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What Is Pneumaturia?

Everyone has gas in the digestive system. Gas in the bladder that passes with the urine is not normal. This condition, called pneumaturia, is rare and can be a symptom of something serious. Here's what you need to know about pneumaturia, its causes, and how it is treated.

Having gas in your bladder is not an illness. It's a symptom of another condition. If you have pneumaturia, you probably won't know it. Sometimes, those with pneumaturia make unusual noises while urinating. Some people describe the noise as a whistle. Others have described it as a barking sound.

Causes of Pneumaturia

Sometimes gas starts in the bladder rather than traveling there from the bowel. A urinary tract infection may be the cause. Several types of bacteria and yeast can form gas in the bladder.

A condition called emphysematous cystitis can cause gas in the urine. If you have this, your bladder is inflamed, and there are gas bubbles in or on the bladder wall. This condition is most common in people with diabetes, especially older women. Excess glucose in the body can feed the bacteria that create the gas.

Emphysematous cystitis has symptoms similar to an ordinary urinary tract infection. It can be serious if not diagnosed and treated promptly. The bladder can rupture and spread the infection, sometimes resulting in death. 

A condition called fistula can cause pneumaturia. That's a passageway between two parts of the body that should not connect. An abnormal connection between the bowel and the bladder can allow air to enter the urine. Sometimes feces pass into the urine as well. This type of fistula can have several causes, including:

Some surgical procedures on the female reproductive system can cause fistulas, including hysterectomies, C-sections, and episiotomy, when a cut is made to make the opening in your vagina bigger for childbirth:

Occasionally, fistulas may result from trauma to the abdomen. Other rare causes include pelvic radiation and tuberculosis.  

Diagnosis of Pneumaturia

Your doctor has several options to find the cause of pneumaturia, including: 

Cystoscopy. Doctors insert a lighted tube into the bladder and use a camera to look for problems. Sometimes they can see the air bubbles and watch them break. The bubbles may give the surface of the bladder a silvery look. 

Sigmoidoscopy. This uses a similar instrument to the one used for cystoscopy to look into your rectum. They are looking for a fistula linking the bladder and bowel. They may use a cystoscope to look for the fistula from the bladder side. 

Lab Tests. Blood and urine tests can tell doctors whether or not you have a urinary tract infection. 

Imaging Tests. To see what's going on in your bladder, your doctors may use various things, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). 

Treatment of Pneumaturia

Pneumaturia is treated by addressing the condition that is causing gas in the urine.

If a fistula is causing the gas, the passage can be closed with surgery. This can range from simple to complex, depending upon the cause and extent of the fistula. Occasionally a small fistula will heal on its own. 

If a urinary tract infection is causing the gas, antibiotics will usually clear it up. If emphysematous cystitis is the cause, antibiotic or antifungal treatment is the first line of defense. Sometimes doctors will need to do more, such as removing affected tissue. 

WebMD Medical Reference

Sources

SOURCES:

Canadian Urological Association Journal: "Emphysematous cystitis: The role of CT imaging and appropriate treatment."

International Journal of Surgery Case Reports: "Entero-vesical fistulas in CROHN’S disease: A case series report and review of the literature."

Mayo Clinic: "Diverticulitis."

Merck Manual Consumer Version: "Urine, Gas in." 

Northwestern Medicine: "Foamy Urine: What's Normal, What's Not." 

Radiology: "Spontaneous Pneumaturia With Report of a Case."

StatPearls [Internet]: "Colovesicular Fistula."

Urinary Associates: "Urinary Fistula." 

Urology Case Reports: "'Pop goes the whistle' - Noisy micturition as the main presentation of pneumaturia." 

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