Hi Alice,

For about three years now, it burns every time I urinate. It hurts before and after. I have been to the doctors and I do not have an STD or UTI. It has got to the point that it wakes me up out of a dead sleep. It feels like a knife is stabbing me, and I can't sit, lay down, or move at all. I was wondering if you knew what else it could be. Thanks.

Dear Reader,

Though it sounds like you’ve been able to eliminate a few possible culprits for your ongoing pain, the best way to find an answer to your burning question may require some additional sleuthing — in the form of a second (or third or fourth) opinion. The pain you're describing can be caused by a sexually transmitted infection (STI) or urinary tract infection (UTI), but there are a number of other pesky conditions that may be putting the sizzle in your symptoms (read on for more on those). As such, you may benefit from making an appointment with specialist — more specifically, a urologist, who specializes in the diagnosis and treatment of urinary tract conditions.  And, in the meantime, preparing for your visit and utilizing a few at-home strategies to relieve some of your discomfort will hopefully put you on the road to a pain-free future.

Beyond an STI or UTI, there are certainly other conditions that can cause painful peeing. Here are just a few:

Interstitial cystitis (IC): Also known as painful bladder syndrome, IC is a chronic inflammatory condition of the bladder that may be causing your burning sensation. Symptoms of IC vary from case to case, but can range from mild discomfort, pressure, tenderness, to intense pain in the bladder and surrounding area. People with IC (who are most often female) may also experience a frequent and urgent need to urinate.

Hydronephrosis: This refers to the swelling of a kidney due to a build-up of urine. It occurs when urine cannot be released from the kidney to the bladder due to a blockage or obstruction. The tricky feature of hydronephrosis is that it may or may not cause symptoms. If symptoms do occur, they might include pain in the abdomen or groin, pain during urination, or an increased urge to urinate. Hydronephrosis is usually associated with an underlying illness or risk factor including kidney stones, a blood clot, scarring of tissue (from injury or previous surgery), tumor, cancer, pregnancy, or UTI.

Vaginitis: If you’re a biological female, your symptoms may be related to inflammation of the vagina. The cause of vaginitis is usually a change in the normal balance of vaginal bacteria or an infection. It can also result from reduced estrogen levels after menopause. Symptoms may include change in color, odor or amount of discharge from vagina, vaginal itching or irritation, pain during intercourse, painful urination, and light vaginal bleeding or spotting.

This list is by no means exhaustive, and thus, the reason to seek out medical attention once again. When you are able to see a provider, it’s good to be prepared to discuss your symptoms, such as frequency and urge of urination along with pain or burning sensations, and how much these symptoms interfere in your daily life. It may be helpful to write it down and bring this information with you. You may also be asked about your medical history in order to help determine whether your burning pain is the result of another condition. If your health care provider suspects you have one of these conditions, you may be asked to provide a urine sample to test for bacteria, blood, or pus in your urine. Other tests might include an ultrasound, X-ray, or blood culture — a lab test that checks for bacteria or other organisms in your blood.  

To get you through until your next appointment, here are a few strategies to help in the short-term:

  • Apply heat: Place a heating pad on your abdomen, back, or side to relax muscles and reduce feelings of pressure or pain.
  • Stay hydrated: Drinking plenty of fluids will help flush bacteria from your urinary tract. However, avoid coffee and alcohol as they can add to your frequency and urge to urinate.
  • Urinate frequently: Avoid delaying urination when you feel the urge to go.
  • Wipe carefully (particularly for females): Wiping from front to back after urinating and after a bowel movement helps prevent bacteria from spreading to the urethra.

You've already begun the process of elimination by being tested for STIs and UTI and you’re right to ask questions about your ongoing pain. Continuing to employ the help of medical experts can help you get to the bottom of your discomfort and hopefully get rid of it — once and for all!  

Alice!

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