Burning micturition among women

Introduction:

Burning micturition is a burning sensation or discomfort while urinating/voiding urine. It is a very common problem among women due to close proximity of urethra to vagina & anus. 

Common causes:

• Urinary tract infection (Cystitis)
• Post coital UTI
• Vaginitis
• STDs like Chlamydia, Gonorrhea, Herpes
• Urinary tract stone/stricture
• Reaction to soaps, perfume etc
• Bubble bath
• Use of spermicides
• Trauma (eg. by foley's catheters)
• Certain drugs (eg. cancer medications)
• Drinking less water

Urinary tract infection (UTI) is most common cause of burning micturition. Let's know about it in detail. It may be of two types

(a) Uncomplicated UTI:  When occurring in the un-instrumented non-pregnant female without structural or neurological abnormalities.

(b) Complicated UTI:  When it is associated with anatomical or functional abnormalities (e.g. diabetes, urinary calculi) that increase the risk of serious complications or treatment failure.

 

☝If following symptoms occur:

• Burning or stinging sensation when passing urine
• Passing urine more frequently (frequency)
• Pain while passing urine (dysuria)
• Pain in the back or low abdomen 
• An urge to pass urine often (urgency)
• Passing only small amounts of urine
• Feeling of incomplete voiding of urine
• Discoloured and smelly urine (sometimes blood in urine)
• Fever (may be associated with chiils, rigors, sweating, headache, nausea, vomiting etc)
• Feeling generally not well

                                 👇

It may be Urinary tract infection/Cystitis (Inflammation of bladder)

The most vulnerable times are at starting sexual activity (hence the term ‘honeymoon cystitis’), during pregnancy and after menopause.

Causative organisms:      

        👇

Mainly bacteria 

• Escherichia coli,  
• Staphylococcus saprophyticus,  
• Klebsiella  sp.  
• Proteus  sp.
• Enterococci  sp.
• Streptococcus faecalis 

Associated risks are:

• Cystitis is very uncomfortable and irritating, but is not a serious problem & can be treated easily. 
• But an untreated infection can spread up to the kidneys and this is a serious issue.

🚗Visit your physician for examination, diagnosis & to rule

 out any complication (if the attack lasts more than 24 hours) 

Diagnostic test:

Microscopy & culture sensitivity of urine done on a fresh 

midstream specimen of urine, collected after proper washing of vulva.

Management is done as:

General measures:

• Self-help
• Keep yourself rested and warm.
• Drink a lot of fluid: try 2 to 3 cups of water at first, and then 1 cup every 30 minutes.
• Try to empty your bladder completely each time.
• Gently wash or wipe your bottom from the front to the back with soft, moist tissues after going to the toilet.
• Take analgesics such as paracetamol for pain.

💊Medications:

Specific antibiotics will be prescribed which should be taken only after physicians advice.

• Trimethoprim 300 mg (o) daily for 3 days (first choice) or    
• Cephalexin 500 mg (o) daily for 5 days   or  
• Amoxycillin/ +  clavulanate 500/125 mg (o) 12 hourly for 5 days   or 
• Nitrofurantoin 100 mg (o) 12 hourly for 5 days   

• Your doctor may advise making the urine alkaline (if pH of urine is acidic)  
• A follow-up urine test will be necessary. 
• If the antibiotics do not work or if you have more attacks, some special tests (including KFT, X-rays, USG) may be necessary to check your urinary tract.

Prevention of further attacks:

• Get into the habit of drinking plenty of fluids, especially on hot days.
• Pass urine often and when you feel like it—do not let it build up.
• Make sure you empty your bladder each time.
• Wash your bottom gently after each bowel motion, using mild soap and soft tissues.
• Empty your bladder immediately after intercourse.
• If your vagina is dry, use lubrication for intercourse 
• Wear cotton underwear; avoid tight jeans and nylon pantyhose.
• Avoid the use of bubble baths and perfumed soaps, talcum powder and vaginal deodorants around the genital area.
• Cranberries as either juice or capsules have been shown to help prevent recurrences of urinary infection in those prone to getting it.

Reference:

1. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
2. Murtagh J, Leggat PA. John Murtagh’s General Practice Companion Handbook.
3. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
4. https://www.leogenic.com/urinary-tract-infection-causes-symptoms-complications-diagnosis-treatment-prevention/ photo credit