Urethral Syndrome

What is urethral syndrome?

Urethral syndrome is the presence of symptoms of a urinary tract infection even though very few or no bacteria are found in the urine. It is also sometimes called symptomatic abacteriuria, which means having symptoms with no bacteria. It occurs in adults of all ages. In urethral syndrome, you usually have painful, frequent urination and an uncomfortable feeling over your pubic bone.

How does it occur?

Urethral syndrome occurs mainly in women and very rarely in men. Usually your healthcare provider cannot find any infection or anything wrong with the kidneys and urinary tract that might be causing the symptoms.

A woman may have urethral syndrome because her urethra (the tube leading from the bladder to outside the body) or genital area may be irritated by:

• sexual activity
• soaps, antiseptic creams, or spermicides
• dyes or perfumes in toilet tissue and feminine hygiene products, such as pads, tampons, and sprays

The glands around the urethra may be inflamed by infection or injury. Injury of the tissues may occur during sex, from the use of a diaphragm, tampon, or pessary, or from long bike rides. Some other possible causes are spasms of the muscles around the urethra, nerve problems caused by a herpes infection, or a disease such as diabetes.

Psychological factors, such as stress, may play a role.

In women who have gone through menopause, the symptoms may be the result of inflammation of the vulva (vulvitis). Hormonal changes (less estrogen) may cause a thinning and inflammation of these tissues around the opening of the vagina and urethra.

What are the symptoms?

The symptoms of urethral syndrome are:

• pain and discomfort in the lower abdomen
• a frequent urge to urinate
• a feeling of pressure in the lower abdomen that doesn't go away after you urinate
• in women, pain around the vulvar region
• pain with urination
• pain with sexual intercourse

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You will have a urine test. You may also have blood tests.

How is it treated?

If no infection is found, some treatments that may help urethral syndrome are:

• Avoid products that are known to cause irritation and allergic reactions.
• Practice good personal hygiene.
• Drink a lot of fluids, especially cranberry juice.

Your healthcare provider may prescribe Pyridium, a medicine that helps reduce pain when you urinate. Pyridium will turn your urine orange and may stain underclothes. Pyridium should be only used for up to two days to avoid hiding other symptoms of other serious conditions.

Estrogen pills or creams may relieve symptoms caused by vulvitis in older women.

Your provider may prescribe an antibiotic if your urine contains pus and a low number of bacteria (not enough to be considered a true infection).

If sexual activity brings on symptoms of the syndrome, your provider may prescribe medicine to relieve pain or an antibiotic. You may need to avoid sexual relations until symptoms go away.

If the urethra has become narrower because of injury or infection, you may not be able to empty your bladder completely. Your provider may dilate the urethra with metal or plastic dilators to widen the opening and make it easier to urinate. Your provider will start with small dilators and gradually increase the size.

You may be given steroid shots in and around the urethra to decrease inflammation.

How long will the effects last?

Following your healthcare provider's recommended treatment and precautions may help you feel better in a week or two. If you continue to have symptoms, your provider may refer you to a urologist (a specialist in problems of the urinary tract). The urologist may do further tests and look into the urethra and bladder (a procedure called cystoscopy).

Urethral syndrome may lead to a urinary tract infection. Call your provider if you develop any new symptoms, such as headache, fever, chills, or blood in your urine.

How can I take care of myself?

• Drink plenty of fluids each day to cleanse the bladder and the rest of the urinary tract.
• Keep the genital area clean, using clear water. Do not wash the genital area with soap.
• Do not use bubble baths, bath oils, or other perfumed bath products.
• After you urinate, wipe from front to back. Use uncolored toilet tissue that is not perfumed.
• Use sanitary pads or tampons that do not contain deodorants or perfumes.
• Don't use feminine hygiene sprays or other perfumed feminine hygiene products.
• Avoid sexual positions that cause irritation or injury to the urethra.
• Urinate before and after intercourse.
• Use prescribed medicines as directed by your provider.
• Keep all appointments for any follow-up exams.

What can be done to help prevent urethral syndrome?

In addition to taking the above steps, you can follow these measures:

• Wear cotton underwear, which allows better air circulation than nylon. Pantyhose should have a cotton crotch.
• Avoid tight clothes in the genital area, such as control-top pantyhose and tight jeans.
• Avoid bicycling often or for long periods of time, especially if you have a long-nose bicycle seat.
• Make sure you have good lubrication in the genital area when you have sex.