By DR GREGGORY PINTO
Many men and women are unfortunately plagued by recurrent episodes of painful urination, called dysuria.
There is a prevalent misconception that an urinary tract infection is always the cause of every occurrence of pain on urination. Patients often take courses of antibiotics with no resolution of symptoms.
There are many causes of dysuria, painful urination that are not related to an infection.
There is tremendous bacterial resistance in the community against many commonly prescribed antibiotics for urinary tract infections (UTIs). The fluoroquinolone antibiotic class, such as Ciprofloxacin, has as high a 35 percent resistance rate against the common E.coli urinary tract bacteria. Ampicillin has about a 55 percent resistance rate against E.coli bacteria in many scientific studies.
Ciprofloxacin and Ampicillin are two of the most commonly prescribed antibiotics given empirically for urinary tract infections and in many cases the urinary tract infections are inadequately treated due to high bacterial resistance rates.
Two antibiotics that have low bacterial resistance rates for most urinary tract infections are Nitrofuratoin and Fosfomycin.
The world is running out of reliable antibiotics and the indiscriminate use of these two antibiotics could eventually lead to increased resistance in the community for both these drugs.
Urinary tract infections management should involve collecting a mid stream urine culture sample that is sent to a microbiology lab to determine the antibiotic sensitivity and resistance profile of the bacteria present in the urine.
Urine lab cultures are not a perfect tool as studies have shown that about 20 percent of negative urine cultures that show no bacteria being present in the urine, are cases of false negative results.
Bacterial DNA testing of sterile negative urine cultures, have shown to actually be positive for bacteria in about one in five cases. Although urine culture tests are not perfect, it is a necessary test to try and avoid the overuse of antibiotics for query urinary tract infections.
Other potential causes of painful urination, dysuria include:
• Sexually transmitted diseases
STIs such as chlamydia, gonorrhea and syphilis can infect the urinary tract system and lead to painful urination. Discharge may be an accompanying symptom in both men and women. A STI requires treatment of the patient and all sexual contacts.
• Urethral stricture
A scarring within the urethra can lead to painful urination. There is often a reduced strength in the urinary stream and usually increased urinary urgency and frequency, with incomplete bladder emptying. Urethral strictures may result from a sexually transmitted disease or it may be the result of trauma, which might be secondary to a previous urethral catheter or pelvic bone fractures.
• Urethral syndrome
Inflammation and irritation of the urethra that is not related to an infection, can lead to pain within the urethra and painful urination. Irritants such as spermicides, douches, bubble baths, scented sanitary napkins, prior radiation or chemotherapy, amongst others can lead to urethral syndrome.
• Infection of the prostate
In men infection of the prostate could lead to painful urination and often discomfort in the perineum, pain after ejaculation and sometimes pain within the pelvis with increased urinary urgency and frequency.
• Interstitial cystitis
Also referred to as painful bladder syndrome. It is often a diagnosis of exclusion but the hallmark of the condition is no bacteria found in the urine. Men and women with interstitial cystitis are quite commonly treated with recurrent antibiotic courses because of painful urination and painful bladder and the cause is not infective. Fortunately interstitial cystitis is not a common disorder.
• Referred pain
Pain can originate elsewhere and be referred, leading to pain in the urethra or painful urination. Kidney or ureteral stones are lead to dysuria as can ovarian cysts in women.
• Vaginal tears
In women, particularly postmenopausal women with decreased vaginal lubrication, vaginal micro tears during sexual intercourse can cause discomfort during urination.
The urethra of a woman is very short and anatomically there is a short distance between the anus with numerous normal bacterial flora and the vagina.
Sadly, many women suffer recurrent dysuria post-sexual intercourse and urinary tract infections and vaginal micro tears are a potential cause as is urinary tract infection caused by bacteria transferred from the region of the anus into the vagina.
• Pelvic inflammatory disorder
PID starts with an infection in the vagina or cervix that ascends into the uterus, fallopian tubes or ovaries. Symptoms may include painful urination, urethral pain, pelvic and abdominal pain, possible fever and chills, abnormal vaginal discharge and painful sexual intercourse. The causes of dysuria, painful urination are numerous.
Many men and women wrongly assume that each episode of painful urination is an urinary tract infection, although an urinary tract infection should be investigated as a cause. Urinary tract infections are often inadequately treated as commonly prescribed antibiotics fail to eradicate resistant bacteria. Recurrent episodes of painful urination should be investigated by an urologist, so that the cause can be determined and the appropriate management can be employed.
If an urinary tract infection is the cause of recurrent dysuria then a functional or anatomical abnormality must be ruled out as the precipitating cause of the urinary tract infection.
An obstructive prostate or urethral stricture could lead to incomplete bladder emptying and recurrent urinary tract infections in men and uterine fibroids could cause extrinsic compression on the bladder in women and also lead to incomplete bladder emptying and recurrent urinary tract infections.
Poorly controlled diabetics or undiagnosed diabetics can lead to the development of a neuropathic bladder with impaired nerve function of the bladder so that the bladder is never emptied completely and those afflicted often have large residual urine volumes in their bladder, whereby bacteria often proliferate.
Seek compassionate, comprehensive and compassionate urological care for any urinary disorder including painful urination.
• Dr Greggory Pinto is a board certified Bahamian urologist and laparoscopic surgeon trained in South Africa, Germany, and France. He can be reached at Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, #68 Collins Avenue/Sixth Terrace, Nassau. Call (242) 326-1929; e-mail firstname.lastname@example.org, or visit the website www.urologycarebahamas.com.