Few things are as uncomfortable and unnerving as painful urination or urinary frequency, also called dysuria.
And more than one condition can be the reason for the pain. Still, most often, the blame can be placed on one of three common and treatable conditions: urinary tract infection, non-specific urethritis, and interstitial cystitis.
More than often, women tend to suffer from these conditions more frequently compared to men — and it’s mainly because the distance from the urethra to the bladder is a much shorter distance in the female body.
The urethra is the gateway to which bacteria can enter the body, up to the bladder, and if not stopped, to the kidneys. Once inside, the symptoms are hard to ignore.
Acute Cystitis
The symptoms of painful urination, frequency, urgency, or bladder discomfort in a woman most often indicate acute cystitis, a.k.a. UTI (urinary tract infection). And there could be a few causes.
It’s common for recent sexual activity to lead to a urinary tract infection. It’s not a reflection on cleanliness or sexual activity — it’s purely that during sex, a lot is going on with friction, bodily fluids, and such, and — once again — the urethra is right there in the middle of all of it.
If you find you’re prone to UTIs following sexual activity, there’s one prescription-free thing you can do that save yourself a lot of grief — and that’s to urinate immediately after sex.
That simple act helps flush any bacteria that may have breached your urethra and can immediately save you a lot of irritation.
But if your discomfort is not a result of sexual activity from the previous evening, then you need to consider the other factors at play here, including:
- A shift in vaginal pH: this acid/base balance can be thrown off by increased sweating, stress, or a topical cream/lotion/soap. It could also be from a high content of foods that cause an acid metabolism, such as sugars, meats, and refined fats (and a relative lack of fresh produce)
- A change of the predominate vaginal bacteria or yeast: yeast is fed by high sugar foods or higher-glycemic foods (e.g., bread, pasta, white rice)
- An irritation around the urethral opening: this could be from tight-fitting or new clothing
- Holding urine too long while traveling, working, etc.
All these lead to bacterial growth where it shouldn’t be, into the urine contents of the bladder.
Typically, identifying the cause can help cut down on occurrences in the future, and a round of antibiotics can prevent a simple urinary tract infection from becoming more common. Lots of water and cranberry juice can help, too.
In approximately half of symptomatic patients with a dip urinalysis consistent with bacterial infection, only about half of these even grow out a predominate bacterial strain. This indicates they don’t have infected urine. Instead, their symptoms are consistent with urethritis, a pain in the tube emptying the bladder.
Urethritis
When a routine urine culture doesn’t show bacterial growth, we must consider other causes of pain in the urethra. First, there are the atypical organisms that can cause it. Sexually transmitted infections such as gonorrhea and chlamydia can also cause it. So, it can be a stealthy bacteria such as Ureaplasma and mycoplasma. Bacterial vaginosis (caused by Gardnerella vaginalis), less common bacterial mixtures, yeast, trichomoniasis, and even herpes simplex type-2 can cause urethral pain. Rapid urine tests and cultures can identify and address these issues.
Less commonly, urethral pain can be caused by irritation. There are many causes for irritation of this sensitive skin area, from sex to urinary leakage to topical ingredients.
But if none of these culprits are to blame, and you are nearing menopause, there’s one more condition to consider.
Interstitial Cystitis
It is estimated that nearly one million American women have interstitial cystitis (IC). And if it comes on, it’s typically around the age of 40.
Interstitial cystitis (IC) can seem like a chronic urinary tract infection, except without bacterial infection. In time, irritation of the bladder leads to scarring, stiffness, and bleeding of the bladder wall. In addition to usual UTI symptoms, the patient with IC can experience bladder/urethral pain with sexual and other physical activity. It is commonly associated with fibromyalgia syndrome (FMS) and irritable bowel syndrome (IBS).
A urologist typically makes the diagnosis of IC after excluding infection and rarer causes such as kidney stones, endometriosis, tuberculosis, a neurological disorder, or radiation. The urologist can also directly visualize the inside lining of the bladder (cystoscopy) and test function.
What causes IC? That’s the million-dollar question. Mainstream medicine considers IC to be an idiopathic illness — meaning “cause-unknown.”
But, like any problematic chronic illness, there are contributors to IC to consider. First, you should know that your parasympathetic nervous system controls your bodily functions of urination — and bladder contraction. This parasympathetic nervous system is automatic but dramatically influences your feeling state.
For example, when you are nervous, your salivation dries up, tears may dry up, your bowels may need to move, nausea may occur, and your urge to pee may increase. This is why it makes sense that stress plays a significant role in IC.
Another interesting finding is that the inside lining of your bladder, the urothelium, generates its own ATP naturally, contributing to contraction. ATP is the molecule that provides energy to muscles and tissues. Therefore, when you read the list of causes of IC below, you may see similarities with all the other “idiopathic” (no known cause) illnesses:
- Autoimmune disorders: there is an unexplained association of IC with other autoimmune diseases such as systemic lupus erythematosus (SLE), Sjogren’s syndrome, inflammatory bowel disease (IBS), and scleroderma.
- Allergy: much of allergy is delayed-type sensitivity and may be caused by foods or chemicals in your environment
- Stress: stress reduction can help alleviate symptoms they are mediated through the parasympathetic nervous system, as mentioned above
- Smoking: significantly contributes to bladder cancer — and likely to IC as well
- Chronic repeated over-distention (holding your pee)
- Sexual, physical, or childhood abuse
