Pneumaturia is the medical term for gas or “air” in the urine, often appearing as bubbles during urination. While sometimes harmless, air in the bladder can signal underlying health issues requiring medical attention.
What Causes Air in the Bladder
Air can enter the bladder through several pathways. One frequent cause is related to medical procedures, such as recent catheterization or cystoscopy, which can temporarily introduce air that passes with urine.
Certain types of bladder infections can also lead to air production. Emphysematous cystitis, a severe urinary tract infection, involves gas-producing bacteria (like Escherichia coli and Klebsiella pneumoniae) that create gas bubbles within the bladder wall or lumen. This condition is more prevalent in individuals with diabetes, as excess glucose can fuel these bacteria.
More concerning causes involve abnormal connections, known as fistulas, between the bladder and other organs. A common type is a colovesical fistula, which forms between the colon and the bladder, allowing intestinal gas and sometimes even fecal matter to enter the bladder. These fistulas can arise from conditions like diverticulitis, Crohn’s disease, or cancer.
Signs and Symptoms of Air in the Bladder
Air in the bladder often presents with noticeable signs during urination. Individuals may observe gas or a bubbling sensation accompanying the urine stream. The urine itself might appear frothy or bubbly, distinct from general foamy urine which can indicate excess protein.
Unusual sounds during urination, sometimes described as a whistle or barking sound, can also occur. Abdominal discomfort or bloating may also be experienced. While these symptoms directly relate to the presence of air, sometimes there are no noticeable symptoms at all.
When Air in the Bladder Signals a Problem
While air in the bladder can be harmless, its presence often signals a serious underlying health issue, particularly when not associated with recent medical procedures.
The most significant concern is the formation of a fistula, an abnormal passageway connecting the bladder to another organ, most commonly the bowel. Colovesical fistulas, for example, allow intestinal gas and potentially fecal material from the intestines to enter the bladder, posing a high risk of severe infection. These fistulas can result from inflammatory bowel diseases like Crohn’s disease, diverticulitis, or even certain cancers affecting the bowel or bladder. Untreated fistulas can lead to serious complications such as abscesses, widespread infections, and sepsis.
Another serious condition indicated by air in the bladder is emphysematous cystitis, a rare but potentially life-threatening infection. This infection is more common in individuals with diabetes or compromised immune systems and can rapidly progress to severe complications, including bladder rupture, renal failure, or septic shock. Urgent medical evaluation is necessary when air in the bladder is accompanied by symptoms such as high fever, severe abdominal pain, nausea, vomiting, blood in the urine, difficulty urinating, or signs of systemic infection like confusion or a rapid heart rate.
Diagnosing and Treating Air in the Bladder
Diagnosing the cause of air in the bladder begins with a comprehensive medical history and physical examination. The doctor will inquire about symptoms, recent medical procedures, and existing health conditions. Initial laboratory tests include urinalysis and urine culture to check for infection, identifying any bacteria or yeast present.
Imaging studies are crucial for visualizing the bladder and surrounding structures. A computed tomography (CT) scan is a common diagnostic tool that can detect air within the bladder or its wall, identify fistulas, and reveal other abnormalities. Magnetic resonance imaging (MRI) or X-rays may also be used. In some cases, a cystoscopy may be performed, involving the insertion of a thin, lighted tube with a camera into the bladder to directly view its inner lining and observe any air bubbles or abnormal connections.
Treatment for air in the bladder focuses entirely on addressing the underlying cause. If a bacterial infection like emphysematous cystitis is responsible, a course of antibiotics is prescribed. For more severe infections, intravenous antibiotics may be necessary, and bladder drainage might be implemented. When a fistula is identified as the cause, surgical repair is often required to close the abnormal connection. The complexity of the surgery depends on the fistula’s location and extent. In some mild cases of fistulas, a catheter may be used to drain urine, potentially allowing the fistula to heal on its own.