Foamy Urine

The renal and urinary systems perform several vital functions in the body. For example, besides excreting waste products and excess water, this system is also responsible for regulating normal blood pressure and synthesis of certain important hormones and neurotransmitters.

The urine is produced by the kidneys and is then drained through the collecting ducts into the urinary bladder. After brief storage in the bladder, the urine is expelled from the body via urethral sphincters. The normal urine produced by well-hydrated individual is pale or straw colored due to massive reabsorption of water in the renal tubules. Sometimes the urine appears foamy or bubbly (which is generally normal); but may indicate an underlying problem which should be addressed as early as possible.

Signs and Symptoms of Foamy Urine

Foamy urine may be idiopathic and normal (i.e. absence of a particular cause or disease process) or c

ould be associated with an underlying pathology. Based on the clinical data, foamy urine is frequently reported in following scenarios:

• Moderate to severe dehydration
• Frequency and velocity of urination
• Passage of very concentrated urine

As discussed previously, foamy urine may be a normal unless it is associated with one or more of the following complaints:

• A foamy urine that appears turbid and cloudy
• Appearance of blood in the urine
• Appearance of pus or thick secretions in the urine
• When foamy urine is associated with thick vaginal discharge (suggesting an active infection)

Foamy Urine – When should you be Concerned and How to Manage?

1. Foamy urine due to Dehydration:

• High frequency of urination (due to diuretics or other drugs) can cause mild dehydration and passage of foamy urine.
• In addition, holding the urine for too long can also lead to forceful urination and passage of foamy urine.
• People who do not drink sufficient amounts of water also complaints of foamy urine.

Treatment

Generally no treatment or intervention is needed if foamy urination is due to dehydration or increased urinary frequency. However, you can definitely try some preventive measures to control this problem.

• Increase your basal water intake and maintain adequate hydration
• Avoid unnecessarily holding the urine for too long
• Avoid passing urine quickly or in a rush
• Consult a healthcare provider if the condition does not resolve

2. Foamy Urine due to leakage of Proteins:

Proteinuria, a condition in which protein appears in the urine can also produce foamy urine. It is noteworthy that leakage of extremely small amounts of protein in the urine may not cause any noticeable symptoms. In other words, if your urine appears foamy due to protein leakage, the amount is generally high and problem could be serious.

The pathophysiology of proteinuria revolves around the damage to the kidney or renal apparatus. This is mainly because, proteins generally do not pass through the glomeruli and therefore do not appear in the urine. High proteinuria indicates:

• High intake of proteins in the diet
• Infection in the kidneys or renal tubules
• Kidney damage

Treatment

High quantities of protein in the urine can be easily identified through urine analysis. Decreasing daily protein intake and management of renal infection often helps.

3. Foamy Urine due to Infection

Urinary tract infection caused by bacteria, viruses and fungi can also produce foamy urine. The condition is characterized by painful urination, urgency and increased frequency of urination and flank pain.

Treatment

Treatment revolves around the identification of the causative agent and control of symptoms via appropriate antibiotic and other medications to control the infection process.

4. Foamy Urine due to fistula formation

Fistula is an abnormal communication or passage between the bladder and large intestine (also known as vesicocolic fistula). The condition is characterized by swelling of intestine and accumulation of fluid under the skin tissues. Foamy urine appears in the fistula formation as a result of accumulated fluid. Along with this disagreeable odor from urine, patient may also experience onset of fecal contents in the urine.

Treatment

Fistula formation is a serious medical condition that is usually reported in the setting of Crohn’s disease and other inflammatory bowel condition. Appropriate medical care should be provided to minimize the risk of complications.

5. Foamy urine due to presence of Semen:

Semen in urine may appear after intercourse in extremely small amounts. Sometimes, traces of semen are left on the urethra that may flush down with urine.

A condition termed as retrograde ejaculation may also cause foamy urine, in which there is malfunctioning of the urinary sphincters that causes the back flow of semen.

Treatment

Appropriate medical (and/or) surgical treatment should be sought to address the symptoms.

6. Foamy Urine due to kidney disease

Individuals with renal disease (secondary to hypertension or diabetes) often complaints of foamy urine. Diagnosis is done through urine analysis and relevant tests.

Treatment

After evaluation of symptoms, appropriate treatment should be sought to address the patient concerns and to control the damage.

References:

1. Kang, K. K., Choi, J. R., Song, J. Y., Han, S. W., Park, S. H., Yoo, W. S., ... & Kim, B. (2012). Clinical Significance of Subjective Foamy Urine. Chonnam medical journal, 48(3), 164-168.

2. Crawford, A. R., Dworkin, L., Leonard, K., Khurshid, H., & Hepel, J. T. (2013). Recurrence of paraneoplastic membranous glomerulonephritis following chemoradiation in a man with non-small-cell lung carcinoma. Rare tumors, 5(2), 62.

3. Lee, K. H., Kang, S. H., Lee, H. W., Park, G. E., Hong, Y. S., Lee, J. E., & Kim, Y. G. (2015). A Case of Light Chain Deposition Disease in a Patient with Diabetes and Nodular Glomerulosclerosis. Korean Journal of Medicine, 88(3), 318-323.