Painful Urination

Painful urination is the sensation of discomfort or pain during, before, or after urination. This is what differentiates the condition from other urinary disorders. For example, if blood is present in the urine without pain, it is classified as hematuria, whereas blood in the urine with pain is classified as blood painful urination.

The condition known as painful urination syndrome is typically caused by an external pathogen that enters the body through the bladder channel, the leg yin channels, or the local collaterals. These collaterals are small branches of the main channels that run through the genitourinary system and provide a potential route for pathogenic invasion during sexual activity or after going to the bathroom. In most cases, transmission of the damp-heat pathogen through the collaterals is the most likely mode of entry, particularly in individuals who are sexually active.

Internal heat or dampness can also cause discomfort during urination. Heat from the Heart or Liver can be transmitted to the lower body. Excess consumption of rich, oily, or spicy foods and alcohol can create dampness in the middle body which can then settle in the lower body. Prolonged heat in the body, such as from yin deficiency or qi stagnation, can also generate dampness in the lower body. Emotional stress and turmoil can disrupt Heart and Liver qi circulation and create heat. When the heat is internal, the symptoms tend to be more widespread, reflecting the original source. External heat tends to produce more focused symptoms in the bladder and urethra. The heat/dampness cycle can also cause other types of painful urination syndromes. These heat types are more common in women than men. Consuming excessive cold or raw foods at irregular times, late at night, or during stress can weaken or harm Spleen and Stomach qi or yang and lead to dampness.

Emotions such as frustration, anger, and stress can affect the flow of energy in the heart and liver. When this energy is blocked for a long time, it can create heat which can be transmitted to the bladder and small intestine. This can lead to similar urinary problems, but can be distinguished by other symptoms. If heat persists, it can harm the yin and cause fluids to become solid, leading to the formation of stones. Liver energy blockages are often the cause of other health issues that can affect urinary function. When energy flow is obstructed, it can cause blood and energy stagnation. This can lead to energy rebelling and invading the spleen, causing deficiency and potentially contributing to painful urination or the development of dampness. Pre-existing stagnation of energy and/or blood can be transferred to the bladder from other pelvic organs after surgeries such as hysterectomy or removal of ovarian cysts. The original source of the stagnation may be removed or repaired, but the underlying stasis can still affect the bladder and cause symptoms.

The kidneys can be affected by a variety of factors, including genetics, age, chronic illness, and sexual activity. Cold temperatures and physical strain can weaken kidney qi, while overwork, lack of sleep, and drug use can damage kidney yin. The kidneys and bladder are closely connected, so when the kidneys are weak, the bladder is more susceptible to infection. Spleen deficiency can be caused by antibiotic use and certain herbal remedies, as well as abdominal surgery and bladder or uterus prolapse. This can lead to discomfort and pressure in the suprapubic region.

Treatment

Maintaining good personal hygiene is crucial for overall health and well-being. In particular, proper wiping techniques (front to back) can prevent the spread of bacteria and potential infection. Tight-fitting or synthetic underwear should also be avoided. Some individuals may be at increased risk for bladder irritation or infection after sexual activity, and should be advised to empty their bladder and try different positions. Partners should also be examined to prevent reinfection. Adequate hydration, approximately 1.5-2 liters per day and more during a bout of painful urination syndrome, is essential.

Acute cases of painful urination may also be accompanied by external symptoms such as fever and chills. However, it is important to remember that inducing a sweat, or diaphoresis, is contraindicated in these cases. The reasoning behind this is that the fever and chills are caused by the "steam" produced by the struggle between damp-heat and normal qi in the bladder, and inducing a sweat can further damage already-compromised yin fluids and worsen the condition.