I don’t want to pry or get overly personal, so you don’t need to tell me the answer to the question I’m about to ask… but you should definitely tell your doctor.

Do you often pass gas when you urinate? If the answer is yes, it could mean that air is entering your urinary tract — a possible sign of a urological problem called a urinary fistula, said Toby C. Chai, MD, a professor of surgery in the department of urology at the University of Maryland Medical Center.

A fistula is an abnormal opening or tunnel-like passageway between two organs. Urinary fistulas can develop between the…

Bladder and the colon or small bowel. Possible symptoms of this type of fistula include the aforementioned gas-passing while urinating (which in medical parlance is called pneumaturia)… recurrent urinary tract infections… and noticeable particulate matter or bits of stool coming through the urethra (the tube that carries urine out of the body) during urination, which doctors refer to as fecaluria.

Such a fistula typically is caused by diverticulitis (inflammation of small bulging pouches in the lower portion of the colon)… inflammatory bowel disease, such as Crohn’s disease… colon cancer or radiation therapy for cancer… or tissue breakdown brought on by diabetes.

Bladder or ureter and the vagina. (A ureter is a tube that carries urine from the kidney to the bladder.) This type of fistula causes constant day-and-night leakage of urine from the vagina, so patients are not able to hold their urine at all.

Most often, such a fistula is caused by injury to the bladder and/or ureter during vaginal childbirth, Cesarean delivery or trauma (such as a car accident). While most fistulas occur immediately following the injury, in rare cases, they may go undetected for months or even years.

Other possible causes include tissue breakdown from diabetes… cancer of a urinary or reproductive organ… or the radiation used to cure these cancers (in which case the fistula may develop months or years after radiation therapy ends).


If you develop any possible symptom of a urinary fistula, such as pneumaturia, fecaluria or constant urinary incontinence, see your doctor or a urologist without delay. Fistulas do not go away on their own and can lead to other problems, such as urinary tract infections and genital skin irritation or breakdown. “Urinary fistulas can really impact your life, causing significant embarrassment and discomfort,” Dr. Chai said. “We get better results the earlier these things are caught.” Various diagnostic techniques — magnetic resonance imaging (MRI), computed tomography (CT) scan and/or cystoscopy (visual examination of the bladder and urethra using a thin, flexible, lighted tube) — can be used to confirm the diagnosis.

Surgery can repair most urinary fistulas. The procedure may be done transvaginally or through an incision in the abdomen, depending on the location and severity of the fistula. Sometimes healthy tissue from elsewhere on the body is grafted to repair the passageway. Recovery typically takes two to six weeks depending on the type of surgery performed. Good news: For most patients, the outcome is excellent.