Homeopathy remedies for Dysuria (Painful Urination)
A burning sensation while urinating is a frustrating and relatively common symptom. Sometimes there is a hidden cause, sometimes not.Dysuria results from lower urinary tract irritation or inflammation, which stimulates nerve endings in the bladder and urethra. The onset of pain provides clues to its cause. For example, pain just before voiding usually indicates bladder irritation or distention, whereas pain at the start of urination typically results from bladder outlet irritation. Pain at the end of voiding may signal bladder spasms; in women, it may indicate vaginal Candidiasis.
Causes-
·
Urinary tract infection
·
Urethritis (in men) caused by gonorrhea or
chlamydia
·
Prostatitis
·
Interstitial cystitis
·
Candidaldermatitis or vaginitis
·
Contact dermatitis or vulvitis
·
Radiation cystitis
·
Urinary retention
Differential Diagnosis of dysuria
UTI is the most common cause of dysuria. Dysuria can also be from other focal inflammation in the vagina, perineal area, prostate, or urethra; however, common vaginal infections that cause dysuria include bacterial vaginosis, vaginal Candidiasis, and vaginal trichomoniasis.
Vaginal atrophy, from the loss of estrogen stimulation to the vaginal mucosa and vulvar skin, can also be associated with dysuria. As the epithelium thins, it becomes prone to injury, with resulting dysuria and pruritis.
Urethritis is caused by sexually transmitted infections such as gonorrhea, Chlamydia, herpes simplex, or trichomoniasis. Prostate infections can cause dysuria and are typically associated with decreased urine flow, urgency, and hesitancy. Both acute prostatitis and upper tract UTI may present as fever and dysuria.
Dysuria is sometimes attributed to the poorly understood “urethral syndrome”. This syndrome of pain on urination without clearly identifiable cause has been ascribed to trauma, chemical irritation, low levels of urinary pathogens, or infection of periurethral tissue by unknown microorganisms.
The diagnosis of urethral syndrome is made only after the symptomatic patient has had normal findings on physical examination, and normal urinalysis and culture.
Workup and Diagnosis for dysuria
¨ History
-UTI, STD, sexual activity, recent antibiotic exposure
-Instrumentation/irritation (urinary catheters, bubble baths, creams, masturbation)
-Fever, abdominal pain, flank pain, vaginal discharge
-Enuresis (especially new-onset), macroscopic haematuria, frequency, urgency
-Family history of kidney stones (increased likelihood of hyper-calciuria)
¨ Physical exam
-Fever, CVA tenderness
-Exam of the urethra/periurethral area for irritation
-Pelvic exam (if done) for cervical motions tenderness, cervicitis, or vaginal discharge.
¨ Labs
-Urinalysis, urine culture
-STD screening if sexually active
-Urine spot calcium and creatinine if evidence of microscopic haematuria
¨ Additional studies based on clinical suspected
-Pelvic ultrasound if PID suspected
-Renal ultrasound/voiding cystourethrogram if history of previous UTI (in girls <7 and boys of any age), or if macroscopic haematuria is present.
-High resolution CT without contrast (kidney stones)
-24-hour urine calcium (hypercalciuria, kidney stones)
Treatment of dysuria
- UTI: Empiric antibiotics (e.g., co-trimoxazole) pending culture; adjust antibiotics based on bacterial sensitivities
- STD
-For an ill patient with signs of PID, consider hospital admission; give IV cefoxitin and PO doxycycline
- Candidal vaginitis: Topical antifungal agents or oral fluconazole
- Hypercalciuria/kidney stones
-Treat with thiazide diuretics (decrease urinary calcium excretion) if patient is persistently symptomatic and/or has urinary calculi.
- Avoid instrumentation/local irritations (e.g. bubble baths)
Remedies-
1. Cantharis. [Canth]
Cantharis symptoms are usually the first ones inquired after when a case of urinary difficulty presents itself. Its symptoms are clear cut, and should not be confounded with those of any other remedy. There is a persistent and violent urging to urinate, with great tenesmus; the urine is passed only in drops and seems like molten lead passing through the urethra, so intense is the burning.
There is with this, usually an aching in the small of the back. It is often indicated in acute cystitis, gravel and urethritis, the great keynotes being the burning and the tenesmus of the bladder; haematuria also calls for Cantharis under certain conditions.
Cantharis symptoms are usually the first ones inquired after when a case of urinary difficulty presents itself. Its symptoms are clear cut, and should not be confounded with those of any other remedy. There is a persistent and violent urging to urinate, with great tenesmus; the urine is passed only in drops and seems like molten lead passing through the urethra, so intense is the burning.
There is with this, usually an aching in the small of the back. It is often indicated in acute cystitis, gravel and urethritis, the great keynotes being the burning and the tenesmus of the bladder; haematuria also calls for Cantharis under certain conditions.
2. Mercurius corrosivus [Merc-c]
Has tenesmus of the bladder with intense burning. The burning is less, but the tenesmus is greater, than in Cantharis. The passing of the urine drop by drop reminds of Aconite, which has the same symptoms. Aconite, however, is adapted to sudden retention of urine, for as soon as the disease becomes fully localized as an inflammation Aconite ceases to be the remedy. Cantharis and Nux vomica have also a similarity in the frequent fruitless efforts to urinate. In the region of the kidneys there is cutting pain which extends into the abdomen, the bladder and urethra. The most distressing symptom is the constant urging to urinate, even a few spoonfuls of urine in the bladder bringing on this urging, which is accompanied by the terrible distress at the neck of the bladder. This pain is aggravated immediately following micturition, showing that with this drug the trouble is more urethral. The urine itself under Cantharis is of a deep red color, deposits sediment of mucus and often contains fibrinous casts.
Has tenesmus of the bladder with intense burning. The burning is less, but the tenesmus is greater, than in Cantharis. The passing of the urine drop by drop reminds of Aconite, which has the same symptoms. Aconite, however, is adapted to sudden retention of urine, for as soon as the disease becomes fully localized as an inflammation Aconite ceases to be the remedy. Cantharis and Nux vomica have also a similarity in the frequent fruitless efforts to urinate. In the region of the kidneys there is cutting pain which extends into the abdomen, the bladder and urethra. The most distressing symptom is the constant urging to urinate, even a few spoonfuls of urine in the bladder bringing on this urging, which is accompanied by the terrible distress at the neck of the bladder. This pain is aggravated immediately following micturition, showing that with this drug the trouble is more urethral. The urine itself under Cantharis is of a deep red color, deposits sediment of mucus and often contains fibrinous casts.
3. Apis mellifica. [Apis]
The symptoms of scanty urine always leads one to consider whether Apis is or is not the remedy, for although Apis produces scanty urine there are number of other drugs that will do the same thing. The keynotes for Apis in urinary affections are scanty or suppressed urine, drowsiness, oedema in in various parts, thirstlessness and suffocation on lying down. The urine is dark, highly aluminous, and contains casts, so it is readily seen how Apis may correspond to any form of Bright's disease. In difficult micturition of children
The symptoms of scanty urine always leads one to consider whether Apis is or is not the remedy, for although Apis produces scanty urine there are number of other drugs that will do the same thing. The keynotes for Apis in urinary affections are scanty or suppressed urine, drowsiness, oedema in in various parts, thirstlessness and suffocation on lying down. The urine is dark, highly aluminous, and contains casts, so it is readily seen how Apis may correspond to any form of Bright's disease. In difficult micturition of children
Apis is often a useful remedy. It has frequent desire, with
the passage of a few drops at a time. Among other symptoms are great irritation
at the neck of the bladder and incontinence of urine. It is also the remedy to
be thought of in retained urine or inflamed bladder after abuse of Cantharis.
4. Apocynum cannabinum. [Apoc]
Apocynum seems to act some what on the kidneys and give rise to various dropsical conditions. It produces scanty urine, which is light in color, or, as it is given, sherry-colored. Its first effect is to produce a copious diuresis; this is followed by the scantiness of urine which results in dropsy. It also produces incontinence and may be useful in enuresis. A sinking bruised feeling at the stomach is an indication for its use. it differs from Arsenic and Apis in the fact that it has unquenchable thirst. Arsenic wants little and often, Apis is thirstless.
Apocynum seems to act some what on the kidneys and give rise to various dropsical conditions. It produces scanty urine, which is light in color, or, as it is given, sherry-colored. Its first effect is to produce a copious diuresis; this is followed by the scantiness of urine which results in dropsy. It also produces incontinence and may be useful in enuresis. A sinking bruised feeling at the stomach is an indication for its use. it differs from Arsenic and Apis in the fact that it has unquenchable thirst. Arsenic wants little and often, Apis is thirstless.
5. Berberis vulgaris.
[Berb vul]
Outside of its action on the genito urinary system Berberis is seldom thought of, land it is one of our principal remedies for troubles of this system. It seems to correspond to many symptoms which occur in cases of renal calculi. It has severe tearing pains in the kidneys, not merely backache, but pains deep in the kidneys themselves; these pains extend down the back in the kidneys themselves; these pains extend down the back and down the ureters into the bladder; nor do stop here, for we find cutting pains in the bladder extending into the urethra. These pains in the back and along the ureters are very severe; they are worse stooping, lying or sitting, and relieved by standing. In the bladder they cause a desire to urinate, and the patient is constantly urinating, for the bladder seems imperfectly emptied. The bladder aches. The urine itself is reddish, has a reddish deposit consisting of mucus, epithelium and lithates. It differs from the Pareira brava urine in being more slimy. Another characteristic symptom of Berberis is pain in the hips while urinating. Coccus cacti has some similar symptoms to Berberis, especially the tearing pains extending from the region of the kidneys, the frequent urging to urinate, the deposits of uric acid and the urine of Coccus cacti is dark. These remedies must be distinguished very carefully as they present many symptoms in common. Berberis has rather more back pains, and seems to act deeper. It is especially indicated in genitourinary troubles, which are due to conditions of atony.
Outside of its action on the genito urinary system Berberis is seldom thought of, land it is one of our principal remedies for troubles of this system. It seems to correspond to many symptoms which occur in cases of renal calculi. It has severe tearing pains in the kidneys, not merely backache, but pains deep in the kidneys themselves; these pains extend down the back in the kidneys themselves; these pains extend down the back and down the ureters into the bladder; nor do stop here, for we find cutting pains in the bladder extending into the urethra. These pains in the back and along the ureters are very severe; they are worse stooping, lying or sitting, and relieved by standing. In the bladder they cause a desire to urinate, and the patient is constantly urinating, for the bladder seems imperfectly emptied. The bladder aches. The urine itself is reddish, has a reddish deposit consisting of mucus, epithelium and lithates. It differs from the Pareira brava urine in being more slimy. Another characteristic symptom of Berberis is pain in the hips while urinating. Coccus cacti has some similar symptoms to Berberis, especially the tearing pains extending from the region of the kidneys, the frequent urging to urinate, the deposits of uric acid and the urine of Coccus cacti is dark. These remedies must be distinguished very carefully as they present many symptoms in common. Berberis has rather more back pains, and seems to act deeper. It is especially indicated in genitourinary troubles, which are due to conditions of atony.
6. Pareira brava.
[Pareir]
This is another drug very similar to Berberis vulgaris-as to pains in the back it is quite similar; yet they do not stop in the hips with Pareira as they do under mostly clinical. It has been found useful in cystitis where there is violent straining to urinate, where the patient has to kneel to urinate, where the urine scalds terribly and where these violent pains in the thighs are present. The urine has a strong ammoniacal odor. Contains thick viscid white mucus or deposits or red sand. The three-legged stool of the drug seems to be: the pain in the thighs, the getting down on all fours to urinate, and the ammoniacal odor of the urine. It is also a useful remedy in the condition known as irritable bladder, dull aching in bladder, feeling as if the bladder were distended, with pain.
This is another drug very similar to Berberis vulgaris-as to pains in the back it is quite similar; yet they do not stop in the hips with Pareira as they do under mostly clinical. It has been found useful in cystitis where there is violent straining to urinate, where the patient has to kneel to urinate, where the urine scalds terribly and where these violent pains in the thighs are present. The urine has a strong ammoniacal odor. Contains thick viscid white mucus or deposits or red sand. The three-legged stool of the drug seems to be: the pain in the thighs, the getting down on all fours to urinate, and the ammoniacal odor of the urine. It is also a useful remedy in the condition known as irritable bladder, dull aching in bladder, feeling as if the bladder were distended, with pain.
7. Equisetum hyemale.
[Equis]
Equisetum acts similarly to Cantharis, but it has less tenesmus and haematuria, and the urine is less scalding. There is pain in the bladder as if too full, not relieved by micturition; the constant desire to urinate is not even relieved by copious urination. The urine is scanty, high colored and contains much mucus. Much mucus in the urine is more indicative of Equisetum than of Cantharis. Chimaphila also has much mucus, is
Equisetum acts similarly to Cantharis, but it has less tenesmus and haematuria, and the urine is less scalding. There is pain in the bladder as if too full, not relieved by micturition; the constant desire to urinate is not even relieved by copious urination. The urine is scanty, high colored and contains much mucus. Much mucus in the urine is more indicative of Equisetum than of Cantharis. Chimaphila also has much mucus, is
especially useful in prostatic troubles, and has made some
cures when there were great quantities of ropy mucus in the urine, which was
quite offensive. This is a wonderful remedy in the cystic irritation of old
men, characterizesd by a constant teasing desire to urinate with little or no
relief following micturition; the patient being frequently compelled to rise at
night. The state is one of irritation rather than inflammation. The general
aggravation of Equisetum seems to be after urinating. Difficulty in beginning
to urinate, strains a great deal, scanty urine. It has proved useful in
enuresis with marked Vesical irritation, being similar here to Eupatorium
purpureum, which is a useful remedy in the vesical irritation of women, with
much burning in the urethra during urination. With the foregoing symptoms,
Equisetum becomes an important remedy in the treatment of cystitis. It has been
suggested in the dysuria of children; the pain being
worse after urinating will distinguish it from Petroselinum, which has the
symptom that the child dances up and down with pain when the urging to urinate
comes on.
8. Digitalis purpurea.
[Dig]
The urinary symptoms of Digitalis consist of a dragging and pressure in the bladder which micturition does not relieve. It has been found useful in inflammation in the neck of the bladder with intense desire to urinate, which is increased even by the passage of a few drops. The patient walks about in great distress; at the same time there is tenesmus of the rectum. The patient is relieved somewhat of these symptoms by lying on the back. The pain at neck of the bladder is throbbing. The urine is scanty, thick and turbid, and contains sediment of brick-dust, like Lycopodium. The urging to urinate in cases calling for Digitalis is often due to the enlargement of the prostate gland, for which it is a remedy.
The urinary symptoms of Digitalis consist of a dragging and pressure in the bladder which micturition does not relieve. It has been found useful in inflammation in the neck of the bladder with intense desire to urinate, which is increased even by the passage of a few drops. The patient walks about in great distress; at the same time there is tenesmus of the rectum. The patient is relieved somewhat of these symptoms by lying on the back. The pain at neck of the bladder is throbbing. The urine is scanty, thick and turbid, and contains sediment of brick-dust, like Lycopodium. The urging to urinate in cases calling for Digitalis is often due to the enlargement of the prostate gland, for which it is a remedy.
9. Terebinth. [Tereb]
The urine of Terebinth is one of its most characteristic features. It is smoky, turbid, depositing sediment like coffee grounds, which indicates the presence of disintegrated blood cells. Haematuria from venous congestion of the kidneys calls often for Terebinth. It has burning during micturition and most painful strangury; the urine, too, may contain albumen and has the odor of violets. Peculiar odors to urine may be fond under the Viola tricolor, where it smells like that of the cat, and Benzoic acid, where it smells strong and ammoniacal, like that of a horse. Terebinth is a useful remedy in cystitis, with much tenesmus of the bladder and the scanty, bloody urine; there is also pressure in the bladder, which extends to the kidneys. In acute and chronic nephritis it is often indicated. The urine, oedema and the bronchial catarrh may all point to the remedy.
The urine of Terebinth is one of its most characteristic features. It is smoky, turbid, depositing sediment like coffee grounds, which indicates the presence of disintegrated blood cells. Haematuria from venous congestion of the kidneys calls often for Terebinth. It has burning during micturition and most painful strangury; the urine, too, may contain albumen and has the odor of violets. Peculiar odors to urine may be fond under the Viola tricolor, where it smells like that of the cat, and Benzoic acid, where it smells strong and ammoniacal, like that of a horse. Terebinth is a useful remedy in cystitis, with much tenesmus of the bladder and the scanty, bloody urine; there is also pressure in the bladder, which extends to the kidneys. In acute and chronic nephritis it is often indicated. The urine, oedema and the bronchial catarrh may all point to the remedy.
10. Nux vomica.
[Nux-v]
Nux vomica affects powerfully the urinary organs, yet it is seldom thought of as having anything especially characteristic about these organs. It affects the lower part of the spine, and we have as a consequence, in the first place, incontinence of urine; there is irritability at the neck of the bladder, and the same symptoms is found here as with the rectum. There are frequent ineffectual efforts to urinate, and these are accompanied by burning and tearing pains; the urine passes in drops. Again, it is indicated in vesical torpor or paralysis; here we have dribbling of urine or retention. Haematuria from abuse of drugs calls of Nux vomica. Cystitis, with this painful urging and scanty urine indicates the remedy. The straining is violent at times, and the urine is dark with red brick-dust sediment, or bloody, or mixed with tenacious mucus.
Opium is similar to Nux in having a partial paralysis of the bladder with spasmodic condition of the sphincter, but with Opium the patient is unconscious that the bladder is full, and there is no desire to pass water. The Stramonium patient passes no water because the urine has been suppressed; it is not secreted.
Camphor gives prompt relief in spasmodic retention of urine.
Nux is useful in the irritable bladder of gout and alcoholism, and to relieve pain and spasm in the passage of urinary calculi.
Nux vomica affects powerfully the urinary organs, yet it is seldom thought of as having anything especially characteristic about these organs. It affects the lower part of the spine, and we have as a consequence, in the first place, incontinence of urine; there is irritability at the neck of the bladder, and the same symptoms is found here as with the rectum. There are frequent ineffectual efforts to urinate, and these are accompanied by burning and tearing pains; the urine passes in drops. Again, it is indicated in vesical torpor or paralysis; here we have dribbling of urine or retention. Haematuria from abuse of drugs calls of Nux vomica. Cystitis, with this painful urging and scanty urine indicates the remedy. The straining is violent at times, and the urine is dark with red brick-dust sediment, or bloody, or mixed with tenacious mucus.
Opium is similar to Nux in having a partial paralysis of the bladder with spasmodic condition of the sphincter, but with Opium the patient is unconscious that the bladder is full, and there is no desire to pass water. The Stramonium patient passes no water because the urine has been suppressed; it is not secreted.
Camphor gives prompt relief in spasmodic retention of urine.
Nux is useful in the irritable bladder of gout and alcoholism, and to relieve pain and spasm in the passage of urinary calculi.
11. Causticum. [Caust]
In paralytic conditions about the bladder Causticum deserves first place. It is one of our great remedies in enuresis, and its characteristics are involuntary micturition at night in sleep, when coughing, sneezing or blowing the nose, showing a weakness of the sphincter. Another indication of this is the difficulty the patient has in passing the last few drops of urine; the fact that he has to wait a long time before it starts, and that during the act it is expelled very slowly, showing not only a weakness of the sphincter but a weakness of the whole muscular system of the bladder. Nocturnal wetting of the bed in children, occurring during the first sleep at night, calls for Causticum. Paralysis of the bladder after labor also calls for this remedy. Zincum is another excellent remedy in these bladder troubles, and it has some symptoms similar to Causticum, such as involuntary spurting of urine when coughing or sneezing; there is apt to be more pain in Zincum cases, however; Scilla and Natrum muriaticum also have involuntary micturition when coughing. Another symptom of Causticum is an excessive deposit of urates in the urine. Another remedy which clinically has proved very useful in enuresis from weakened muscular action is Ferrum phosphoricum. Rhus aromatica has enuresis of nervous origin, and has been used successfully in senile cases.
In paralytic conditions about the bladder Causticum deserves first place. It is one of our great remedies in enuresis, and its characteristics are involuntary micturition at night in sleep, when coughing, sneezing or blowing the nose, showing a weakness of the sphincter. Another indication of this is the difficulty the patient has in passing the last few drops of urine; the fact that he has to wait a long time before it starts, and that during the act it is expelled very slowly, showing not only a weakness of the sphincter but a weakness of the whole muscular system of the bladder. Nocturnal wetting of the bed in children, occurring during the first sleep at night, calls for Causticum. Paralysis of the bladder after labor also calls for this remedy. Zincum is another excellent remedy in these bladder troubles, and it has some symptoms similar to Causticum, such as involuntary spurting of urine when coughing or sneezing; there is apt to be more pain in Zincum cases, however; Scilla and Natrum muriaticum also have involuntary micturition when coughing. Another symptom of Causticum is an excessive deposit of urates in the urine. Another remedy which clinically has proved very useful in enuresis from weakened muscular action is Ferrum phosphoricum. Rhus aromatica has enuresis of nervous origin, and has been used successfully in senile cases.
12. Sepia. [Sep]
One of the prominent remedies for lithaemic conditions is Sepia, and the condition of the urine becomes an indication for its use. It has reddish clay-colored sediment adhering to the vessel, sediment of red sand so-called. The Sepia urine differs from others in being offensive. Sepia is also a remedy for wetting the bed at night during the first sleep. Lycopodium is a prominent remedy for the indication of red sand in the urine. It is a sort of gravel and is passed in quantities, so that often the child will scream with pain on passing the water. Lycopodium will then help. Sarsaparilla and Benzoic acid have similar symptoms, the latter having as a characteristic strong horse-like urine. Natrum muriaticum also has their red sand or brick-dust sediment. Another remedy having this symptom very marked in Ocimum canum. This is a very useful remedy in renal colic and gravel. The patient has to micturate every few minutes, during which he wrings his hands and groans with pain. Nausea is often present. The quantity of sand deposited is very large. In cystitis, with a constant desire to urinate and dragging in the bladder, Sepia may prove useful; here it will be indicated by its general Symptoms.
One of the prominent remedies for lithaemic conditions is Sepia, and the condition of the urine becomes an indication for its use. It has reddish clay-colored sediment adhering to the vessel, sediment of red sand so-called. The Sepia urine differs from others in being offensive. Sepia is also a remedy for wetting the bed at night during the first sleep. Lycopodium is a prominent remedy for the indication of red sand in the urine. It is a sort of gravel and is passed in quantities, so that often the child will scream with pain on passing the water. Lycopodium will then help. Sarsaparilla and Benzoic acid have similar symptoms, the latter having as a characteristic strong horse-like urine. Natrum muriaticum also has their red sand or brick-dust sediment. Another remedy having this symptom very marked in Ocimum canum. This is a very useful remedy in renal colic and gravel. The patient has to micturate every few minutes, during which he wrings his hands and groans with pain. Nausea is often present. The quantity of sand deposited is very large. In cystitis, with a constant desire to urinate and dragging in the bladder, Sepia may prove useful; here it will be indicated by its general Symptoms.