Pain when passing urine can be very distressing. It ranges from just a feeling of warmth to feeling like you are passing razor blades. There are several different causes of pain passing urine in men. Here we list the top 8.
No. 1 : Urinary Tract Infection
To be more technically accurate, this is an infection of the urine in the bladder commonly called a cystitis. Although this is much more common in women, it can also occur in men. This is what happens: bacteria normally found on the skin climbs its way up the urethra (urine tube inside the penis) and finds its way into the bladder. The usual defense mechanism of the body is to pass the bacteria out along with the urine. However, sometimes not all the bacteria is passed out and it multiplies to cause a bladder infection.
Factors that can increase the risk of this happening would be dehydration, holding on when you have to go, stones in the bladder or the use of urinary catheters.
Patients who have a bladder infection will frequently also experience urinary frequency (having to go all the time), urinary urgency (really really really have to go) and other symptoms of infection like fever and body aches. Some patients also experience nausea.
Bladder infections are extremely easy to diagnose with a simple urine test and easy to treat with some antibiotics.
No. 2 : Bladder stones
Bladder stones are stones that sit in the bladder (as the name suggests). Most of these stones are small enough to be passed out along with the urine. However, because the edges of these stones can be sharp, they can cut and injure the urethra on the way out. This causes a sudden intense pain in the middle of the urine stream. However, the pain also fades very quickly. Sometimes, you can even hear the stone striking the side of the toilet.
Before the stone is passed out, when it is sitting in the bladder, it can irritate the bladder and also cause urinary frequency and urgency. It can also cause a symptom called strangury which is when you feel like you need to go but when you do, no urine passes. Instead, you may even pass some blood. Speaking of blood, bladder stones may cause some blood to be in the urine. When the amount of blood is very small, the urine will not appear red. Instead it will look cloudy. Bladder stones also increase the risk of developing a bladder infection (see above).
Most of the time there is no need to treat bladder stones. Most of them pass out by themselves. Of course if there is an infection it needs to be treated. There are also medicines that can help the stones pass out. If the Doctor suspects the bladders stones may be smaller pieces of a bigger stone coming from your kidneys, you may need an ultrasound of CT scan.
No. 3 : Chlamydia
Chlamydia is one of the most common STDs around. It is a small bacteria that infects the urethra. It can be caught from both penetrative sex (vaginal or anal) as well as oral sex. The problem is many people who are infected with Chlamydia actually do not show any symptoms. And hence they will unknowingly pass it on to their sexual partners.
Although Chlamydia can cause discomfort passing urine it is usually very mild. In fact, some patients describe it as an “itch” rather than a pain. Chlamydia infections can also cause a thin clear to yellowish, greenish discharge from the penis. Again this can be so mild that the only clue is a stain on the shorts in the morning. Symptoms of Chlamydia can develop as quickly as 3 days after infection or can take up to 2 weeks to develop.
Chlamydia infections are easily detected with a simple urine test in men. It is also very easily treated with antibiotics. However, getting cured of Chlamydia does not protect you from getting it again. That is why the other very important aspect to treating Chlamydia is also to treat your sexual partners. Even if they do not exhibit any symptoms.
No. 4 : Gonorrhea
Gonorrhea is also a very common STD. Like Chlamydia, it infects the urethra and can be caught via both penetrative sex as well as oral sex. However, unlike Chlamydia, the symptoms of Gonorrhea usually develop faster. Also, the discomfort when passing urine is also more severe with most patients describing it as actual pain. Another clue that the infection is by Gonorrhea rather than Chlamydia is that the discharge caused by Gonorrhea is usually copious and very yellow. To a point that many patients have to stuff tissues into their shorts just to absorb the discharge and prevent their pants from staining. Of course it is very possible to have both a Chlamydia and Gonorrhea infection at the same time.
Just like Chlamydia, Gonorrhea infections are easily detected with a simple urine test in men. In fact, these 2 infections are usually tested together in the same test. Treating Gonorrhea is also easy with antibiotics. And treating your sexual partners is also crucial.
No. 5 : NSU – Non-Specific Urethritis (aka Non-Gonococcal Urethritis)
I like to describe NSU as “Chlamydia lite”. NSU refers to an STD infection of the urethra. But by an unknown organism. Common organisms include Ureaplasma Urealyticum, Mycoplasma Genitalium, Mycoplasma Hominis, Mycoplasma Parvum etc. However, since the approach to treatment is the same for all these different infections, many Doctors do not spend resources trying to figure out which it is. If the patient’s medical history suggests a urethritis and his urine tests do not detect any Chlamydia or Gonorrhea but has evidence of an infection (e.g. the presence of white blood cells), it is classified as an NSU and treated as such.
The symptoms of NSU are very similar to Chlamydia. They take between 3 days to 2 weeks to come on. The urinary discomfort is usually very mild and so is the discharge.
NSU is easily treated with antibiotics. Unless they are resistant. That is too complicated a discussion to have here and is something you need to discuss with your Doctor if you suffer from it.
A not so common and difficult infection to treat that causes NSU is Mycoplasma Genitalium.
No. 6 : Herpes
Herpes is a virus that can be sexually transmitted. Herpes can be caught via any kind of sexual contact including oral sex. It commonly causes painful blisters and ulcers on the skin. However, it can also cause painful ulcers inside the urethra. These are tricky to diagnose as it is very difficult to look inside the urethra to see the ulcers. Clues to a diagnosis of Herpes include intense pain on the initiation of the urine stream. During the stream the pain fades and is again intense at the end of the stream. The inguinal lymph nodes may also be swollen. Sometimes, it is possible to visualize the ulcers by gently opening the tip of the urethra.
The diagnosis of urethral herpes can be tricky. If the ulcers can be visualized, a swab can be taken and sent to the lab for confirmation. Blood tests are usually not helpful.
Treating Herpes involves taking anti-viral medication. This will make the ulcers (and therefore the pain) go away faster. However, the nature of Herpes is to recur. In other words, the symptoms will come back whether or not you have had another sexual contact. For more detailed information on Herpes please click here for our article on Herpes.
No. 7 : Prostatitis (Prostate infection / inflammation)
The prostate is a walnut sized gland that sits just below the bladder. It is responsible for producing fluid that makes up part of the semen. Bacteria can enter the prostate via the urinary tract. Since the prostate lies just in front of the rectum, bacteria can enter the prostate via the rectum too. Also, if a patient is very ill and there is bacteria in his blood (septicaemia), the blood can bring the bacteria to the prostate and seed the prostate with bacteria.
Once the prostate becomes infected and inflamed, the condition is called a Prostatitis. There are many types of prostatitis. In its most acute form, the patient will have severe pain passing urine, fever, nausea, urinary frequency and urgency and generally feel extremely unwell. In more chronic forms, the symptoms are not so severe.
Prostate infections can be caused by both STD and non-STD bacteria. Diagnosing a prostate infection usually involves a blood and semen test. Your Doctor may also want an ultrasound of MRI depending on your unique clinical scenario.
Treatment of Bacterial Prostatitis requires a rather long course of antibiotics. Frequently one month or even longer.
No. 8 : Balanitis
Balanitis refers to an infection of the foreskin. When the foreskin is infected, inflamed and swollen, it will be painful when urine comes into contact with it. So unlike the situations described above where the pain is within the urinary tube, the pain during urination experienced by a patient with balanitis is actually on the foreskin. All sorts of bacteria and fungus can infect the foreskin. Conditions that weaken the immune system like Diabetes increases this risk. A tight foreskin can also tear more easily. The torn skin can cause a lot of pain and also is at a greater risk of infection.
Diagnosing a balanitis is usually straightforward and your Doctor can make a diagnosis with just a physical examination. Your Doctor may want to take some skin swabs to determine if the infection is caused by a bacteria or a fungus.
Treating a balanitis does not only involve treating the infection. But also should include treating the underlying cause. If a patient has Diabetes, his blood sugar should be adequately controlled. If the foreskin if too tight, the patient should consider a circumcision. Please click here for our article on Circumcision.
In Conclusion
Pain when passing urine is never normal. There are several possible causes including infections and non-infections. You should see your Doctor for a diagnosis and treatment.
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