What is fecaluria?

Fecaluria is the complaint of passing feces (stool) in the urine. It is a distinctive and concerning symptom indicating an abnormal connection between the gastrointestinal tract and the urinary system.

Understanding Fecaluria

Fecaluria occurs when there is a pathway that allows colonic or intestinal contents to enter the bladder or other parts of the urinary tract, leading to their expulsion during urination. This passage can involve solid stool, fragments of stool, or a mixture of gas and stool (known as pneumaturia, which often accompanies fecaluria). It is a clear sign of an internal fistula, an abnormal connection between two epithelialized organs.

Common Causes of Fecaluria

The primary cause of fecaluria is typically an abnormal passage, or fistula, forming between a section of the bowel (most commonly the colon) and the urinary bladder. These fistulas allow fecal material to bypass the normal excretory pathway and enter the urinary stream. Several conditions can lead to the formation of such fistulas:

• Diverticulitis: This is the most frequent cause, where inflammation and infection of small pouches (diverticula) in the colon wall can erode into the bladder.
• Crohn's Disease: A chronic inflammatory bowel disease that can cause deep ulcers and inflammation, leading to fistula formation in various parts of the digestive tract, including connections to the bladder. Learn more about gastrointestinal fistulas from reliable sources like the Mayo Clinic.
• Malignancy: Tumors originating in the colon, bladder, or adjacent organs can invade and erode through the walls, creating a communication between the two systems.
• Surgical Complications: Rarely, abdominal or pelvic surgery can inadvertently lead to fistula formation due to injury or post-operative infection.
• Trauma: Severe pelvic trauma can also result in such connections.

Associated Symptoms and Complications

Fecaluria is rarely an isolated symptom. It is often accompanied by other signs that further indicate an underlying fistula:

• Pneumaturia: The passage of gas in the urine, which is highly suggestive of a communication between the bowel and bladder. Gas produced by bacteria in the colon enters the bladder and is expelled during urination.
• Recurrent Urinary Tract Infections (UTIs): The introduction of fecal bacteria into the sterile urinary tract frequently leads to persistent and often severe UTIs that are difficult to treat.
• Dysuria: Pain or discomfort during urination.
• Suprapubic Pain: Pain above the pubic bone, indicating bladder irritation or infection.
• Hematuria: Blood in the urine, sometimes due to inflammation or infection.
• Feculent Vaginal Discharge (in women): If the fistula involves the vagina as well.

Untreated, fecaluria and the underlying fistula can lead to serious complications, including chronic pain, electrolyte imbalances, malnutrition, and potentially life-threatening infections like urosepsis due to uncontrolled bacterial spread from the bowel to the bloodstream.

Diagnosis and Treatment Overview

Diagnosing the cause of fecaluria typically involves a combination of medical history, physical examination, and imaging studies to locate and characterize the fistula. Common diagnostic tests include:

• CT Scan: A computed tomography scan of the abdomen and pelvis is often the initial imaging modality to visualize the fistula and surrounding anatomy.
• Cystoscopy: A procedure where a thin, lighted tube with a camera is inserted into the urethra to examine the inside of the bladder and identify the bladder opening of the fistula.
• Colonoscopy: An examination of the colon to identify the bowel opening of the fistula or to diagnose underlying conditions like Crohn's disease or diverticulitis.
• Fistulography: Injecting contrast dye into the fistula tract to visualize its path on X-ray.

Treatment for fecaluria primarily focuses on surgical repair of the fistula, along with managing any underlying conditions such as diverticulitis or inflammatory bowel disease. Antibiotics are also crucial for treating and preventing infections.