Passage of Gas Through Urine (Pneumaturia)

Pneumaturia is the passage of gas from the bowel into the urine, a pathognomonic symptom of an enterovesical fistula (most commonly a colovesical fistula). This abnormal connection allows flatus from the colon to enter the bladder, which is then expelled during urination, often described as a bubbling or fizzing sensation. It is frequently accompanied by recurrent urinary tract infections and sometimes fecaluria (stool in the urine). The most common cause is complicated diverticulitis, followed by colorectal cancer and Crohn's disease. The presence of pneumaturia necessitates a full workup, including a CT scan and endoscopy, to confirm the fistula and identify the underlying cause, which almost always requires surgical correction.