Dysuria: Is it Just Pain or Something Worse?

As we enter the warmer weather seasons, I am starting to see more kids with a chief complaint of “dysuria,” or pain when they pee. When kids say it hurts to pee, most parents immediately assume there is a urinary tract infection. However, less than 10% of kids with painful urination (even if they have a fever, too) actually have a urinary tract infection. So, what’s up with the pee pain??

 

First of all, it’s important to make sure the child has true dysuria. Kids may not always have the right vocabulary or communication skills to relay painful urination. For example, a child in a diaper who cries with a wet diaper may be voicing discomfort from a diaper rash. Or, an older child may say it hurts to pee when in fact, she is trying to voice discomfort from itching, as seen in pinworms.

 

While it’s important to rule out a urinary tract infection, the most common cause of new dysuria, in an otherwise healthy boy or girl, is very commonly local irritation. Let me break this down for boys versus girls.

 

Boys:

 

Circumcised little boys almost never have a urinary tract infection. The anatomy of it all is quite protective. It’s more difficult for bacteria to climb up the urethra in a circumcised little boy because there’s less cross contamination. However, circumcised little boys may still complain of dysuria.

 

The urethral meatus, or the exit hole at the tip of a circumcised penis, is easily irritated: it’s folded into a synthetic or cloth diaper, is exposed to ammonia and other chemicals in urine, and is subject to other trauma from clothes and every day life. With repeated trauma, the meatus can get inflamed, or irritated, and eventually can narrow. An irritated meatus is a painful one, and it hurts to have to push urine through a small exit hole, too. So, it stands to reason, that even a circumcised little boy would complain of dysuria from time to time.

 

Uncircumcised little boys are less likely to have dysuria from local trauma, and more likely to have symptoms from local infections. Germs can get stuck under the foreskin, and cause a local skin infection, which irritates the skin at the urethral exit hole. When urine flows by, it burns.

 

Girls:

 

Little girls are a bit more complex. So again, it’s important to rule out UTI. But, just like little boys, girls can have localized irritation that consequently burns when they pee. For girls, though, it can be difficult to tell if the pain is from irritation at the meatus or the vagina. Little girls may have vaginal discharge, itchiness, and even unusual odors in addition to dysuria, which can be alarming to parents. So, when in doubt, have it checked out!

 

Causes:

 

Things like bubble baths, wet bathing suits, sweat, lotion, tight-fitting pants, and fancy underpants can all cause localized irritation. Mild dehydration, urinating with a full bladder, and even constipation can also cause dysuria.

 

Here are my top tips and tricks for preventing painful pee:

 

  1. Avoid contamination: little boys should keep their penis clean, and little girls should wipe from front to back.
  2. Avoid irritation: both boys and girls should avoid scented lotions, wipes, or soaps. Also, only take bubble baths occasionally, and wait until the end of bath time to wash hair. This way, no one is sitting in dirty, soapy water.
  3. Avoid excess moisture: don’t wear wet swimsuits or clothes for a long time, and if your child is sweaty, have him/her rinse off.
  4. Dink plenty of water and avoid excess sugar: these are just good healthy habits, but dilute urine is gentler. Things like caffeine, carbonation, and excess sugar or sweeteners can also be bladder irritants.

 

If your parent radar goes off, never hesitate to come see the pediatric experts at KidMed. We can test your child’s urine for infection, but we can also give you other resources to help treat the pain!

 

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