A breastfeeding mother of one week complaining of painful urination. What is the most causative?

Dysuria

Dysuria, a commonly encountered medical symptom, refers to the painful or uncomfortable sensation experienced during urination. It is a very prevalent urinary symptom experienced by most people at least once in their lifetime. The causes of dysuria can be divided into 2 categories: infectious and noninfectious. The discomfort associated with dysuria can significantly impact an individual's quality of life and necessitates prompt evaluation and appropriate management. Understanding the potential causes and seeking timely medical attention is crucial to alleviate discomfort and address any underlying health concerns associated with dysuria. Treatment varies depending on the etiology. This activity describes the evaluation and treatment of dysuria and explains the role of the interprofessional team in improving care for patients with this condition.

The causes of dysuria can be divided broadly into 2 categories: infectious and noninfectious. Infectious causes include UTIs, urethritis, pyelonephritis, prostatitis, vaginitis, and STIs. Noninfectious causes include skin conditions, foreign bodies or stones in the urinary tract, trauma, benign prostatic hypertrophy, and tumors. Additionally, interstitial cystitis, certain medications, specific anatomic abnormalities, menopause, reactive arthritis (Reiter syndrome), and atrophic vaginitis can all cause dysuria.

One of the most common causes of dysuria is a UTI, which occurs in both males and females. Due to anatomical considerations, UTIs are much more common in females than males. In females, bacteria can reach the bladder more easily due to a shorter and straighter urethra than in males, as the bacteria have far less distance to travel to reach the bladder from the urethral meatus. Females who use the wrong wiping technique, from back to front instead of the preferred front to back, take baths instead of showers, or do not use washcloths to clean their vaginal area first when bathing, can predispose themselves to more frequent UTIs due to repeated contamination of the urethral meatus with perirectal and other bacteria.

Females also tend to experience dysuria more frequently than males due to their higher likelihood of recurrent UTIs. Most UTIs are uncomplicated and relatively simple to treat. However, persistent dysuria may be associated with complicated UTIs, which are found in men with UTIs, incompletely treated simple UTIs, prostatitis, pregnancy, immunocompromised status, catheters, nephrolithiasis, renal failure, dialysis, neurogenic bladder, anatomical or functional abnormalities of the urinary tract, pelvic floor dysfunction, and overactive bladder.

Treatment of dysuria depends on the underlying etiology whenever possible. The most common cause of dysuria is a UTI. Empiric antibiotic therapy based on a patient's history and symptoms is usually the most cost-effective treatment. No further evaluation is necessary in those cases where dysuria from uncomplicated UTI is suspected. When the clinician suspects a complicated UTI, as in the presence of associated symptoms like nausea, vomiting, fever, or chills, then along with starting antibiotics, additional testing like blood cultures, a metabolic panel, or a complete blood count are all viable options. Imaging with ultrasonography or a CT scan can diagnose suspected pyelonephritis, stones, or urinary obstruction.

Source: National Library of Medicine/National Center for Biotechnology Information