventive approaches can help reduce how often infections come back. Which method is suitable is decided after examination.

When should you seek emergency care?

• Fever, shivering and pain in the side (flank)
• Being unable to keep fluids down because of nausea or vomiting
• Being unable to pass urine at all or passing urine with great difficulty
• Visible blood or clots in the urine
• Symptoms of a urinary tract infection during pregnancy
• Symptoms getting rapidly worse if you have diabetes, have had a kidney transplant or are on treatment that suppresses the immune system
• In men, burning together with a high fever and pain in the perineum (this may be acute prostatitis)

When should you see a urologist?

A urological examination is advisable if the burning does not go away within a few days, continues despite treatment, recurs several times a year, if you are a man, if you see blood in your urine or if your urine flow has become weaker. For blood in the urine, you may also want to read our article on the causes of blood in the urine.

Op. Dr. Mücahit Kabar sees patients in Bursa (Nilüfer), Turkey, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) and Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). Appointments are booked through the hospitals’ online booking pages or appointment lines. Consultations are held in English or Turkish; the hospitals’ international patient departments can arrange interpreters for other languages. If you are travelling from abroad, you can send your questions and reports by WhatsApp to +90 541 622 54 82 before your visit. See the contact and appointment information for details.