The term dysuria is used to describe painful urination, which often signifies an infection of the lower urinary tract. The discomfort is usually described by the patient as burning, stinging, or itching. Pain occurring at the beginning of or during urination suggests a urethral site of disease, whereas pain after voiding implies pathology within the bladder or prostate area. Sometimes a patient will relate a history of pain in the suprapubic area.
In women with dysuria, the first question should be whether the discomfort is internal or external; in addition to urinary tract inflammation or infection, vaginal inflammation can cause dysuria as urine passes by the inflamed labia. If the sensation is internal or suprapubic, a urinary tract source is more likely; questions about associated fever, chills, back pain, nausea, vomiting, and prior urinary tract infections should be asked in an attempt to differentiate upper from lower urinary tract infection. If the sensation is "outside," then a vaginal etiology should be suspected. Questions about a vaginal discharge or itching should always be asked. Vaginitis and a urinary tract infection often coexist, and vaginal infections in some populations are seen almost six times more frequently than urinary tract infections. Remember that women often do not spontaneously volunteer information about a vaginal discharge or vaginal itching. To help delineate the etiology of dysuria in the individual patient, both a urinalysis and a pelvic examination will often be necessary.
Urinary frequency should be differentiated from polyuria, which specifically relates to the passage of an abnormally large volume of urine in a relatively short period of time. Frequency of normal urination may vary considerably from individual to individual depending on personality traits, bladder capacity, or drinking habits. Because of this fact, a history of frequency is sometimes difficult to obtain. Changes in the pattern of frequency or a history of voiding more than once at night after retiring, however, are clues to urinary pathology. Ask about volume and voiding times, since a large bladder capacity may conceal an increase in urine production. Frequency commonly accompanies the dysuria associated with urinary tract infections but less commonly with vaginitis. Ask also about periodicity of symptoms because day frequency without nocturia, or frequency lasting only a few hours at a time, suggests nervous tension or a psychiatric cause.
The average adult bladder holds between 400 and 700 ml of urine. Normal patterns of urination may vary considerably; adults generally void 5 to 6 times daily but no more than once after retiring. The average 24-hour urinary output is 1200 to 1500 ml. Urinary frequency may occur because of either increased urine volume or decreased bladder capicity (i.e., less than 200 ml).
Americans today have an enormous variety of content available to them at any time of day, and this material is available in a number of formats and through a range of digitally connected devices. Yet even as the number of ways people spend their time has expanded, a Pew Research Center survey finds that the share of Americans who have read a book in the last 12 months (73%) has remained largely unchanged since 2012. And when people reach for a book, it is much more likely to be a traditional print book than a digital product. Fully 65% of Americans have read a print book in the last year, more than double the share that has read an e-book (28%) and more than four times the share that has consumed book content via audio book (14%).
For instance, 16% of blacks report that they use their cellphones to read books. That is nearly double the share of blacks who read books on traditional computers (9%) and four times the share who read books using dedicated e-readers (4%). Hispanics are less likely than blacks as a whole to read books on cellphones (11% do so), but Hispanics are also substantially more likely to read books on cellphones than on e-readers or traditional computers. By contrast, whites tend to turn to a range of digital devices when reading e-books: 13% read e-books on cellphones, but 18% read e-books on tablet computers, 10% use e-book readers and 11% engage with e-book content on desktop or laptop computers. 2b1af7f3a8