In the case of alleged ‘recurrent urinary tract infections’ without any pathogens or pathogens being found, the so-called ‘urethral syndrome’ may be present. It is often confused with a urinary tract infection or urethral infection due to similar symptoms, such as frequent urination, painful urination and blood in the urine, as well as suprapubic pelvic pain. Urethral syndrome is a condition that affects the urethra. This is a long cylindrical cavity that connects the urinary bladder to the outside of the body. The urethra is responsible for transporting urine (and semen in men) out of the body. People with urethral syndrome have an irritated urethra. Urethral syndrome is also known as symptomatic abacteriuria. Adults of any age can develop this condition, but it is most common in women.
- What is urethral syndrome?
- Synonyms
- Prevent
- Symptoms of urethral syndrome
- Symptoms in men and women
- Symptoms in men
- Symptoms in women
- Causes of irritation of the urethra
- Urethral obstruction
- Pathogens
- Spasms of the external urethral sphincter
- Psychological cause
- Genital atrophy
- Inflammation of the paraurethral glands
- Irritants or treatment
- Medical treatment
- Trauma to the urethra
- Nerve problems
- Risk factors
- Examination and diagnosis
- Therapy
- Prognosis
- Prevention
Inside of the urethra / Source: Michael Reeve, Wikimedia Commons (CC BY-SA-3.0)
What is urethral syndrome?
Urethral syndrome involves irritation of the urethra, for which no bacterial or viral cause can be found. The complaints sometimes closely resemble a urinary tract infection or urethral infection. The urethral syndrome is a diagnosis by excluding all other conditions that could explain the complaints.
Synonyms
Urethral syndrome is also known as urethral pain syndrome or symptomatic abacteriuria.
Prevent
Epidemiological data on urethral syndrome are scarce in 2023. It mainly occurs in women between the ages of 30 and 50. Occasionally the syndrome is also seen in children and men.
Symptoms of urethral syndrome
Symptoms in men and women
In general, the following complaints may occur with urethral syndrome:
- urge to urinate
- frequent micturition: needing to urinate frequently – seven times a day or more.
- difficulty urinating
- pain when urinating
- occasionally also suprapubic (located above the pubic bone) pelvic pain and back pain
- pain in the lower abdomen
- a feeling of pressure in the abdomen
- pain during sex
- blood in the urine
Symptoms in men
There are also some symptoms that only occur in men. These include:
- swelling of the testicles
- pain during ejaculation
- blood in the semen
- discharge from the penis or urethra
Symptoms in women
In women, urethral syndrome can also cause a feeling of discomfort in the vulvar area.
Causes of irritation of the urethra
The cause of urethral syndrome is unclear in 2023. Usually a multifactorial condition can be assumed.
Urethral obstruction
In the past, some researchers postulated that it may be due to urethral obstruction, which in certain cases could be corrected surgically by urethral dilation (regular stretching of the urethra) or incision, but carries the risk of incontinence.
Pathogens
Infectious causes were also examined. In most cases, pathogens such as Chlamydia trachomatis, Mycoplasma hominis or Ureaplasma urealyticum cannot be found or are difficult to detect. The condition is considered urethritis or urethral inflammation if a bacterial or viral infection is found. In some cases there is a bacterial infection that is not visible in the urine or urine culture.
Spasms of the external urethral sphincter
Some symptoms may be due to spasms of the external urethral sphincter, which may be associated with increased external sphincter tone.
Psychological cause
Other authors assumed a psychogenic cause. However, no significant association could be found between urethral syndrome and psychosomatic diseases. The latter seems to be more a consequence of the chronic complaints that some affected people suffer from.
Genital atrophy
Genital atrophy can be considered as another factor that may play a role in the development of the complaints: postmenopausal estrogen deficiency or estrogen deficiency leads to atrophic changes in the bladder and urethra and can promote urethral syndrome.
Inflammation of the paraurethral glands
Urethral syndrome can also be caused by low-grade inflammation of the paraurethral glands. The paraurethral glands or Skene’s glands are glands in women around the exit of the urethra. They are embryologically related to the male prostate.
Irritants or treatment
Irritation of the urethra can also be a reaction to shower or bath soap, vaginal douches, sanitary towels, spermicide cream, hypersensitivity to urinary tract infections and sexual intercourse. Sensitivity to certain foods and drinks containing caffeine can also trigger urethral irritation, as can spicy or spicy foods and alcohol.
Medical treatment
Urethral syndrome can also be triggered by postoperative scars and adhesions, as well as chemotherapy and radiation (radiotherapy).
Trauma to the urethra
Injury to the urethra can be caused by certain activities, such as certain sexual activities, cycling, or wearing very tight clothing.
Nerve problems
Nerve problems caused by diseases such as diabetes or herpes.
Risk factors
The following factors may increase the risk of developing urethral syndrome:
- urethral inflammation or bladder infection caused by bacteria
- taking certain medications
- having sex without a condom
- sexually transmitted infections (STDs)
- have sexual intercourse (for women)
Cystoscopy / Source: Alexilusmedical/Shutterstock
Examination and diagnosis
A diagnosis is usually made once all other possible causes that could cause the symptoms have been excluded. An important cause is infections caused by viruses and bacteria. The doctor will ask questions about your complaints, consider your medical history and then perform a physical examination. Urinalysis can also be performed. If necessary, blood tests or an ultrasound of the pelvic area can also be done. The doctor may use a scope to view the inside of your urethra (cystoscopy).
Therapy
The treatment of urethral syndrome depends on the cause. The doctor may prescribe antibiotics, which are often used if infection is suspected, even if it is not detectable by examination. A urologist can also prescribe medications to relieve pain and inflammation. If the irritation is caused by a soap or hygiene product, the doctor will advise you to stop using this product or to change products. Further treatment may not be necessary. Sometimes dietary changes are advised to treat urethral syndrome. The doctor may then advise against taking coffee, alcohol or spicy foods.
Prognosis
Treatment of the underlying cause in combination with lifestyle advice often gives a favorable prognosis.
Prevention
It is not always possible to prevent urethral syndrome. However, you can reduce your risk of developing this condition by:
- to use a condom during sex
- the use of perfume-free products
- limiting or reducing alcohol and caffeine intake
- avoiding spicy foods