Foamy Urine

What does it mean when you have foamy urine?

The aspect of the urine can provide a lot of useful information regarding a person’s health. The first tendency when one notices that the urine has become foamy is to panic. However, there is no need to panic, as the foamy urine can be caused by a wide range of factors and conditions. The sooner you are properly informed on the subject, the easier it will be to calm down. As you will have the opportunity to read below, one of the most common causes that leads to such changes is the forceful urination.

If there is no forceful urination but the urine is nevertheless foamy, this may be related to the increased quantities of proteins or to a kidney problem. Before you start panicking, try to think about the chemicals that you are using the clean the toilet (these can interact with the urine and cause it to appear foamy). The doctor will most likely recommend that you take a sample of urine and take it to the laboratory for analysis (there it will be determined whether the foamy appearance is suggestive of an illness or not). In general, the persistence of the foamy aspect of urine requires immediate urine analysis. The doctor will either recommend a standard dipstick test or, in the situation that more serious conditions are suspected, a 24-hour urine collection test.

Causes of Foamy Urine

These are the causes that can lead to the appearance of the foamy urine:

• Forceful/rapid urination
  • The urine stream is modified by the presence of air
  • This is seen in healthy individuals, when the bladder is extended to its maximum capacity
  • The forceful urination is responsible for the foamy appearance of the urine
  • The urine returns to normal in a couple of minutes
• Highly concentrated urine
  • The urine has a darker color and appears highly concentrated
  • Common seen in people who are dehydrated, pregnant women or in those who have performed intense physical exercise
  • Increasing the intake of fluids should allow the aspect of the urine to return to normal
  • When the intake of fluids is adequate, the concentration of the urine is going to be reduced – no more foamy urine, no more darker color (now – pale yellow)
  • Persistence of foamy urine – other health problems may be present
• Chemical substances
  • The toilet cleaners and other chemical substances that are used on the toilet bowl can cause the urine to appear as if it were foamy
  • This problem can be identified by urinating into a sterile container (no foam – healthy)
• Semen in the urine
  • This is common in healthy male individuals, after they have had sexual intercourse (however, the quantity is not enough to modify the appearance of the urine)
  • Foamy urine caused by the presence of semen is encountered in those who suffer from bladder sphincter malfunctions (semen is propelled backward into the bladder, modifying the appearance of the urine)
  • Medication can also cause the above-mentioned dysfunction (known in the medical world as the retrograde ejaculation)
• Increased quantities of proteins in the urine (proteinuria)
  • Most common causes of proteinuria include:
    • Intense physical exercise
    • Diet rich in protein/protein supplements
    • Kidney disease
    • High blood pressure (untreated)
    • Diabetes
  • Risk factors
    • Trauma
    • Toxins
    • Infection
    • Medication
    • Disease (multiple myeloma, amyloidosis)
    • Age (over 65 years of age)
    • Family history of similar problems
  • Pregnancy
    • Proteinuria – serious problem, can lead to complications (eclampsia)
• Urinary tract infection/Bladder infection
  • Bacterial overgrowth at the level of the bladder or the urinary tract
  • Apart from the foamy urine, these are the other symptoms present:
    • Burning or stinging sensation upon urination
    • Intense need to urinate
    • Sense of urgency
    • Blood might be present in the urine
    • Nausea and vomiting
    • Fever
    • Abdominal or back pain
• Vesicocolic fistula
  • Abnormal connection between the urinary bladder and colon
  • Because of the fistula, bacteria can easily reach the urinary bladder
  • Foamy urine
  • Frequent infections
  • The other symptoms are similar to the ones of the urinary tract/bladder infection
  • Main causes
    • Surgical complication
    • Tumor
    • Inflammatory condition (Crohn’s disease)
• Kidney disease
  • Foamy urine can appear in the following situations:
    • Diabetes
    • High blood pressure
    • Kidney stones
    • Kidney infections (frequent)
    • Trauma
    • Medication (side-effect)
    • Drug abuse
  • Symptoms include:
    • Swelling at the level of the legs
    • Fatigue
    • Nausea and vomiting
    • Lack of appetite (anorexia)
    • Back pain
    • Weakness
    • Blood in the urine
    • Foul odor of the urine
• Other causes
  • Amyloidosis
  • Neoplasm
  • Accidental ingestion of chemicals
  • Toxic poisoning with heavy metals
  • Snake/insect bites (venom)
  • Cardiovascular disease (heart failure, inflammation or enlargement of the heart muscle)
  • Systemic infection (with proteinuria and fever)
  • Organ failure (liver or kidney)
  • Autoimmune disorders (such as systemic lupus erythematosus)
  • Stenosis of the renal arteries
  • Rheumatoid arthritis
  • Sarcoidosis
  • Anemia (such as sickle cell anemia).

Diagnosis of Abnormal Foamy Urine

These are the most common methods of diagnosis for the underlying conditions that lead to the foamy urine:

• General methods:
  • Medical history of the patient
    • History of the symptoms
    • Pre-existing conditions
    • Other treatments and surgical interventions
  • Patient evaluation
    • Physical examination
    • Patient anamnesis
  • Urinalysis
    • Dipstick test
    • 24-hour urine collection test
    • Liquid crystals – detection of human serum albumin in urine
    • Creatinine levels (urine sample)
  • Imaging studies
    • X-ray
    • MRI
    • CT scan
• For the vesicocolic fistula:
  • Specialized imaging tests
  • Small camera visualization (this is placed into the bladder through the urethra – identification of abnormal communication)
• For the kidney problems:
  • Patient assessment (thorough evaluation)
  • Blood tests
    • Measurement of kidney function
    • Filtration rate
    • Electrolyte levels
  • Blood pressure assessment
  • Comprehensive urinalysis (24-hour urine collection test – accurate assessment of proteinuria).

How to treat Foamy Urine?

As the foamy urine is merely a symptom, the treatment is often concentrated on the underlying condition. Once the condition behind the foamy urine has been treated, the symptoms are going to disappear on their own (without additional treatment being necessary).

These are the treatment measures that can be taken, depending on the underlying cause:

• Antibiotics
  • Recommended for urinary tract/bladder infections
  • Powerful antibiotics can also be recommended in case of systemic infections
  • The antibiotics are prescribed after lab studies (identification of bacteria)
  • In more severe cases, more than one antibiotic might be prescribed
  • Oral/intravenous antibiotics (the latter are reserved for severe cases, with systemic involvement)
  • The antibiotics should be taken for as long as they are prescribed, otherwise the bacteria will develop resistance to the infection
  • Probiotics are administered at the same time with the antibiotic treatment, so that the healthy intestinal flora is maintained
• Organ transplantation in case of organ failure
• Immunosuppressants – recommended as treatment for those who suffer from different autoimmune diseases
• For fistula:
  • Surgical repairing of the fistula
• For proteinuria:
  • Angiotensin converting enzyme (ACE) inhibitors
  • Aldosterone antagonist (such as spironolactone)
  • Angiotensin receptor blocker (ARB)
  • Secondary proteinuria (caused by autoimmune disease)
    • Steroids
    • Steroid-sparing agents
    • Angiotensin converting enzyme (ACE) inhibitors
• For cancer:
  • Radiation therapy
  • Chemotherapy
  • Surgical removal (if possible).

Apart from the treatment of the underlying cause, it is also possible to administer symptomatic treatment (for the symptoms that are associated to the foamy urine). The most common symptomatic treatment includes anti-inflammatory medication, such as acetaminophen and ibuprofen. This medication is administered with the purpose of bringing pain relief to the patient, as well as reduce the inflammation. In more severe cases, more powerful medication might be administered, for similar purposes. Corticosteroids, such as prednisone or hydrocortisone, can reduce both the pain and inflammation but they cannot be administered for prolonged periods of time, due to the associated negative side-effects. More powerful analgesics are recommended for patients who suffer from chronic conditions, so as to help them get through the pain and discomfort. However, these can cause addiction and they should be administered with care.

Prevention of Foamy Urine

In many patients, the foamy urine is caused by infections at the level of the urinary tract or bladder. Such infections can be easily prevented by maintaining an excellent hygiene in the area. It is recommended that one avoids sitting down on public toilets; if you do have to sit down, make sure that you properly disinfect the toilet seat before using it. You should also avoid washing the intimate area too thoroughly, as such actions destroy the natural flora and leave the genital area exposed to bacterial overgrowth. Increasing the water intake can help in case of dehydration, with the appearance of the urine being immediately improved. It is also important to avoid the excessive consumption of tea or coffee, as these beverages can easily contribute to the dehydration of the body.