Pneumaturia is the passage of gas or air during urination. While unsettling, it is a symptom of an underlying medical condition, not a disease itself. This article clarifies the sensations associated with pneumaturia, explores its causes, and outlines steps for medical evaluation.
Describing the Sensation
Individuals experiencing pneumaturia often report a distinct bubbling or fizzing sensation as urine is expelled. Some describe it as a hissing or sizzling sound accompanying the urine stream. Visually, the urine may appear to contain small air bubbles, distinct from the fine foam that can indicate protein in the urine. This phenomenon typically involves the direct passage of gas from the bladder, which can interrupt the normal flow of urine.
The sensation itself is not usually painful, but the unexpected nature of passing gas with urine can be alarming. It is a noticeable change from typical urination and often prompts concern.
Underlying Causes
The most frequent reason for air in urine is an abnormal connection, known as a fistula, between the urinary tract and the bowel. Diverticulitis is a common cause of such fistulas.
Other conditions leading to fistula formation include inflammatory bowel disease, particularly Crohn’s disease, and colorectal cancer. Prior abdominal or pelvic surgeries, trauma, or radiation therapy can also result in these abnormal connections. Less commonly, gas-forming urinary tract infections, such as emphysematous cystitis, can cause pneumaturia. This severe infection involves bacteria or yeast producing gas bubbles within the bladder wall and is more prevalent in individuals with diabetes. Pneumaturia can also occur temporarily after certain medical procedures involving the urinary tract, such as catheterization.
When to Seek Medical Attention
Pneumaturia always warrants medical evaluation. It often signals an underlying condition requiring proper diagnosis and management.
Seek attention if pneumaturia is accompanied by other symptoms, such as abdominal pain, fever, changes in bowel habits, or blood in the urine. Other concerning signs include a burning sensation during urination, frequent urges to urinate, or discolored urine. Delaying medical advice or attempting self-diagnosis is not recommended, as underlying causes can be serious.
Diagnostic Approaches and Management
To identify the cause of pneumaturia, a healthcare provider typically begins with a physical examination. This is followed by urine tests, including urinalysis and urine culture, to check for infections or gas-producing bacteria or yeast.
Imaging studies are frequently used to visualize the urinary and digestive tracts. A Computed Tomography (CT) scan of the abdomen and pelvis, often with contrast, is a common tool to detect fistulas or gas within the bladder wall. Endoscopic procedures like cystoscopy, where a thin, lighted tube is inserted into the bladder, allow direct visualization of the bladder lining and can reveal gas bubbles or changes. A colonoscopy or sigmoidoscopy may also be performed to examine the bowel for a fistula source.
Management focuses on addressing the identified underlying cause. If an infection is present, antibiotics are typically prescribed. For fistulas, surgical intervention is often necessary to repair the abnormal connection between the bowel and the bladder. Once the root cause is successfully treated, pneumaturia usually resolves.