Pneumaturia - Causes, Diagnosis, and Treatment

What Is the Meaning of Pneumaturia?

Under normal conditions, some amount of gas is present in the digestive system. The gas forms in the digestive tract when the air is swallowed while talking, eating, drinking, and laughing. If carbohydrates are consumed in excess, the bacteria break them into simpler substances, and this could be one of the reasons for gas in the digestive system. However, the problem arises when this gas passes to the urinary system resulting in the formation of bubbles in the urine. These bubbles give rise to a condition known as pneumaturia. It is not a diagnosis but a symptom of conditions that affect the digestive and the urinary system. Pneumaturia subsides when the factors responsible for it are treated.

What Are the Causes of Pneumaturia?

The presence of gas in the urine can be due to a bladder infection or a fistula. The abnormal communication between the body parts is known as a fistula. The causes of pneumaturia have been described below:

1. Emphysematous Cystitis - It is a type of urinary tract infection in which gas is formed in the urinary bladder due to some bacteria and fungi. The other bacteria and fungi responsible for emphysematous cystitis include Klebsiella pneumoniae, Proteus mirabilis, and Candida albicans. Patients suffering from diabetes, urinary tract obstructions, and using catheters for a long time to drain urine are at very high risk.

2. Fistula - The human body comprises several organ systems that are very well separated from each other. When an organ communicates with the other due to some disease or pathology, it is known as a fistula. The most common cause of pneumaturia is an enterovesical fistula. The abnormal communication between the bowel and the urinary bladder is known as an enterovesical fistula. The gas from the bowel easily passes to the urinary bladder resulting in the presence of air bubbles in the urine.

3. Emphysematous Pyelonephritis - It is a severe infection of the kidneys and the tissues present around them. The gas accumulates in the functional units of the kidneys and the collecting tubules present in them. When the urine flows through the kidneys, the gas mixes up with it, resulting in the presence of air bubbles in the urine.

4. Deep-Sea Diving - The scuba divers usually wear a condom catheter that is attached to their drysuit to pass urine. When the divers remain for a prolonged period underwater, they tend to develop pneumaturia.

What Happens in Pneumaturia?

The most significant point that needs to be kept in mind is pneumaturia is a symptom and not a condition. The changes that the patient experiences while urinating are listed below:

1. The urine flow is restricted so the patient can pass a few drops of urine each time.

2. Pain and burning sensation while urinating are commonly seen.

3. The patient experiences pain in the lower back and abdominal region.

4. The urine flow gets interrupted due to the presence of bubbles or gas.

5. The patient might hear some sound while urinating due to the presence of bubbles.

What Methods Are Used to Diagnose Pneumaturia?

The diagnosis of pneumaturia is based on laboratory and imaging tests. The laboratory tests help check whether the gas in the urine is due to a bacterial infection. Imaging tests help to check if the cause of pneumaturia is a fistula. The following tests are done to diagnose pneumaturia:

1) Laboratory Tests - The following laboratory tests are done to detect urinary tract infections:

• Urinalysis - It is a simple urologic test in which the patient is required to send the collected urine sample to the laboratory. In the case of urinary tract infection, the white blood cells are present in an increased number in the urine.

• Blood Tests - The doctor might seek blood test reports from the patient to check the condition of the kidneys and if any other infection is present in the body.

2) Imaging Tests - The imaging tests mentioned below are usually recommended:

• Cystoscopy - It is an invasive procedure wherein the doctor inserts a small telescope-like instrument into the urinary bladder through the urethra. It helps to diagnose and treat problems of the urinary tract. The bubbles present in the urine are also visible, and the surface of the bladder looks silvery.

• Ultrasound - It is a diagnostic procedure wherein the patient is laid on the X-ray table. A device known as the transducer is moved over the patient’s abdomen, and the urinary tract images are obtained on the computer screen. These images help to detect the problems of the urinary bladder and other organs.

• Computed Tomography (CT) Scans - CT scan is one of the effective methods to diagnose pneumaturia because it allows the doctor to have a three-dimensional view of the urinary tract and its abnormalities.

How Is Pneumaturia Treated?

Pneumaturia is a symptom that will subside when the condition is treated. Urinary tract infections and fistulae are the most common causes of pneumaturia. The treatment comprises surgical and non-surgical options that have been described below:

• Antibiotics to Treat Urinary Tract Infections - The commonly used antibiotics are listed below:

  • Amoxicillin and Clavulanic Acid.

  • Cephalexin.

  • Ciprofloxacin.

  • Nitrofurantoin.

  • Trimethoprim.

  • Ceftriaxone.

  • Fosfomycin.

• Antibiotics to Treat Enterovesical Fistula - If the cause of the fistula is Crohn's disease, the following drugs are recommended to shrink the fistula to some extent:

  • Azathioprine.

  • Prednisolone.

  • Infliximab.

• Surgical Treatment - In the case of urinary tract infections, no surgical treatment is required as it subsides with the help of antibiotics. Surgery is required for enterovesical fistula if the antibiotics fail to treat it. Laparoscopic surgery is most commonly indicated to repair the fistula. It has been described below:

  • Laparoscopy - Laparoscopic surgery is also known as “key-hole” surgery and is usually performed under general anesthesia. After making the incision or cut, the doctor inserts an instrument known as a laparoscope. It is a tube-like instrument and has a camera at one end to view the internal organs. Small surgical instruments are passed through the laparoscope to remove the portion of the bowel that communicates with the urinary bladder. A nasogastric tube is inserted and left in place, as the patient will not be able to eat anything orally until the bowel movements become normal.

Conclusion:

Pneumaturia, or the presence of bubbles in the urine, is one of the major symptoms of urinary tract infections and colovesical fistula. It is not a life-threatening problem, but ignorance may result in severe complications. The patient must consult the doctor if the urinary tract infection and fistula recur even after taking the medications. Timely diagnosis and treatment of the conditions causing pneumaturia to help the patient get rid of the symptoms and live a healthy life ahead.