Urethral Syndrome

What is urethral syndrome?

Urethral syndrome is a condition that causes irritation of your urethra. This is the tube connecting your bladder to the outside of your body. Your urethra carries urine (pee) and semen (sperm) away from your body.

Other names for urethral syndrome include:

• Abacterial cystitis.
• Frequency-dysuria syndrome.
• Symptomatic abacteriuria.
• Urethral pain syndrome (UPS).

Urethral syndrome symptoms are similar to those of other conditions. They may look the same as symptoms seen in urinary tract infections and urethritis. But unlike these conditions, viral and bacterial infections don’t cause urethral syndrome. Several factors can result in urethral syndrome, which can make it difficult for healthcare providers to identify the exact cause.

Who might have urethral syndrome?

People of any age, race or gender might have urethral syndrome. But people assigned female at birth (AFAB) have this condition more commonly than people assigned male at birth (AMAB), and it affects those ages 30 to 50 the most. Healthcare providers diagnose urethral syndrome most often in white women and white people AFAB.

How common is urethral syndrome?

Up to 25% of patients who see a healthcare provider with symptoms in their lower urinary tract may have urethral syndrome.

What is the difference between urethral syndrome and urethritis?

Bacterial or viral infections cause urethritis, including nongonococcal urethritis in men. But urethral syndrome doesn’t come from an infection. If an infection isn’t causing your symptoms, your provider may suspect urethral syndrome.

What causes urethral syndrome?

Researchers don’t know what causes urethral syndrome. But they do know that bacterial and viral infections don’t cause it.

They suspect that several factors may contribute to urethral syndrome, including:

• Abnormal narrowing of your urethra (posterior urethral stenosis or urethral stricture in men and people AMAB).
• Additional irritation of your urethra.
• Hormonal imbalances, such as low amounts of estrogen.
• Injury to your urethra.
• Pelvic floor dysfunction.
• Sensitivity of your urethra after a urinary tract infection (UTI).
• Sexually transmitted diseases and infections (STDs and STIs).
• Spasms of your urethra.
• Stress.

An injury to the urethra can come from:

• Rough sexual intercourse.
• Using a diaphragm.
• Using a tampon.
• Bike riding.

Several things may cause additional irritation to the urethra:

• Caffeine.
• Alcoholic drinks.
• Spicy foods.
• Cancer treatments, including chemotherapy and radiation therapy.
• Condoms and contraceptive gels, including lubrication with spermicide.
• Scented products, such as bubble baths, perfumes and soaps.

What are the symptoms of urethral syndrome?

The symptoms of urethral syndrome may include:

• Blood in your urine (hematuria).
• Difficulty urinating (urinary retention).
• Feeling an immediate urge to urinate.
• Frequent urination, especially during the day.
• Painful intercourse (dyspareunia).
• Painful urination (dysuria).
• Pain in your genitals, lower abdomen and lower back.
• Pressure in your abdomen.
• Waking up at night needing to urinate (nocturia).

In men and people assigned male at birth (AMAB), symptoms of urethral syndrome may also include:

• Blood in your semen (hematospermia).
• Discharge from your penis (urethral discharge).
• Painful ejaculation.
• Swollen testicles (scrotal swelling).

In people assigned female at birth (AFAB), symptoms of urethral syndrome may also include discomfort in your vulvar area (vulvodynia or vulvitis).

How is urethral syndrome diagnosed?

A healthcare provider who specializes in urinary system problems (urologist) can help diagnose urethral syndrome. Your provider will first ask about your symptoms and do a physical examination. They will need to rule out other conditions with similar symptoms, such as:

• Bladder cancer.
• Cervical cancer.
• Painful bladder syndrome (interstitial cystitis).
• STIs.
• Urethritis.
• UTIs.

If your provider suspects urethral syndrome, they may take a urine (pee) sample. They will do a:

• Urinalysis, to screen for common health conditions, including urinary tract infections.
• Urine culture, to look for bacteria or yeast.

If you have blood in your urine, your provider may suggest tests including:

• CT scan, to see your upper urinary tract.
• Cystoscopy, to view the inside of your urethra or bladder.

Your provider may also suggest other tests such as:

• Bacterial vaginosis test, to rule out bacterial vaginosis.
• Pap smear, to rule out cervical cancer.
• Urine cytology, to rule out bladder cancer.
• Vaginal swabs, to rule out fungal infections and STIs.

They may also suggest imaging studies such as:

• Bladder ultrasound, kidney ultrasound or pelvic ultrasound, to rule out cysts, tumors and other conditions.
• MRI of the pelvis, to rule out interstitial cystitis.

How is urethral syndrome treated?

Treatments for urethral syndrome focus on reducing your discomfort and the frequency of urination. Your provider may treat urethral syndrome with:

• Biofeedback, to help your pelvis to relax.
• Medications, to improve blood flow and relieve pain.
• Meditation or hypnotherapy, to reduce stress.
• Surgery, to widen your urethra.

How do I take care of myself with urethral syndrome?

Lifestyle changes can help to reduce irritation of your urethra. These changes may include:

• Avoiding highly acidic foods.
• Doing activities such as tai chi and yoga to help control and relax muscles.
• Eating plenty of dairy products, fruits and vegetables.
• Increasing the amount of water you drink (hydration).
• Limiting the amount of alcohol you drink.
• Reducing stress.
• Using unscented detergents and soaps.

How can I reduce my risk of urethral syndrome?

You can reduce your risk of urethral syndrome by:

• Avoiding scented soaps and detergents.
• Getting tested and treated promptly for STIs.
• Urinating as soon as you can after sexual intercourse.
• Using protection during sexual intercourse.
• Wearing pants that aren’t too tight-fitting.
• Wearing underwear made from cotton instead of nylon.
• Wiping your genitals from front to back after urinating.

Are there other conditions that put me at higher risk of urethral syndrome?

Other conditions that may put you at higher risk of urethral syndrome include:

• Bacterial infections of your bladders or kidneys.
• Giving birth without having an incision between your vagina and anus (episiotomy).
• STIs.
• Taking immunosuppressants.

What can I expect if I have urethral syndrome?

You may have urethral syndrome throughout your life. But symptoms may decrease over time, especially with proper treatment and lifestyle changes.

How do I take care of myself with urethral syndrome?

Urethral syndrome can affect your sense of well-being. Symptoms can cause anxiety, depression and stress. Talking to your provider or a therapist about your concerns can help provide symptom relief and prevent the discomfort from returning.

When should I see my healthcare provider?

See your provider if your symptoms get worse. They will test you for other issues such as UTIs.

Also, see your provider if you don’t notice any results from your treatments after some time. They’ll be able to suggest other treatments that may help.

A note from Cleveland Clinic

Urethral syndrome is a condition that causes irritation of your urethra. Healthcare providers don’t know the exact cause. The main symptoms of urethral syndrome include blood in your urine, difficulty urinating, frequent urination and painful urination. Providers first diagnose urethral syndrome by ruling out other conditions. Treatment focuses on medications to relieve discomfort as well as techniques to help you relax. Lifestyle changes can also help. Though urethral syndrome can be a lifelong condition, symptoms may decrease over time.