Urinary burning and frequency can be caused by many different conditions and may not be because of a urinary tract infection. Other conditions that can cause these symptoms include:
- Chronic vaginitis
- Vulvar and urethral atrophy
- Lichen sclerosus
- Interstitial cystitis
A full gynecology work up is a crucial place to start in determining the cause, as many urinary problems and gynecology problems are intertwined. The work up includes urine testing, cultures, a vaginal exam, a rectal exam, and evaluation of the pelvic floor to determine if abnormalities are contributing to the symptoms. In some cases, imaging with ultrasound or MRI may be indicated. Often, a gynecologist can diagnose and treat these conditions without the need for further work up. Some women will be referred for a cystoscopy to look inside the bladder.
PCE was first identified by Dr. Ingrid Carlson over approximately two years while at Mayo Clinic and publication of the case series regarding this condition is currently pending. PCE, or periclitoral atrophic erosions, can affect any age group and are tiny lesions seen in the crease between the urethra and the clitoris. They are easily treatable but often missed on a routine exam because of their location and size, and they are exquisitely painful and sensitive. Because of this, they cause irritation of the urethral area which can feel like a urinary tract infection. Often urine cultures are normal and do not indicate infection.
Chronic vaginitis can also cause urinary symptoms. It is important to do aerobic and anaerobic cultures of the vagina, as vaginitis can mimic the symptoms of UTI and is often incompletely treated with the antibiotics used for a presumed bladder infection. Cultures will often grow from the urine showing "normal vaginal flora" or low concentrations that would not meet the criteria for a urinary tract infection.
Fistulas are small tunnels that can be formed after obstetrical trauma or pelvic surgery. They can create an abnormal connection between the bowel and the vagina or the bowel and the bladder. These can cause chronic vaginitis or chronic urinary tract infection. They can often be detected on a special type of MRI that looks closely at the pelvis.
After menopause or because of prolonged suppression of the ovaries by hormonal medications, atrophy can occur at the vagina, vulva, and urethra. Because the urethra is very sensitive to estrogen levels, this can cause the urethra to be more open than normal as the tissues thin out and bacteria can more easily get into the bladder. When this is present, it can predispose to a urinary tract infection, especially after intercourse.
Lichen sclerosus is a skin condition that can cause burning and discomfort. It can cause burning with urination, especially when it is close to the urethral opening. Urine testing will often be normal.
Many times a urinary tract infection is just that - and can be treated with antibiotics. When the urine tests are normal or the discomfort, burning, frequency, and pain do not subside, it's time for further investigation. Seeing your gynecologist is a good place to start.