Painful urination (dysuria): causes, red flags and when to get help

Dysuria is the medical word for pain, burning or stinging when you pass urine. The NHS lists it first among UTI symptoms, alongside needing to pee more often, needing to go during the night, sudden urgency, cloudy or bloody urine, lower tummy pain or back pain just under the ribs, a high or very low temperature and feeling tired or weak.

The NHS says UTIs affect different parts of the urinary tract and include cystitis (bladder infection), urethritis (infection of the urethra) and kidney infection. Where the pain is felt helps: burning at the moment of passing urine suggests the urethra and bladder, while pain in the back or side with fever suggests the kidney.

A urinary infection is the commonest cause by far, but the table lists others named in NHS and NICE sources.

The NHS asks for an urgent GP appointment or NHS 111 if you think you, your child or someone you care for may have a UTI and: you are aged 65 or older; your child is 15 or younger; you have a very high or low temperature, feel hot or cold or are shivering; you are a man, or trans or non-binary and assigned male at birth; you have diabetes; symptoms get worse quickly or do not improve within 48 hours; you keep getting UTIs; you use a catheter; you are pregnant; you have pain in the lower tummy or the back just under the ribs; you have blood in your pee; or you have a weakened immune system. It says some of these could be symptoms of a kidney infection, which can be serious if untreated because it could cause sepsis.

The NHS says to call 999 or go to A&E now if you or your child are confused, drowsy or have difficulty speaking. For older, frail people and people with a catheter it says symptoms of a UTI may include agitation or confusion, leaking that is worse than usual and new shivering or shaking.

The NHS kidney infection page adds being sick, not having had a pee all day, and a very low temperature below 36C to its reasons for an urgent appointment or 111.

• Fever, shivering, or feeling generally unwell.

• Pain in the back or side, just under the ribs.

• Blood in the urine.

• Being a man, over 65, pregnant, diabetic or having a catheter or weakened immune system.

• Not passing any urine, or repeated vomiting.

• Confusion, drowsiness or difficulty speaking: 999.

NICE CKS says a woman with suspected UTI is asked about onset, severity and evolution of symptoms, sexual history, risk factors for recurrent or complicated infection, the possibility of pregnancy and contraception used. Examination covers vital signs and the abdomen, possibly with a pelvic examination, and a pregnancy test is arranged. In men, CKS lists dysuria, frequency, urgency, nocturia and suprapubic pain as the picture of a lower UTI, and notes that men who are frail, elderly or catheterised may present atypically.

The NHS says a GP may do a urine test, though this is not always needed. CKS says urine dipstick and/or culture is arranged depending on the clinical presentation, age and risk factors, and that in men a urine sample should be cultured before starting antibiotics, with dipsticks not relied on alone.

Urine dipstick and urine culture are the usual tests. If an STI is possible the NHS says a sexual health clinic may test a sample of pee, take blood tests and swabs from the urethra, vagina or anus. A person who has had two UTIs in 6 months or three in a year may be referred to a specialist for further tests; the NHS lists a different antibiotic, low-dose antibiotic for up to 6 months, vaginal oestrogen for those in or after menopause, or specialist referral as options.

Kidney stones are diagnosed by symptoms, urine and blood tests and, for severe pain, a CT scan in adults or an ultrasound in pregnancy or under-16s, as the NHS describes.

The NHS says a GP may give self-care advice and a painkiller, prescribe a short course of antibiotics, or ask you to wait 48 hours before starting antibiotics in case symptoms settle. Take every dose of any prescribed course even if you feel better. A pharmacist can supply the same medicines as a GP for eligible women aged 16 to 64. For kidney infection the NHS says antibiotic tablets are usually taken for 7 to 14 days with recovery over about 2 weeks.

To ease symptoms the NHS suggests paracetamol up to 4 times a day for pain and fever, rest, drinking enough fluids so you pass pale urine regularly, and avoiding bladder irritants such as fruit juice, coffee and alcohol. It says there is no evidence that cystitis sachets or cranberry help once an infection has started, though some evidence suggests D-mannose or cranberry products may help prevent recurrences, with a warning to avoid cranberry if taking warfarin.

To reduce recurrence it advises wiping front to back, keeping the genital area clean and dry, drinking plenty of fluids, peeing soon after sex, not holding urine in, avoiding scented soap and spermicidal lubricant, and wearing cotton underwear.

A pharmacist for eligible women with typical symptoms; a GP for men, pregnant women, older people, children, those with recurrent infections or any of the other situations above; a sexual health clinic if an STI might be responsible, where the NHS says you usually do not need a GP referral; urology for repeated infections or when stones, prostate problems or other causes are suspected.