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Neuro Doctor
Neuro Doctor, Neurologist (MD)
Category: OB GYN
Satisfied Customers: 4716
Experience:  American Board Certified Neurologist, Internal Medicine
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Dear Doctor, I am 26 weeks pregnant. This is my first

Customer Question

Dear Doctor,
I am 26 weeks pregnant. This is my first pregnancy. Below are the symptoms that I faced at different points in my pregnancy. Look forward to your advice on what problem I am facing. Thank you.
Week 16 of my pregnancy
I had severe constipation for 4 days. On the fifth day theconstipation cleared but a pain started in my left inner groin area. This pain has continued since then and only gotten worse. The pain occurs when I sleep or lie down on bed for even 30 minutes. When I wake up I feel strong pain in my left groin, and left pubic area and face great difficulty in turning over in bed from one side to the other, or getting up from the bed. The pain is particularly high when I wake up but once I urinate or pass bowel the pain subsides.Week 23 of my pregnancy
I had spotting (blood spots in my undergarment). The doctor check my vagina and there was no blood there. So doctor was not sure if blood came from Urethra or Vagina.
After 2-3 days of this incident, I started noticing air bubbles in my urine (please see attached picture). Since then I have been seeing air bubbles in my urine - there are less bubbles in the morning and more during afternoon/evening (perhaps as I start eating during the day).Week 25 of my pregnancy
I noticed very small fecal matter in my urine. This happened only once. (please see attached picture)Week 26 of my pregnancy
My lower left abdominal pain has become worse. I feel very sore in that area. The pain is particularly high on the day I am unable to pass bowel.
Even when I am sitting, I feel air bubbles popping out of my urethra/vagina area (I am not sure whether it comes out from urethra or vagina)
The physician conducted following test. All tests reports came back Normal. I have mentioned few values as well.
- Protein total spot urine test (my value <6 mg/dl)
- Creatinine spot urine test (my value 17.88 mg/dl
- Urinalysis (all values within range)
- Urine culture (No growth after 2 days)
- Blood test (my glucose level was slightly low, but everything else was normal, e.g. blood creatinine level = 0.49, eGFR>60)
Look forward to your advice on
1) What problem I may be facing?
2) What other tests I may need to get done?
3) What treatment options exist?
4) What impact can this have for me or my pregnancy?
Submitted: 2 months ago.
Category: OB GYN
Expert:  Neuro Doctor replied 2 months ago.

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all types of neurological & other medical conditions including the concerns of “New onset lower abdominal/groin area pain along with air & fecal matter in the urine" you have mentioned here and I am very glad to help you with your health concerns.

I have tried to answer your questions one by one below here;

1) What problem I may be facing?

Your symptoms are suspicious for development of Fistula between the lower gastrointestinal tract and the urinary system (bladder or urethra). A fistula is an abnormal connection between two hollow organ systems like gastrointestinal tract and bladder/urethra or vaginal tract etc . In your case the most likely connection is between the lower gastrointestinal tract and the urinary system because you are seeing air and fecal matter in the urine. These items should never be seen in the urine, and these seem to be coming from the lower gastrointestinal tract through this abnormal fistula connection between two systems

2) What other tests I may need to get done?

The tests you already have had are not going to show a fistula. You need some kind of radiological testing or scanning etc (tests like urethrography, or cystoscopy, MRI scanning etc). Certain type of radiological testing are not safe during pregnancy but the type of condition you may be having requires you a thorough investigation because if a fistula is found then it needs to be sealed asap otherwise it can lead to complications. Investigations also necessary to find out the cause for the fistula.

3) What treatment options exist?

If a fistula is diagnosed then as mentioned above some kind of surgical management (surgical sealing or repair) is generally necessary

4) What impact can this have for me or my pregnancy?

With early diagnosis and proper treatment most likely this should not have any adverse impact on your health or your pregnancy.

Please let me know if you have any further questions, and please click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. If you have follow-up or additional questions you can ask them after the rating too.

Best regards,

Customer/p>
Expert:  Neuro Doctor replied 2 months ago.

Hi, Please let me know if you have any additional questions or if you want to discuss this further. Please do not forget to click a positive rating. If you have follow-up or additional questions you can ask them after the rating too. Best regards!Customer/p>