Evaluation of dysuria in children and adolescents
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Section Editors
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
Many conditions of the genitourinary tract cause dysuria, which is defined as symptoms of pain and/or burning associated with urination. This commonly reported sensation is produced by the muscular contraction of the bladder and the peristaltic activity of the urethra, both of which stimulate the pain fibers of the edematous and inflamed mucosa. In addition, pain may occur when urine comes into contact with the inflamed mucosa.
This topic will review the causes of dysuria and the approach to the child with dysuria. The evaluation of adult women and men with dysuria, the features and diagnosis of urinary tract infections in children, and the evaluation of sexual abuse in children and adolescents are discussed elsewhere. (See "Acute uncomplicated cystitis and pyelonephritis in women" and "Approach to dysuria in the adult man" and "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis" and "Evaluation of sexual abuse in children and adolescents".)
Dysuria, defined as symptoms of pain and/or burning associated with urination, may be caused by a wide range of infectious and noninfectious causes, but it usually stems from one of several common disorders of childhood and adolescence (table 1). Most children with dysuria as a chief complaint will have primary disorders of the genitourinary tract. Although patients with urethritis secondary to systemic illnesses may have dysuria as one of their many symptoms, this specific complaint is only occasionally the principal reason for seeking care.
Young children may also complain of painful urination when they are instead experiencing related symptoms, such as pruritus as is seen with Enterobius vermicularis (pinworms). (See "Vulvovaginal complaints in the prepubertal child", section on 'Pinworm'.)
In addition, those who have experienced sexual abuse may present with a complaint of dysuria, which has no physical basis, or they may exhibit behaviors that are interpreted by adult observers as indicative of genital pain. (See "Evaluation of sexual abuse in children and adolescents", section on 'Presentation'.)
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- Life-threatening conditions
- Common conditions
- - Infectious causes
- Lower urinary tract infections
- Balanitis and balanoposthitis
- Pelvic inflammatory disease
- - Noninfectious conditions
- Nonspecific (chemical) urethritis
- Local trauma
- Labial adhesions
- - Other conditions
- Physical examination
- Laboratory studies
- - All patients
- - Possible sexually transmitted disease
- - Postmenarcheal females
- ALGORITHMIC APPROACH
- Systemic syndromes
- Prepubertal male
- Prepubertal female
- Adolescent male
- Adolescent female