Physical activities such as horseback riding or bicycling can lead to dysuria with minimal urethral discharge. Dysuria may also be a feature of psychogenic conditions such as somatization disorder, chronic pain syndromes, major depression, and chemical dependency. An algorithm for the evaluation of patients with acute dysuria is provided in Figure 1. Suggested algorithm for the evaluation of acute dysuria in patients of either gender or both genders. Suggested algorithm for the evaluation of acute dysuria in patients of either gender. The timing, frequency, severity, and location of dysuria are important.
In adult women, a history of external dysuria pain as the urine passes over the inflamed vaginal labia suggests vaginal infection or inflammation, whereas a history of internal dysuria pain felt inside the body suggests bacterial cystitis or urethritis. Longer duration and more gradual onset of symptoms may suggest C. It is important to inquire about the presence of other genitourinary symptoms. Dysuria is frequently accompanied by urinary frequency, hesitation, slowness, or urgency.
Urinary frequency is most often caused by decreased bladder capacity or painful bladder distention. Other causes include overflow secondary to BPH, urethral pathology, and, rarely, a central or peripheral neurologic disorder. Urinary hesitation and slow urination are most commonly caused by urethral obstruction but may also be secondary to decreased bladder contractility.
Urinary urgency occurs as a result of trigonal or posterior urethral irritation caused by inflammation, stones, or tumor and is common with cystitis. Urethral discharge is highly associated with urethritis. Information should also be obtained about the patient's sexual and general medical history. In sexually active patients, urethritis or vulvovaginitis can be a likely cause of dysuria. A history of sexually transmitted disease STD can point to urethral scarring or a current STD, especially in patients with high-risk sexual behaviors.
Patients who have diabetes mellitus may present with vulvovaginitis secondary to candidiasis. Questions should be asked about the use of medications, herbal remedies, and topical hygiene products. Dysuria can be caused by medications such as ticarcillin Ticar , penicillin G, and cyclophosphamide Cytoxan.
Dysuria can also occur with the use of, among others, saw palmetto, pumpkin seeds, dopamine, or cantharidin, 6 and with the use of a number of topical hygiene products, including vaginal sprays, vaginal douches, and bubble baths. Possible diagnoses based on the findings of the history are summarized in Table 2. The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication. Although protocols have been established for telephone triage and presumptive treatment of carefully selected women with dysuria, 3 — 5 most patients require a physical examination with special focus on the genitourinary system.
The patient's general condition and vital signs should be recorded. Palpation and percussion of the abdomen provide information about kidney, ureter, or bladder inflammation.
Tenderness over the costovertebral angle suggests pyelonephritis. A pelvic examination in women and a perineal and penile examination in men can identify the presence of discharge, trauma, or infective lesions such as herpes or chancroid. Although a pelvic examination is often useful in patients at risk for vaginal infections, it is less of a priority when both vaginal discharge and vaginal irritation are explicitly denied and the symptoms of both internal dysuria and urinary frequency are present.
A digital rectal examination in men helps to assess the prostate gland. When prostatitis is suspected, gentle digital examination is advised because a vigorous examination can precipitate bacteremia and sepsis. An enlarged prostate can indicate an obstructive cause of dysuria; however, obstructive symptoms related to BPH can occur without palpable enlargement of the gland.
Possible diagnoses based on the physical findings in patients with dysuria are provided in Table 3. The laboratory investigation of dysuria is directed by the most probable diagnosis. Diagnostic options include urine studies, vaginal and urethral studies for STDs, radiologic studies, and invasive procedures Table 4 4 , 21 — Patients in whom covert bacteriuria can cause complications, such as pregnant women and patients with disorders that affect immune status e. Accurate diagnosis of infection; helpful for determining antimicrobial susceptibility of infecting bacteria Gold standard for bladder cancer screening Poor sensitivity but excellent specificity; can detect high-grade malignant cells before cystoscopically distinguishable gross lesion is present.
Easy to perform; wet-mount preparation can detect Trichomonas vaginalis and Candida species; Gram staining can detect Neisseria gonorrhoeae. Gold standard specificity close to percent for N. Detects N. Suspected upper urinary tract pathology e. Noninvasive, relatively inexpensive, and rapid in emergencies; no exposure to radiation or contrast medium Limitations: user dependent; poor visualization in obese patients and patients with open wounds, and dressings or other devices overlying pertinent area. Unusual gas patterns e. Inexpensive Limitations: lack of visualization if urinary tract is obscured by gas, feces, contrast medium, or foreign bodies in intestine; clear visualization prevented by uterine fibroids, ovarian lesions, obesity, and ascites.
Visualization of renal parenchyma, calyces pelvis, ureters, bladder, and, occasionally, urethra; therefore, can identify extent of urinary obstruction. Assessment for causes of chronic dysuria, such as congenital abnormalities of lower urinary tract and abnormal bladder e.
CT with and without contrast medium, helical CT 23 , Discrimination of different types of solid tissue noncontrast study Detection of calcifications in renal parenchyma or ureter Improved visualization of avascular structures such as cysts, abscesses, necrotic tumors, and infarcts contrast study Measurement of concentrating ability of kidneys. Contrast-enhanced CT is radiologic test of choice; easy to perform and easily accessible; improved visualization in obese patients No misregistration artifacts with helical CT unlike regular CT with or without contrast medium ; therefore, reliable demonstration of small lesions.
Identification of urinary tract obstruction or mass Evaluation of renal function Evaluation of renal vasculature MRA. Useful in patients with renal insufficiency or allergy to iodinated contrast media, because gadolinium contrast agents are non-nephrotoxic and hypoallergenic Without contrast medium, MRI is not the screening method for renal masses; when contrast medium and fat suppression are used, sensitivity of MRI is comparable to that of CT with contrast medium.
Detection of bladder or urethral pathology Confirmation of diagnosis of interstitial cystitis. Information from references 4 and 21 through Urinalysis and Urine Cultures. Because UTI is the most common cause of dysuria, urinalysis is often helpful. When UTI is unlikely based on the history and physical findings, urine studies may be deferred. The specificity of the dipstick test makes it useful for identifying hematuria, pyuria, or bacteriuria.
Leukocyte esterase is a marker for white blood cells and has a sensitivity of 75 percent for the detection of UTI. Pyuria has a sensitivity of 96 percent. The gold standard for evaluating dysuria is microscopic examination of spun, clean-catch, midstream urine sediment. Pyuria is diagnosed by the presence of three to five white blood cells per high-power field, and hematuria is diagnosed by the presence of three to five red blood cells per high-power field.
Pyuria detected on urinalysis is associated not only with bacterial UTI, but also with T. Therefore, the finding of pyuria on urinalysis does not eliminate the need for a gynecologic evaluation.
Sterile pyuria may be present in patients with prostatitis, nephrolithiasis, urologic neoplasms, and fungal or mycobacterial infections. Many physicians depend on urine Gram staining to identify a UTI. Achieving the best correlation between the Gram stain and significant bacteriuria by culture requires good collection techniques, appropriate methods of observation by a skilled observer, and use of an appropriate stain. Urine Gram stains may demonstrate urinary pathogens, most commonly coliform organisms, or sexually transmitted organisms such as T.
Urine culture is also commonly used to investigate dysuria.
Cultures are not essential in selected young women when clear-cut signs and symptoms of acute dysuria indicate a high probability of uncomplicated cystitis. Urine cultures can be deferred when dysuria is described as largely external and a probable urethral or vaginal cause is identified. When symptoms are present, a count of 10 3 colony-forming units CFU per mL of urine is generally diagnostic of infection.
Some authorities suggest that a pure colony count of 10 2 CFU per mL for a known pathogen from a scrupulously collected urine sample is sufficient to diagnose a UTI when dysuria is present. Vaginal or Urethral Smears and Cultures. If a patient with dysuria has a vaginal or urethral discharge or is sexually active, vaginal or urethral specimens should be obtained for wet-mount preparation and Gram staining, along with appropriate cultures.
Although cultures for C. Only in cases of sexual assault and child abuse are cultures absolutely necessary because of their percent specificity. Radiology and Other Studies. Imaging studies and other diagnostic tests are indicated when the diagnosis is in doubt, when patients are severely ill or immunocompromised and do not respond to antibiotic therapy, and when complications are suspected Table 4 4 , 21 — Already a member or subscriber? Log in. JUDY D. He is presently an associate editor for American Family Physician. Address correspondence to Richard Sadovsky, M.
Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. Seller RH. Differential diagnosis of common complaints. Philadelphia: Saunders, — Hoffman RF. Acute dysuria or pyuria in men. Decision making in medicine: an algorithmic approach. Louis: Mosby, —7. HMO Pract. Cleve Clin J Med. The effectiveness of a clinical practice guide line for the management of presumed uncomplicated urinary tract infection in women.
Am J Med. Evaluation of dysuria in men. Am Fam Physician. Margolis S, ed. Johns Hopkins symptoms and remedies: the complete home medical reference. New York: Rebus, —9. In: Hurst JW, et al. Medicine for the practicing physician. Stamford, Conn. Schwiebert LP. Dysuria in women. Ambulatory medicine: the primary care of families.
Richardson DA. Dysuria and urinary tract infections. Obstet Gynecol Clin North Am. Jolleys JV. Factors associated with regular episodes of dysuria among women in one rural general practice. Br J Gen Pract. Need for diagnostic screening of herpes simplex virus in patients with nongonococcal urethritis. In the United States , the medicinal uses of saw palmetto were first documented in by Dr. Read, a physician in Savannah, Georgia , who published a paper on the medicinal benefits of the herb in the April issue of American Journal of Pharmacy.
He found the herb useful in treating a wide range of conditions. Its sedative and diuretic properties are remarkable," Read wrote. A pungent tea made from saw palmetto berries was commonly used in the early s to treat prostate enlargement and urinary tract infections. It was also used in men to increase sperm production and sex drive, although these uses are discounted today. One of the first published medical recommendations that saw palmetto was effective in treating prostate problems appeared in the edition of United States Dispensatory.
In the late s, the use of medicinal plants , including saw palmetto, began to decline in the United States, while at the same time, it was on the rise in Europe.
The National Institute on Aging recommends that people taking saw palmetto should obtain it only from reputable sources. Dosages vary depending on the type of saw palmetto used. A typical dose is mg per day of standardized extract g per day of ground dried whole berries. It may take up to four weeks of use before beneficial effects are seen.
In late , the web-based independent consumer organization ConsumerLab. There are no special precautions associated with taking saw palmetto, even in high doses. However, BPH can become a serious problem if left untreated. Men who are experiencing symptoms should be examined by a physician, since the symptoms of BPH are similar to those of prostate cancer. Men over the age of 50 should have a yearly prostate exam.
Saw palmetto should only be used under a doctor's supervision by people with prostate cancer, breast cancer, or any sex hormone related diseases. Although the effects of saw palmetto on a fetus is unknown, pregnant women are advised not to take saw palmetto. Saw palmetto can alter hormonal activity that could have an adverse effect on the fetus.
Women taking birth control pills or estrogen replacement products should consult a physician before taking saw palmetto. Persons taking testosterone or other anabolic steroids should not take saw palmetto without first consulting their doctor. In rare cases, allergic reactions to saw palmetto have been reported. Symptoms include difficulty breathing, constricting of the throat, hives, and swelling of the lips, tongue, or face.
Persons experiencing any of these symptoms should stop taking saw palmetto and seek immediate medical attention. The only reported minor side effects are rare and include cramps, nausea, diarrhea, and headache. Saw palmetto may interfere with such hormone-related drugs as testosterone and estrogen replacements, including Premarin, Cenestin, Vivelle, Fempatch, and Climara. Anyone on these types of medications should consult their doctor before taking saw palmetto. There are no known restrictions on food, beverages, or physical activity while taking saw palmetto.
Anabolic steroids — A group of mostly synthetic hormones sometimes taken by athletes to temporarily increase muscle size. Aphrodisiac — Any substance that excites sexual desire. Estrogen — A hormone that stimulates development of female secondary sex characteristics. Placebo — An inert or innocuous substance used in controlled experiments testing the efficacy of another substance.
Progesterone — A steroid hormone that is a biological precursor to corticoid another steroid hormone and androgen a male sex hormone. Testosterone — A male hormone produced in the testes or made synthetically that is responsible for male secondary sex characteristics.
Saw Palmetto for Men & Women: Herbal Healing for the Prostate, Urinary Tract, Immune System and More (Medicinal Herb Guide) [David Winston AHG] on. Jan 9, Saw Palmetto for Men & Women: Herbal Healing for the Prostate, Urinary Tract, Immune System and More. (Storey Medicinal Herb Guides). by.
Urethra — The canal that carries urine from the bladder. Several herbs and minerals have been used in conjunction with saw palmetto in treating BPH. A European study showed positive results in treating patients with a daily dose of mg of saw palmetto extract and mg of nettle root extract. Many alternative health practitioners also recommend saw palmetto be used in combination with the herb pygeum africanum, pumpkin seeds, zinc, flaxseed oil, certain amino acids, antioxidants, and diets high in protein and soy products. Some factors that can impair the effectiveness of saw palmetto include beer, cigarette smoke, and some chemical pesticides used on fruit and vegetables.
Some physicians recommend using saw palmetto in addition to a prescription medicine, such as Proscar, Hytrin, or Cardura. Gong, E. Gunther, S. Patterson, A. Kristal, et al. Kaplan, S. Volpe, and A. Peng, C. Glassman, L. Trilli, et al. Box , Gaithersburg, MD Cite this article Pick a style below, and copy the text for your bibliography.
There are no special precautions associated with taking saw palmetto, even in high doses. Native Americans in the southeast United States have used saw palmetto since the s to treat male urinary problems. Gong, E. Men should have this blood test done before they begin taking saw palmetto to make sure they get correct results. Serenoa repens saw palmetto : a systematic review of adverse events. Also reviewed by the A. The effect of increasing doses of saw palmetto fruit extract on serum prostate specific antigen: analysis of the CAMUS randomized trial.
September 22, Retrieved September 22, from Encyclopedia. Then, copy and paste the text into your bibliography or works cited list. Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia. However, there is much scientific documentation outlining the effectiveness of the herb in treating irritable bladder and urinary problems in men with benign prostate hyperplasia BPH , an enlargement of the prostatic gland.
BPH produces a swelling of the prostate gland that obstructs the urethra.
The Agency for Health Care Policy and Research estimates there are six million men between the ages of who have BPH serious enough to require some type of therapy. Health practitioners in both the allopathic and natural medicine communities recommend annual prostate for men over the age of 50, and an annual blood test that measures prostate-specific antigen PSA , a marker for prostate cancer.
Many of these trials have shown saw palmetto works better than the most commonly used prescription drug, finasteride, sold unter the trade name Proscar. Originally prescribed to treat hypertension , Cardura and Hytrin can cause a drop in blood pressure , causing light-headedness and fainting. Saw palmetto is listed in the Physicians Desk Reference for Herbal Medicine edition as a treatment for prostate complaints and irritable bladder. A review of 24 European trials appeared in the November issue of the Journal of the American Medical Association.
The trials involved nearly 3, men, some taking saw palmetto, others taking Proscar, and a third group taking a placebo. The results were nearly comparable to the results from the group taking Proscar and superior to the results from men taking the placebo. As of , however, many American physicians still regard the effectiveness of saw palmetto as requiring further proof.
There is very little documentation or scientific research regarding saw palmetto use in women. There are claims that it can be used to enlarge breasts, but these claims have not been scientifically tested. Native Americans. In the s, the medical botanist John Lloyd noted that animals that ate saw palmetto appeared healthier and fatter than other livestock.
Read, a physician in Savannah, Georgia , who published a paper on the medicinal benefits of the herb in the April issue of the American Journal of Pharmacy. One of the first published medical recommendations that saw palmetto was effective in treating prostate problems appeared in the edition of the United States Dispensatory. A typical dose is mg per day of standardized extract, or 1 — 2 g per day of whole berries that have been dried and ground.
BPH can become a serious problem, however, if left untreated. Men over the age of 50 should have a yearly prostate examination. Saw palmetto should be used only under a doctor's supervision by people with prostate cancer, breast cancer , or any sex hormone related diseases. Physicians who accept saw palmetto as an effective remedy for prostate problems nevertheless point out that it is not completely free of side effects. Symptoms include difficulty breathing, constricting of the throat, hives , and swelling of the lips, tongue, or face. Other reported minor side effects are rare.
They include cramps, nausea, diarrhea , and headache. Anyone on these types of medications should consult with their doctor before taking saw palmetto. Many alternative health practitioners also recommend saw palmetto be used in combination with the herb pygeum africanung, pumpkin seeds, zinc, flaxseed oil, certain amino acids, antioxidants , and diets high in protein and soy products. Fleming, Thomas, editor. PDR for Herbal Medicine. Sahelian, Ray. Saw Palmetto, Nature's Prostate Healer. New York : Kensington Publishing Corp. Winston, David.
Ernst, E. Lowe, F. Overmyer, Mac. Wilt, Timothy J. Saw palmetto is a natural plant remedy used to treat men who are experiencing difficulty when urinating. Saw palmetto is not used to treat cancer. It is used to treat non-malignant enlargement of the prostate gland, also called benign prostatic hyperplasia BPH.
The prostate gland is found only in men. It is located where the bladder drains into the urethra. The urethra is the tube that takes urine out of the body. The prostate gland contributes to the fluid in which sperm are ejaculated semen. It is common for the prostate to enlarge in men over age This enlargement often is not malignant. It is thought to occur because of the action of testosterone , a male hormone, on the cells of the prostate. As the prostate grows, it can press on the urethra and narrow it. This causes men to have problems with urination that include the frequent urge to urinate especially at night and a week, dribbling, interrupted urine stream.
Saw palmetto is the bushy palm, Serenoa repens that grows to a height of about 18 feet 6 m along the coast of the United States from South Carolina to Florida , and in Southern California. It is also found in Europe along the Mediterranean. Other names for this plant are American dwarf palm, cabbage palm, serenoa, or sable. The medicinal part of the saw palmetto is an extract from the dark, olive-sized berries.
Saw palmetto has a long history of use by Native Americans in treating bladder inflammation, urinary difficulties, sexual difficulties, and respiratory tract infections. Of these uses, the only scientifically substantiated claim is that saw palmetto eases urinary difficulties and increases urine output. Although the exact mechanism of action of saw palmetto has not been determined, it is believed to interfere with the action of testosterone on the prostate gland. Finasteride Proscar, also known as Permixon is a prescription drug used to treat BPH that works in the same way.