Post-Appendectomy Concerns: Increased Bubbles in Urine Explained

Q: Post-Appendectomy Concerns: Increased Bubbles in Urine Explained

Hello： In response to your question, common symptoms of a colovesical fistula include the passage of gas during urination, and in more severe cases, fecal matter may appear in the urine. <br>However, you should not be overly concerned, as colovesical fistulas are not very common,

Bubbles in urine after peritonitis?

A little over a month ago, on November 6th, I underwent emergency surgery for appendicitis that had progressed to peritonitis.
My last blood test was on December 5th, showing an inflammatory index of just over one and a white blood cell count of 9,000.
The wound is healing well, and my attending physician said I do not need to return for follow-up.
However, I have noticed an increase in bubbles in my urine since the surgery, and I am drinking more than 2,000 cc of water daily.
My daily activities and routine are normal, and the color of my urine is very light.
I am now very worried about the possibility of developing a fistula between the colon and bladder leading to peritonitis.
Could this happen, and what symptoms should I be aware of? Thank you, Dr.
Ke.

A-Cheng, 30~39 year old female. Ask Date: 2013/12/13

Dr. Ke Fangxu reply Surgery

Hello: In response to your question, common symptoms of a colovesical fistula include the passage of gas during urination, and in more severe cases, fecal matter may appear in the urine.
However, you should not be overly concerned, as colovesical fistulas are not very common, especially following appendectomy, and there have been no reported cases of this occurring.
The turbidity of urine post-surgery is more likely due to a urinary tract infection caused by the catheter.
It is advisable for you to undergo a urinalysis to determine if further treatment is necessary.

Reply Date: 2013/12/13

More Info

After an appendectomy, particularly in cases of perforated appendicitis leading to peritonitis, patients may experience various urinary changes, including an increase in bubbles or foam in their urine. This phenomenon can be attributed to several factors, and it is essential to understand the underlying mechanisms to alleviate concerns about potential complications such as a fistula between the bladder and the colon.

Understanding Increased Bubbles in Urine:
The presence of bubbles in urine can occur for several reasons. One common cause is the presence of protein in the urine, known as proteinuria. This can happen due to various factors, including dehydration, urinary tract infections, or kidney issues. However, in the context of your recent surgery, it is more likely that the bubbles are related to the physiological changes following the surgical procedure rather than a direct complication.

Increased urine bubbles can also result from the introduction of air into the urinary tract, which may occur during catheterization or as a result of changes in bladder dynamics post-surgery. If the bladder was manipulated during the surgery, it could lead to temporary changes in how urine is expelled, potentially causing more bubbles.

Concerns About Fistula Formation:
Your concern about the potential formation of a fistula between the bladder and the colon is valid, especially after a significant abdominal surgery. A fistula could develop if there was significant inflammation or damage to the tissues surrounding the bladder and colon during the surgery. However, the development of such a complication is relatively rare.

Signs of a fistula may include:
1. Persistent Urinary Symptoms: Such as frequent urination, urgency, or pain during urination.

2. Fecal Matter in Urine: This is a more definitive sign and would require immediate medical attention.

3. Recurrent Infections: If you experience frequent urinary tract infections, it may warrant further investigation.

4. Unusual Discharge: Any unusual discharge from the urinary tract should be evaluated.

Given that your inflammatory markers have returned to normal and your overall recovery seems to be progressing well, the likelihood of a fistula is low. However, if you notice any of the symptoms mentioned above or if your urinary symptoms worsen, it would be prudent to consult your healthcare provider for further evaluation.

Recommendations:
1. Hydration: Continue to maintain good hydration, as this can help dilute the urine and potentially reduce the appearance of bubbles.

2. Monitoring Symptoms: Keep track of any changes in your urinary habits or any new symptoms that may arise.

3. Follow-Up Care: Although your doctor has indicated that no further follow-up is necessary, if you have ongoing concerns, do not hesitate to seek a second opinion or request a follow-up appointment for peace of mind.

In summary, while increased bubbles in urine post-appendectomy can be concerning, they are often benign and related to the physiological changes following surgery. However, staying vigilant for any signs of complications and maintaining open communication with your healthcare provider is essential for ensuring a smooth recovery.

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