Dysuria is the sensation of pain and/or burning, stinging, or itching of the urethra or urethral meatus associated with urination. This is exacerbated by and associated with detrusor muscle contraction and urethral peristalsis, which stimulates the submucosal pain receptors, resulting in pain or a burning sensation during urination.

Dysuria isn’t about how often a person go (urinary frequency), though urinary frequency often happens together with dysuria. Dysuria is not a diagnosis. It’s a sign or symptom of an underlying health problem.

True dysuria requires differentiation from other symptoms, which can also occur due to pelvic discomfort from various bladder conditions such as interstitial cystitis, prostatitis, and suprapubic or retropubic pain. This distressing condition can be caused by multiple underlying factors, including urinary tract infections (UTIs), bladder inflammation, sexually transmitted infections (STIs), kidney stones etc.

Pathophysiology

Dysuria typically occurs when urine comes in contact with the inflamed or irritated urethral mucosal lining. This is exacerbated by and associated with detrusor muscle contractions and urethral peristalsis, which stimulates the submucosal pain and sensory receptors, resulting in pain, itching and/or a burning sensation during urination. Various inflammatory or neuropathic processes can increase the sensitivity of these receptors.

Occasionally, inflammation from surrounding organs, such as the colon, can result in dysuria.

Noninfectious causes of dysuria, such as urinary calculi, tumors, trauma, strictures or foreign bodies, and atrophic vaginitis, can result from irritation of the urethral or bladder mucosa. Decreased capacity and elasticity of the detrusor muscle can cause urinary urgency or incontinence as well as dysuria.

Who gets dysuria?

Men and women of any age can experience painful urination, but it’s more common in women. Urinary tract infections (UTIs) are commonly associated with dysuria. Urinary tract infections are more common in women than men.

Other people at a higher risk of dysuria include:

• Pregnant women.
• Diabetic patients (men and women).
• Other disease and/or infection(s) of the bladder and/or urinary tract.

What are the symptoms of dysuria?

History

Symptoms of painful urination or dysuria can vary between men and women, but both genders usually describe it as a burning (most common symptom), stinging or itching.

A good doctor should try to determine the timing, severity, duration, and persistence of the symptoms. For example, pain at the beginning of urination suggests a urethral problem such as urethritis. Pain at the end of urination may be from the bladder or prostate.

Initial history should include features of a possible local cause that may be causing dysuria, such as vaginal or urethral irritation. Any history regarding risk factors like pregnancy, the possibility of a kidney stone, trauma, tumor, recent urologic procedures, and possible urologic obstruction merits consideration.

Patient history should include information regarding associated symptoms like fever, chills, flank pain, low back pain, nausea, vomiting, joint pains, hematuria, nocturia, urgency, frequency, and incontinence. 

History regarding recent sexual activity is crucial. Attention must be given to gender-specific details. In women, it is essential to note menstrual history, complaints of vaginal discharge, and whether the patient is using contraception. Males can present with different symptoms than females. Symptoms may highlight the anatomical site of pathology (see Image. Illustration of Dysuria). Males may experience perineal pain or obstructive urinary symptoms and dysuria, which could be caused by prostatitis.

Sexual Activity

Male patients require inspection for a urethral discharge, and the urethral meatus should be checked for redness, crusting, and exudate. The inside lining of the underwear should also be checked for signs of discharge. If urethritis or a discharge is suspected, the urethra can be milked to elicit a specimen for testing. This is done by placing a gloved finger at the base of the penis on the ventral surface and pressing inwards. Then, slowly move the entire hand forward towards the glans. Any discharge produced should be collected for culture.

In older patients, a history regarding changes in mental status is necessary, as often, the most common symptom of a UTI in older adults is confusion. Obtaining a history regarding the recurrence of symptoms is also necessary.

Physical examination

A thorough physical examination should be performed. A purulent urethral discharge is suggestive of gonorrhea. Isolated dysuria without other symptoms is most likely from chlamydia. Dysuria with genital ulcers suggests possible herpes simplex virus, and balanoposthitis is sometimes associated with Mycobacterium genitalium.

The clinician should also look for physical findings of fever, rash, direct tenderness over the bladder area, and joint pain. Physical findings of increased temperature, rapid pulse, or low blood pressure in the presence of dysuria can indicate systemic infection. Regional lymph nodes should be palpated. Urological obstruction due to a stone or tumor can result in findings of flank pain, hematuria, decreased urination, and bladder spasms. All these physical findings should be investigated carefully.

Symptoms in women can be internal or external. Pain outside vaginal area may be caused by inflammation or irritation of this sensitive skin. Internal pain can be a symptom of a urinary tract infection.

How is dysuria diagnosed?

Review complete medical history of your patient, ask about current and past medical conditions, such as diabetes mellitus or immunodeficiency disorders. Also ask about his/her sexual history to determine if an STI could be the cause of the pain. Tests to screen for STIs may also be needed, especially if there is any discharge from penis or from vagina. If you are a woman of childbearing age, a pregnancy test may be done. Also ask about current prescriptions and over-the-counter medication use and any tried to manage the dysuria, ask about current symptoms and obtain a clean catch sample of urine.

Urine sample will be analyzed for white blood cells, red blood cells or foreign chemicals. The presence of white blood cells tells us that our patient has inflammation in her/his urinary tract.

A urine culture reveals if patient has a urinary tract infection and if so, the bacteria that are causing it. This information allows doctor to select the best medicine that will work best in treating that specific bacteria. 

Urine analysis

Urinalysis is the most useful test to start the workup in a patient with dysuria. Urinalyses positive for nitrites carry a high predictive value of a positive urine culture (75%-95%). Positive leukocytes (anything more than a trace positive) are also highly predictive but slightly less than nitrites (65%-85%). The presence of both positive nitrites and leukocytes on a dipstick is highly predictive. Dysuria in a patient with only positive leukocyte esterase or pyuria in the urine suggests urethritis.

Gram stain microscopy showing Gram-negative diplococci is diagnostic for gonorrhea. Typically, microscopic examination of urethral secretions demonstrating 5 white blood cells (WBCs) or more per oil immersion microscopic field is diagnostic for urethritis; however, some have suggested this cutoff be lowered to just 2 WBCs. The most sensitive test for male gonorrhea or chlamydia is urinary nucleic acid amplification testing (NAAT). The sample should be obtained at least 20 minutes after the most recent void and optimally at least 1 hour afterward.

Urine culture

Patients who do not respond to initial treatment and those with risk factors for a possible complicated UTI should have a full urine culture and sensitivity analysis performed. If a systemic infection is suspected, it is important to check a complete blood count and a metabolic panel, including serum creatinine, especially if the patient has nausea, vomiting, fever, or chills. Blood cultures must be performed if there is a suspicion of systemic spread of infection. In severe cases, hospitalization should be considered.

If STIs are suspected, such as in younger, sexually active patients, a urethral or cervical/vaginal probe should be performed. Samples should be obtained to diagnose Neisseria gonorrhoeae and Chlamydia trachomatis. Women with vaginal symptoms should have a wet mount examination or a vaginal DNA probe. In male patients with suspected chronic prostatitis, gentle prostatic massage can help obtain a sample of the expressed prostatic secretions for a urine culture. If the patient has suspected hematuria and bladder cancer or has a significant smoking history, then urine cytology can be helpful in addition to cystoscopy.

Imaging tests

Imaging tests like ultrasonography or CT scan may be in order in cases of dysuria where patients show signs of having a complicated UTI, obstruction, unexplained fevers, flank pain, hydronephrosis, abscess, stones, or tumors. However, imaging is not necessary in most cases of simple dysuria. In selected cases, cystoscopy can be performed to evaluate symptoms of chronic or intractable dysuria resistant to standard therapies, which can be associated with bladder cancer, vesicle stones, prostatitis, or hematuria.

Urethral Pain Syndrome

The exact cause of urethral pain syndrome is unknown. Formerly urethral syndrome, this syndrome typically presents with dysuria as a key symptom. Other symptoms include urinary frequency and suprapubic discomfort. The bladder pain is relieved somewhat by voiding. There may also be hesitancy, slowing of the urinary stream, and a feeling of incomplete bladder emptying. Urine cultures are typically negative, and the urinary symptoms are usually worse during the day than nighttime.

Urethral pain syndrome is found predominantly in women aged 30 to 50 years. In this group of women, vaginal pathology (vaginal infections, atrophic vaginitis, and similar pathology) should be carefully excluded.

The diagnosis is primarily one of exclusion. There is an overlap between urethral pain syndrome and interstitial cystitis, as there is a definite lack of consensus on specific criteria between these disorders, and they may not be mutually exclusive. 

Reactive Arthritis

Formerly called Reiter syndrome, reactive arthritis was historically used to describe the combination of urethritis, conjunctivitis, and arthritis. Arthritis is usually a postinfectious autoimmune response. Reiter syndrome reflects only a portion of all patients with reactive arthritis. It is defined as arthritis, which follows an infection that cannot be cultured from the affected joint.

When triggered by a sexually transmitted organism, the condition is called sexually acquired reactive arthritis. It usually presents in younger adults, with gastrointestinal and genitourinary infections being the most common triggering events. The most common causative genitourinary organism is Chlamydia trachomatis, followed by Chlamydia pneumoniae, E. coli, Ureaplasma urealyticum, and Mycoplasma genitalium. Intravesical bacillus Calmette-Guérin (BCG), an immunotherapy for bladder cancer, has also been identified as a rare cause, affecting about 1% to 2% of treated patients.

The arthritis produced is usually acute, nonsymmetrical, and typically affects the lower extremities (predominantly knees), although it may occur in almost any joint. This arthritis typically follows the original infection by 1 to 4 weeks. Ocular effects are present in about 20% of all cases of reactive arthritis. The diagnosis is made by clinical suspicion where there is a history of urethritis preceding arthritis and the lack of any evidence for other types of arthritis.

Tests for reactive arthritis

Urinary NAAT can help identify chlamydia and gonorrhea in suspected cases. Human leukocyte antigen B27 (HLA-B27) testing will be positive in 30% to 50% of patients with reactive arthritis, but a negative test does not rule it out.

Appropriate antibiotic treatment (both allopathic and Homeopathic) is usually recommended for chlamydia-based reactive arthritis if an active infection is present. Allopathic antibiotics for chronic infection-related arthritis are more controversial as most randomized trials of long-term antibiotic therapy show little or no improvement. Allopathic treatment of arthritis includes NSAIDs, intra-articular and systemic glucocorticoids, and other disease-modifying agents such as sulfasalazine and methotrexate, remission in 3-5 months.

With Homeopathic treatment (given below) reactive arthritis typically lasts only 3 to 5 weeks, and most patients enjoy a complete cure.

What are the causes of dysuria or painful urination?

The causes of dysuria can be divided broadly into 2 categories: infectious and noninfectious. Infectious causes include UTIs, urethritis, pyelonephritis, prostatitis, vaginitis, and STIs. Noninfectious causes include skin conditions, foreign bodies or stones in the urinary tract, trauma, benign prostatic hypertrophy, and tumors. Additionally, interstitial cystitis, certain medications (especially allopathic), specific anatomic abnormalities, menopause, reactive arthritis (Reiter syndrome), and atrophic vaginitis can all cause dysuria. 

Common cause

One of the most common causes of dysuria is a UTI, which occurs in both males and females. Due to anatomical considerations, UTIs are much more common in females than males. In females, bacteria can reach the bladder more easily due to a shorter and straighter urethra than in males, as the bacteria have far less distance to travel to reach the bladder from the urethral meatus. Females who use the wrong wiping technique, from back to front instead of the preferred front to back, take baths instead of showers, or do not use washcloths to clean their vaginal area first when bathing, can predispose themselves to more frequent UTIs due to repeated contamination of the urethral meatus with perirectal and other bacteria. Females also tend to experience dysuria more frequently than males due to their higher likelihood of recurrent UTIs.

Most UTIs are uncomplicated and relatively simple to treat. However, persistent dysuria may be associated with complicated UTIs, which are found in men with UTIs, incompletely treated simple UTIs, prostatitis, pregnancy, immunocompromised status, catheters, nephrolithiasis, renal failure, dialysis, neurogenic bladder, anatomical or functional abnormalities of the urinary tract, pelvic floor dysfunction, and overactive bladder.

Infections causing dysuria

The most common cause of male urethritis is infectious from sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium. Chlamydia is the most commonly identified cause of nongonococcal urethritis (found in about 50% of cases), followed by Mycoplasma genitalium. Other organisms, such as Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Gardnerella vaginalis, and Ureaplasma urealyticum, are less commonly found. Refractory cases should have testing for Trichomonas vaginalis. When testing patients suspected or at risk for STIs, consider screening for HIV and syphilis. Gonorrhea is found in about 22% of symptomatic men.

Bacterial prostatitis

Urethritis associated with bacterial prostatitis is often caused by gram-negative organisms such as Escherichia coli (E coli). Chlamydia trachomatis most often causes dysuria and epididymitis in men younger than 35 years and by E coli, Pseudomonas, and other gram-negative coliforms in older men.

Dysuria associated with frequency and suprapubic pain without objective evidence of infection, inflammation, or any other identifiable cause is sometimes called urethral pain syndrome (formerly urethral syndrome). This is similar to mild interstitial cystitis, possibly just a different variation of the same disorder. Both lack positive urine findings of infection.

Urethral Syndrome

Urethral syndrome has more continuous but milder dysuria, usually described as a constant irritation. It is possibly related to urethral stenosis and/or hormonal imbalances, although the exact cause remains unknown. Painful spasms of the pelvic musculature are common. Suprapubic discomfort and urinary frequency may be present but are usually not the primary urinary symptoms and are generally less severe than interstitial cystitis. Urinary frequency is much more severe during the daytime, often requiring voiding every 30 to 60 minutes with little or no nocturia. Urethral syndrome patients are typically females ranging from 13 to 70 years of age.

Interstitial cystitis typically has more bladder discomfort, frequency, urgency, and pain when the bladder is full, somewhat relieved upon voiding.

Food causing dysuria

Various foods can increase bladder and urethral irritation, of which caffeine is the most prevalent. High-potassium and hot, spicy foods also irritate the bladder and urethra.

Uncommon causes of dysuria include endometriosis, atrophic vaginitis, urethral strictures, diverticula, inflammation or infection of the paraurethral/Skene’s glands, syphilis, mycobacterium, herpes genitalis, and infected urachal cysts. Other causes include a double-J urinary stent, recent urethral instrumentation or Foley catheterization, bladder calculi, prostatitis, traumatic sexual intercourse, pelvic floor dysfunction, herpes zoster, and lichen sclerosis.

Topically applied products, such as douches, bubble baths, and contraceptive gels, can also irritate the urethra.

Overactive bladder will present with urgency and frequency as the primary symptoms. There may also be intermittent suprapubic pain or discomfort.

Complications

Depending on the cause of dysuria, short-term complications can include acute renal failure, development of systemic infection and sepsis, acute anemia from hematuria, urethral strictures with urinary retention, and emergent hospitalizations. Long-term complications include end-stage renal disease, infertility, long-term disability from recurrent infections, strictures or urinary tract cancers, and death from severe systemic infections or advanced urinary tract cancers. Patients with complicated UTIs can develop recurrences with expanded antibiotic (allopathic) resistance, leading to higher rates of hospitalizations and increased morbidity and mortality

Both (allopathic and Homeopathic) treatment of dysuria depends on the underlying etiology whenever possible. The most common cause of dysuria is a UTI. Empiric antibiotic therapy based on a patient’s history and symptoms is usually the most cost-effective treatment. No further evaluation is necessary in those cases where dysuria from uncomplicated UTI is suspected. When the clinician suspects a complicated UTI, as in the presence of associated symptoms like nausea, vomiting, fever, or chills, then along with starting antibiotics, additional testing like blood cultures, a metabolic panel, or a complete blood count are all viable options. Imaging with ultrasonography or a CT scan can diagnose suspected pyelonephritis, stones, or urinary obstruction.

Allopathic treatment for dysuria

How is dysuria treated with allopathic drugs?

Antibiotic Therapy

Antibiotic therapy for urethritis depends on the underlying organism, which is most likely sexually transmitted for example: 

Gonorrhea

• Treated with ceftriaxone, cefixime, ceftizoxime, cefoxitin, or azithromycin.
• Quinolones are no longer recommended due to increasing resistance.

Nongonococcal urethritis

• Usually treated with single-dose azithromycin (1 gram) or doxycycline (100 mg BID for 7 days).
• These regimens generally have about an 80% overall cure rate.

Chlamydia

• Doxycycline is generally preferred.

Mycoplasma

• A relatively common cause of persistent urethritis, mycoplasma demonstrates resistance to standard therapy with doxycycline, which now has a high failure rate.
• Azithromycin appears more effective than doxycycline and is currently recommended for Mycoplasma genitalium and Ureaplasma urealyticum.
• An extended azithromycin regimen, which tends to avoid induced macrolide resistance, is also available (500 mg orally to start, then 250 mg daily for the next 4 days). This is appropriate for those who fail initial doxycycline therapy.
• Ten days of moxifloxacin 400 mg daily is recommended if this azithromycin regimen fails.
• Prolonged erythromycin therapy does not appear to be effective and is not recommended.
• Recurrent symptoms tend to be related to noncompliance, repeat exposure, chronic prostatitis, or infections with Trichomonas vaginalis or Mycoplasma genitalium.

Trichomonas

Trichomonas is present in only about 2.5% of male urethritis cases. When present, treatment is metronidazole 2 g for the patient and his or her partner. 

Infrequent causes of urethritis include Treponema pallidum (syphilis) and Haemophilus influenza, which can be transmitted during oral sex.

Physicians should be mindful of the possibility of antimicrobial resistance, and optimal antibiotics should be started based on likely pathogens, local resistance patterns, and costs associated with the treatment. When dysuria occurs due to chronic prostatitis in males, appropriate oral antibiotics are recommended after obtaining a urine culture.

If the cause of dysuria is renal stones, various treatment options can be considered depending on the size and location of the calculi. Stones smaller than 5 mm typically pass on their own. Patients should be asked to hydrate themselves and strain the urine to document the evidence of a passed stone. Stones larger than 5 mm are treatable through various modalities, including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, percutaneous nephrolithotomy (PCNL), and rarely open surgery.

Abscess

When the patient presents with dysuria and a suspected perinephric abscess, an imaging study like ultrasonography or a CT scan should be performed. Once it is confirmed to be an abscess, the patient should be hospitalized and intravenous antibiotics should be initiated, followed by open surgical or percutaneous catheter drainage, or both.

If the cause of dysuria is benign prostatic hypertrophy, medical treatment with alpha-blockers or 5-alpha reductase inhibitors should be considered. If the patient has no symptomatic improvement after trying the medical therapy, the surgical option of transurethral resection of the prostate should be considered, but this is typically reserved for other urinary symptoms rather than isolated dysuria.

Pudendal neuralgia and/or pelvic floor dysfunction may also cause dysuria in some patients and should be considered when standard dysuria treatments have failed.

Phenazopyridine

Doxycycline

A clinical trial of this antibiotic may cure some patients of otherwise intractable dysuria from an unusual organism. 

Azithromycin

Estrogen Cream

Other

There is generally no specific surgical treatment for dysuria, Nd:YAG laser ablation is in experimental stages and has shown some promise in carefully selected female patients with symptoms refractory to medical therapy. Laser ablation of squamous metaplasia of the trigone and bladder neck areas has demonstrated success in some patients with trigonitis. The initial necrotic tissue coagulation immediately after laser ablation is followed by the regrowth of normal urothelium.

How is dysuria treated permanently?

Homeopathy has variety of best proven medicines for dysuria in last two hundred years, here are few of them:

Uva Ursi

Cystitis, with bloody urine. Uterine hemorrhage. Chronic vesical irritation, with pain, tenesmus, and catarrhal discharges. Burning after the discharge of slimy urine. Pyelitis. Calculous inflammation. Dyspnea, nausea, vomiting, pulse small and irregular. Cyanosis. Urticaria without itching. Frequent urging, with severe spasms of bladder; burning and tearing pain. Urine contains blood, pus, and much tenacious mucus, with clots in large masses. Involuntary; green urine. Painful dysuria.

Gaultheria

Inflammatory rheumatism, pleurodynia, sciatica, and other neuralgias, come within, the sphere of this remedy. Cystic and prostatic irritation, undue sexual excitement, and renal inflammation. Smarting and burning. Intense erythema.

Borax Vanata

Urine hot, smarting pain in orifice. Pungent smell. Patient afraid to urinate, screams before urinating. Small red particles on diaper. Galactorrhea. Leucorrhea like white of eggs, with sensation as if warm water was flowing. Membranous dysmenorrhea. Sterility. Favors easy conception. Sensation of distention in clitoris with sticking. Pruritus of vulva and eczema.

Calcarea Carbonicum

Urine dark, brown, sour, fetid, abundant, with white sediment, bloody. Irritable bladder. Enuresis. Frequent emissions. Increased desire. Semen emitted too soon. Coition followed by weakness and irritability. 

Before menses, headache, colic, chilliness and leucorrhea. Cutting pains in uterus during menstruation. Uterus easily displaced. Leucorrhea, milky. Uterine polypi.

Sepia Officianalis

Urinary red, adhesive, sand in urine. Involuntary urination, during first sleep. Chronic cystitis, slow micturition, with bearing-down sensation above pubis. Organs cold. Offensive perspiration. Gleet; discharge from urethra. Condyloma surround head of penis. Complaints from coition.

Pelvic organs relaxed. Bearing-down sensation. Leucorrhea yellow, greenish; with much itching. Menses Too late and scanty, irregular; early and profuse; sharp clutching pains. Violent stitches upward in the vagina. Prolapse of uterus and vagina.

Rhus Toxicodendrone

Urine dark, turbid, high-colored, scanty urine, with white sediment. Dysuria, with loss of blood. Swelling of glands and prepuce-dark-red erysipelatous; scrotum thick, swollen, edematous. Itching intense.

Swelling, with intense itching of vulva. Pelvic articulations stiff when beginning to move. Menses early, profuse, and prolonged, acrid. Lochia thin, protracted, offensive diminished, with shooting upwards in vagina.

Lycopodium Clavatum

Pain in back before urinating; ceases after flow; slow in coming, must strain. Retention. Polyuria during the night. Heavy red sediment. No erectile power; impotence. Premature emission. Enlarge prostate. Condylomas.

Menses too late; last too long, too profuse. Vagina dry. Coition painful. Ovarian pain. Varicose veins of pudenda. Leucorrhea, acrid, with burning in vagina. Discharge of blood from genitals during stool.

Chimaphilia Umbilata

Urging to urinate. Urine turbid, offensive, containing ropy or bloody mucus, and depositing a copious sediment. Burning and scalding during micturition and straining afterwards. Must strain before flow comes. Scanty urine. Acute prostatitis, retention, and feeling of a ball in perineum. Fluttering in region of kidney. Sugar in urine. Unable to urinate without standing with feet wide apart and body inclined forward.

Labia inflamed, swollen. Pain in vagina. Hot flashes. Painful tumor of mammae, not ulcerated, with undue secretion of milk. Rapid atrophy of breasts. Women with very large breasts and tumor in the mammary gland with sharp pain through it.

Cannabis Indica

Urine loaded with slimy mucus. Must strain; dribbling; has to wait some time before the urine flows. Stitches and burning in urethra. Dull pain in kidney. After sexual intercourse, backache. Oozing of white, glairy mucus from glans. Satyriasis. Prolonged thrill. Chordee. Sensation of swelling in perineum or near anus, as if sitting on a ball.

Menses profuse, dark, painful, without clots. Backache during menses. Uterine colic, with great nervous agitation and sleeplessness. Sterility. Dysmenorrhea with sexual desire.

Conium Maculatum

Urine with difficulty in voiding. It flows and stops again. Interrupted discharge. Dribbling in old men. Sexual desire increased; power decreased. Sexual nervousness, with feeble erection. Effects of suppressed sexual appetite. Testicles hard and enlarged.

Dysmenorrhea, with drawing-down thighs. Mammae lax and shrunken, hard, painful to touch. Stitches in nipples. Wants to press breast hard with hand. Menses delayed and scanty, parts sensitive. Breasts enlarge and become painful before and during menses. Rash before menses. Itching around pudenda. Unready conception. Induration of os and cervix. Ovaritis; ovary enlarged, indurated; lancinating pain. Ill effects of repressed sexual desire or suppressed menses, or from excessive indulgence. Leucorrhea after micturition.

Copaiva Officianalis

Constant, ineffectual desire to urinate; contraction of the urethra; emission of urine in drops. Itching, soreness, and sensation of scalding in the urethra, before and after the emission of urine. Inflammation of the urinary organs; swelling, dilatation, and inflammation of the orifice of the urethra. Pain as from excoriation in the orifice of the urethra, which remains wide open, with throbbing pain in the penis generally. Hematuria. Urine foaming; greenish-turbid, smelling like violets. Yellow, purulent gonorrhea. Burning and sensation of dryness in the region of the prostate gland; induration of the prostate gland. Swelling and induration of the testes.

Burning and itching of urethra; itching of vulva; burning red spots in vulva. Milky, acid, excoriating discharge with painful menstruation. Profuse gonorrheal discharge. Metrorrhagia.

Clematric Erecta

Troubles from suppressed gonorrhea. Violent erections with stitches in urethra. Testicles hang heavy or retracted, with pain along spermatic cord; worse, right side. Tingling in urethra after urinating. Frequent, scanty urination; burning at orifice. Interrupted flow. Urethra feels constricted. Urine emitted drop by drop. Inability to pass all the urine; dribbling after urinating. Pain worse at night, pain along the spermatic cord. Commencing stricture.

Red, burning, vesicular, scaly, scabby. Itches terribly. Glands hot, painful, swollen; worse inguinal glands. Glandular indurations and tumors of breast. Varicose ulcers.

Ledum Pauluster

Burning in urethra after urinating. Stream of urine frequently stops during its flow. Frequent want to urinate, with scanty emission. Diminished secretion of urine. Frequent and copious emission of urine. Swelling of urethra. Violent and prolonged erections. Pollutions of sanguineous or serous semen. Inflammation of the glans. Inflammatory swelling of penis (balanitis); the urethra is almost closed. Increased sexual desire. Catamenia too early and too copious; the blood is bright red.

Belladonna

Urine retention. Acute urinary infections. Sensation of motion in bladder. Urine scanty, with tenesmus; dark and turbid, loaded with phosphates. Vesical region sensitive. Incontinence, continuous dropping. Frequent and profuse. Hematuria where no pathological condition can be found. Prostatic hypertrophy. Testicles hard, drawn up, inflamed. Nocturnal sweat of genitals. Flow of prostatic fluid. Desire diminished.

Sensitive forcing downwards, as if all the viscera would protrude at genitals. Dryness and heat of vagina. Dragging around loins. Pain in sacrum. Menses increased, bright red, too early, too profuse. Hemorrhage hot. Cutting pain from hip to hip. Menses and lochia very offensive and hot. Labor-pains come and go suddenly. Mastitis pain, throbbing, redness, streaks radiate from nipple. Breasts feel heavy; are hard and red. Tumors of breast, pain worse lying down. Badly smelling hemorrhages, hot gushes of blood. Diminished lochia.

Cantharis Vasicatoria

Intolerable urging to urinate. Nephritis with bloody urine. Violent paroxysms of cutting and burning in whole renal region, with painful urging to urinate. Intolerable tenesmus; cutting before, during, and after urine. Urine scalds him and is passed drop by drop. Constant desire to urinate. Membranous scales looking like bran in water. Urine jelly-like, shreddy. Strong desire for sex; painful erections. Pain in glans. Priapism in gonorrhea.

Retained placenta, with painful urination. Nymphomania. Puerperal metritis, with inflammation of bladder. Menses too early and too profuse; black swelling of vulva with irritation. Constant discharge from uterus; worse false step. Burning ovarian pain; extremely sensitive. Pain in os coccyx, lancinating and tearing.

Acid Benzoicum

Repulsive odor from urine; changeable color; brown, acid. Enuresis; dribbling, offensive urine of old men. Excess of uric acid. Vesical catarrh from suppressed gonorrhea. Cystitis. Pressure on spinal column. Coldness in sacrum. Dull pain in region of kidneys.

Nitricum Acidium

Urine scanty, dark, offensive. Cold on passing. Burning and stinging. Urine bloody and albuminous. Alternation of cloudy, phosphatic urine with profuse urinary secretion in old prostatic cases. Soreness and burning in glans and beneath prepuce. Ulcers; burn and sting; exude, offensive matter.

External parts sore, with ulcers. Leucorrhea brown, flesh-colored, watery, or stringy, offensive. Hair on genitals falls out. Uterine hemorrhages. Menses early, profuse, like muddy water, with pain in back, hips and thighs. Stitches through vagina. Metrorrhagia after parturition.

Phosphoricum Acidium

Urine frequent, profuse, watery, milky. Diabetes. Micturition, preceded by anxiety and followed by burning. Frequent urination at night. Phosphaturia. Emissions at night and at stool. Seminal vasculitis. Sexual power deficient; testicles tender and swollen. Parts relax during embrace. Prostatorrhea, even when passing a soft stool. Eczema of scrotum. Edema of prepuce, and swollen glans-penis. Herpes preputialis. Sycotic excrescences. 

Menses too early and profuse, with pain in liver. Itching; yellow leucorrhea after menses. Milk scanty; health deteriorated from nursing.

Staphysagria

Especially after self-abuse; persistent dwelling on sexual subjects. Spermatorrhea, with sunken features; guilty look; emissions, with backache and weakness and sexual neurasthenia. Dyspnea after coition. Parts very sensitive, worse sitting down. Irritable bladder in young married women. Leucorrhea. Prolapsus, with sinking in the abdomen; aching around the hips.

Cystocele (locally and internally). Cystitis in lying-in patients. Ineffectual urging to urinate in newly married women. Pressure upon bladder; feels as if it did not empty. Sensation as if a drop of urine were rolling continuously along the channel. Burning in urethra during micturition. Prostatic troubles: frequent urination, burning in urethra when not urinating. Urging and pain after urinating. Pain after lithotomy.

Sabal Serrulata

Constant desire to urinate at night. Enuresis; paresis of sphincter vesicae. Chronic gonorrhea. Difficult urination. Cystitis with prostatic hypertrophy. Prostatic troubles; enlargement; discharge of prostatic fluid. Wasting of testes and loss of sexual power. Coitus painful at the time of emission. Sexual neurotics. Organs feel cold.

Ovaries tender and enlarge; breasts shrivel. Young female neurotics; suppressed or perverted sexual inclination.

Ferrum Picricum

Pain along entire urethra. Frequent micturition at night, with full feeling and pressure in rectum. Smarting at neck of bladder and penis. Retention of urine.

Kreosotum

Urine offensive. Violent itching of vulva and vagina, worse when urinating. Can urinate only when lying; cannot get out of bed quick enough during first sleep. Dreams of urinating. Enuresis in the first part of night. Must hurry when desire comes to urinate.

Corrosive itching within vulva, burning and swelling of labia; violent itching between labia and thighs. Burning and soreness in external and internal parts. Leucorrhea, yellow, acrid; odor of green corn; worse between periods. Hemorrhage after coition. Menses too early, prolonged. Menstrual flow intermits; ceases on sitting or walking; reappears on lying down. Pain worse after menses.

Berberus Vulgaris

Urinary burning pains. Sensation as if some urine remained after urinating. Urine with thick mucus and bright-red, mealy sediment. Bubbling, sore sensation in kidneys. Pain in bladder region. Pain in the thighs and loins on urinating. Frequent urination: urethra burns when not urinating. Neuralgia of spermatic cord and testicles. Smarting, burning, stitching in testicles, in prepuce and scrotum.

Pinching constriction in mons veneris, vaginismus, contraction and tenderness of vagina. Burning and soreness in vagina. Desire diminished, cutting pain during coition. Menses scanty, gray mucus, with pain in kidneys and chilliness, pain down thighs. Leucorrhea, grayish mucus, with painful urinary symptoms. Neuralgia of ovaries and vagina.

Sarsaparilla officianalis

Urine scanty, slimy, flaky, sandy, bloody. Gravel. Renal colic. Severe pain at conclusion of urination. Urine dribbles while sitting. Bladder distended and tender. Child screams before and while passing urine. Sand on diaper. Renal colic and dysuria in infants. Pain from right kidney downward. Tenesmus of bladder; urine passes in thin, feeble stream. Pain at meatus. Bloody, seminal emissions. Intolerable stench on genitals. Herpetic eruption on genitals. Itching on scrotum and perineum. Syphilis; squamous eruption and bone pains.

Nipples small, withered, retracted. Before menstruation, itching and humid eruption of forehead. Menses late and scanty. Moist eruption in groin before menses.

Thuja Occidentalis

Urethra swollen inflamed. Urinary stream split and small. Sensation of trickling after urinating. Severe cutting after. Frequent micturition accompanying pains. Desire sudden and urgent but cannot be controlled. Paralysis sphincter vesicae. Inflammation of prepuce and glans; pain in penis. Balanitis. Gonorrheal rheumatism. Gonorrhea. Chronic induration of testicles. Pain and burning felt near neck of bladder, with frequent and urgent desire to urinate. Prostatic enlargement.

Vagina very sensitive. Warty excrescences on vulva and perineum. Profuse leucorrhea; thick, greenish. Severe pain in ovary and inguinal region. Menses scanty, retarded. Polypi; fleshy excrescences. Ovaritis; worse left side, at every menstrual period. Profuse perspiration before menses.

Petroselinum Sativam

The urinary symptoms give the keynotes for this remedy. Piles with much itching. Urinary burning, tingling, from perineum throughout whole urethra; sudden urging, to urinate; frequent, voluptuous tickling in fossa navicularis. Gonorrhea; sudden, irresistible desire to urinate; intense biting, itching, deep in urethra; milky discharge.

Apis Mellifica

Urine burning and soreness when urinating. Suppressed, loaded with casts; frequent and involuntary; stinging pain and strangury; scanty, high colored. Incontinence. Last drops burn and smart.

Adema of labia; relieved by cold water. Soreness and stinging pains; ovaritis; worse in right ovary. Menses suppressed, with cerebral and head symptoms, especially in young girls. Dysmenorrhea, with severe ovarian pains. Metrorrhagia profuse, with heavy abdomen, faintness, stinging pain. Sense of tightness. Bearing down, as if menses were to appear. Ovarian tumors, metritis with stinging pains. Great tenderness over abdomen and uterine region.

Natrium Muriaticum

Pain just after urinating. Increased, involuntary when walking, coughing, etc. Has to wait a long time for it to pass if others are present. Emission, even after coitus. Impotence with retarded emission.

Menses irregular; usually profuse. Vagina dry. Leucorrhea acrid, watery. Bearing-down pains; worse in morning. Prolapsus uteri, with cutting in urethra. Ineffectual labor-pains. Suppressed menses. Hot during menses. 

Merc Sole

Frequent urging. Greenish discharge from urethra; burning in urethra on beginning to urinate. Urine dark, scanty, bloody, albuminous. Vesicles and ulcers; soft chancre. Cold genitals. Prepuce irritated, itches. Nocturnal emissions, stained with blood.

Menses profuse, with abdominal pains. Leucorrhea excoriating, greenish and bloody; sensation of rawness in parts. Stinging pain in ovaries. Itching and burning; worse, after urinating; better, washing with cold water. Morning sickness, with profuse salivation. Mammae painful and full of milk at menses.

P. S: This article is only for doctors and students having good knowledge about Homeopathy and allopathy.

For proper consultation and treatment, please visit our clinic.

None of above-mentioned medicine(s) is/are the full/complete treatment but just hints for treatment; every patient has his/her own constitutional medicine.

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

 Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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