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dysuria
Painful or difficult urination, generally related to inflammation of the lower genitourinary tract.
Etiology:
1) urinary tract infection (UTI): most common cause
2) vulvovaginitis
3) urethritis - generally sexually transmitted
4) chemical irritation
a) chemical irritants
b) bubble baths
c) feminine hygiene products
d) contraceptive gels/foams
5) mechanical irritation
a) diaphragm
b) pessary
6) allergic reaction
7) prostatitis
8) urinary calculus
9) tumor: bladder cancer
10) postmenopausal atrophic vaginitis
11) sexual abuse
12) Reiter's syndrome
13) lumbar disc herniation [3]
Epidemiology:
- common in women
Laboratory:
1) urinalysis
a) pyuria
b) hematuria
2) urine culture
3) vaginal secretion
a) wet mount
b) KOH staining
4) tests for sexually transmitted diseases
a) Chlamydia:
1] GenProbe
2] culture
b) Neisseria gonorrhoeae
1] gram stain: intracellular Gm- diplococci
2] culture on selective media
3] GenProbe
c) Herpes simplex
1] Tzanck smear
2] culture
3] acute & convalescent serologies
Management:
1) discontinue use of offending agents
2) treat urinary tract infection (UTI)
3) sexually transmitted disease: treat patients & partners
4) Pyridium 200 mg PO TID for 2 days (urinary analgesic)
5) diet
a) hydrate: 8-10 glasses of water/day
b) cranberry juice acidifies urine
c) some patients benefit from yogurt
6) patient education
a) void frequently
b) discontinue use of diaphragm/pessary
c) void after sexual intercourse
Related
micturition (urination)
urethritis
General
sign/symptom
References
- nlmpubs.nlm.nih.gov/hstat/ahcpr/
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 522-523
- NEJM Knowledge+ Pain Management and Opioids: Recharge