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GuptaMD
GuptaMD, Dr
Category: Urology
Satisfied Customers: 7955
Experience:  MD. Experienced in Pediatric Urology and Nephrology
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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 the constipation 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. 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.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: 5 months ago.
Category: Urology
Customer: replied 5 months ago.
Please see attached pictures for reference
- air bubbles in urine
- fecal matter in uring
Expert:  GuptaMD replied 5 months ago.

Hi,

Thanks for your query,

You need to get the urine test done trying to ensure that there is no contamination with feces.

The most likely explanation, if the urine test is normal again, is slight involuntary passage of stools while passing urine - likely normal.

Air bubbles can be due to small amounts of protein in the urine, again possibly normal in pregnancy,

Overall, it does not appear to be a serious problem,

The urine examination again will certainly confirm the same, in my opinion,

Warm regards

Dr Gupta, MD

Customer: replied 5 months ago.
Thank you Dr Gupta. I already got the following urine and blood tests done. Following were the results:
- 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)These tests were conducted last week (i.e. 4-5 days after I saw the fecal matter, and I have been seeing bubbles in urine for 3 weeks now). You mentioned - "You need to get the urine test done trying to ensure that there is no contamination with feces." Do I need to get the tests again? If so, can you specify which test I should get?You mentioned "Air bubbles can be due to small amounts of protein in the urine, again possibly normal in pregnancy". My Total protein spot urine test value is <6mg/dl. Can this much protein cause air bubbles?How about the bubbles I feel coming out my urethra? What could be reason for that?Thank you.
Expert:  GuptaMD replied 5 months ago.

Hi,

I saw the earlier report, just wanted to confirm the same :)

I believe that the reason for the air bubbles is that the air gets trapped under the clitoral hood/flap/thing against the urethra. It's just extra external air caught in there.
Strengthening your pelvic floor muscles with kegel's exercise will help,

Warm regards

Dr Gupta, MD

Customer: replied 5 months ago.
Thank you Dr Gupta. To make sure I understood correctly - Would you like me to get these tests again?
If so, please suggest
1) What reason I should give to my Physician for getting the tests conducted again (In US only the Doctor can order the test, I cannot order the tests....so what would be the best way to convince my Physician to order these tests again)
2) Which tests should I get done again?
3) Also, could I have developed a 'Vesicocolic Fistula'? I am wondering I may have developed Diverticulitis when I had severe constipation in Week 16 of my pregnancy. And that Diverticulitis may have led to Vesicocolic Fistula?
Expert:  GuptaMD replied 5 months ago.

Hi,

In case you had a fistula, your urine test would not have been normal.

You would probably suffer from incontinence as well, and significantly more symptoms than what you are experiencing.

These tests may be difficult to order again in the USA :) especially given that they are normal.

Warm regards

Dr. Gupta. MD

Customer: replied 5 months ago.
Thank you Dr Gupta, appreciate your response.
1) Can you please indicate what other symptoms I would have observed if it was a fistula? Also what would not have been normal in urine test?
2) Also, as I mentioned above, I have extreme pain in the lower left abdomen, left groin, and pubic area. Towards the end of the day it also feels sore (even though I have very limited physical activity in the day). In the last 4-5 days I have noticed when I eat semi-solid/liquid diet the pain is much less that day, but the days I eat normal food (like bread, roti, vegetable, etc.) my pain flares up. Could this be Diverticulitis?
3) If it is Diverticulitis, can you please suggest what I should do so it does not get worse?
Expert:  GuptaMD replied 5 months ago.

Hi,

A fistula suggests a connection - so there would likely some signs of urine being contaminated in this case. This could be in the form of pus cells in large number or other microscopic abnormalities, and even bacteria in the urine.

Also the pain can be due to diverticulitis, but also due to many other reasons.

It would be best if you were examined by your doctor to confirm the same, so that proper treatment could be initiated,

Warm regards

Do remember to leave a positive feedback if the reply was helpful,

Dr Gupta, MD

23 Sept 2016, 10:16 AM

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