FOAMY URINE
The normal color of urine is pale yellow to dark amber, and is also flat. A variety of factors can cause changes in the color and foaminess of a person's urine. It could be from diet to drugs or disease.
If the urine looks foamy, it could be because the bladder is full and that the urine is hitting the toilet fast enough to stir up the water. But conditions that could also cause foamy urine are causes one would need to see their doctor about.
Historically, persistent foamy urine that is noticed after voiding is considered a warning sign of kidney disease. Foamy urine is characterized by the appearance and persistence of small to medium bubbles in urine that is voided into a container (e.g. a toilet bowl). The appearance of a layer of large bubbles upon voiding, which quickly dissipate, can be considered normal.
Foamy urine has traditionally been considered by physicians, as well as by patients, as a sign and symptom of excessive protein in the urine (proteinuria). In fact, it is listed by most health records in their specialty templates as a symptom of kidney disease. Only a small fraction of patients that volunteer this complaint will be found to have abnormal proteinuria, therefore most cases of 'foamy' urine remain unexplained.
It was clear that the medical world is far from fully knowing exactly what foamy urine means. Perhaps a better understanding of this phenomenon might be achieved by looking at mechanisms of foam formation in general terms and asking relevant questions:
- Can foamy urine indicate something other than proteinuria?
- Apart from protein, what substances in urine make foam appear?
- How does foam form generally?
CAUSES OF FOAMY URINE
- The most obvious cause of foamy urine is the speed of urination. Just as water foams up when it comes out of the tap quickly, urine foams if it hits the toilet quickly. However, this kind of foam should also clear up quickly.
- Another cause of foamy urine though uncommon, is retrograde ejaculation. This is a condition that happens in men when semen backs up into the bladder instead of being released from the penis.
- Sometimes, urine can also be foamy when it is concentrated. When an individual has not had much water to drink and therefore is dehydrated, their urine is more concentrated.
- Foamy urine can also indicate that you have too much of proteins, such as albumin, in the urine. In such a case, the protein in the urine reacts with the air to create foam.
- The medicine phenazopyridine is another uncommon cause of foamy urine. People take this medication to treat the pain from urinary tract infections.
- Sometimes too, the problem is actually just your toilet. Some toilet cleaning chemicals can make urine look foamy. If this is the cause, the foam should disappear as soon as the cleaner is flushed out of the toilet.
Several medical conditions can also result in bubbly or foamy urine. They include:
- Dehydration
If the urine is very dark and highly concentrated, it may appear foamy. This is because that person may not be drinking enough water and clear fluids that would dilute the other substances in the urine.
- Kidney disease
Kidney disease may cause foamy urine.
Normally, the kidneys filter extra water and waste products out of the blood into the urine. Sometimes, other important substances that the body needs (like Protein) are too big to go through the kidneys' filters, therefore they remain in the bloodstream. However, damaged kidneys don't filter as well as they should. Such damaged kidneys end up allowing too much protein to leak into the urine.
This condition is called proteinuria. It is a sign of chronic kidney disease or the late stage of kidney damage, called end-stage renal disease.
Symptoms of proteinuria may include:
- Vomiting
- Swelling
- Itchy skin
- Nausea
- Shortness of breath
- Unexplained fatigue
- Frequent urination
If a person has these symptoms and a family history of kidney disease, high blood pressure, or diabetes, they should see a doctor for testing.
- Diabetes
Diabetes and other causes of high blood sugar also commonly result in foamy urine. A person with uncontrolled diabetes will have more blood glucose molecules in their body. Glucose is a large molecule just as protein. The kidneys may have trouble filtering the molecules correctly if blood glucose levels are too high. Consequently, the kidneys may allow excess glucose and proteins to escape into the urine. In addition to foamy urine, people with uncontrolled diabetes can have symptoms such as:
- Unexplained fatigue
- Blurred vision
- Dry mouth
- A constant feeling of thirst
- A frequent need to urinate
- Unexplained hunger
- Itchy skin
SYMPTOMS THAT OCCUR WITH FOAMY URINE
Urine can foam up briefly every once in a while. This is usually due to the speed of urine flow. Foamy urine is more likely to be a sign of disease especially if it happens often or if it gets worse over time. If your urine is foamy, look for other symptoms as well. The symptoms could be clues that a medical condition could be causing the problem:
- Darker colored urine
- Fatigue
- Changes in the amount of urine
- Swelling in your hands, feet, face, and abdomen, could mean fluid buildup from damaged kidneys
- A loss of appetite
- Nausea and Vomiting
- Sleep problems
- Cloudy urine
- In males, dry orgasms or releasing little to no semen during orgasm
- In males, infertility or having difficulty getting a female partner pregnant
RISK FACTORS
A person is more likely to have foamy urine if he/she has a full bladder, which can make the urine stream more forceful and faster.
Urine can also get foamy if it is concentrated, this can occur due to dehydration or pregnancy.
Protein in the urine which is usually due to kidney disease can also cause foaminess. A person is more likely to get kidney disease if they have:
- Diabetes
- High blood pressure
- A family history of kidney disease
The causes of retrograde ejaculation include:
- Diabetes
- Drugs used to treat high blood pressure, mood or an enlarged prostate
- Nerve damage from a spinal cord injury or multiple sclerosis
- Surgery on the prostate or urethra
DIAGNOSIS
A doctor can diagnose the cause of foamy urine by performing a urine test to determine whether levels of proteins are high.
If the urine is found to have high levels of protein, the doctor may decide to confirm that this effect is consistent. He might recommend a 24-hour urine test, which test requires a person to collect all the urine that they produce throughout the 24hour period.
The collected sample will be taken to a laboratory to compare the amount of albumin, which is a primary protein in the blood, to the amount of creatinine, a waste product.
A person may have kidney disease if the albumin to creatinine ratio is higher than average. Another cause may be an injury to the kidneys that could affect the filtration process.
A doctor may recommend tests to assess blood glucose levels or other indications of kidney function.
Diagnosing protein in urine
When a person's kidneys are beginning to have problems, and there is not too much protein in the urine, symptoms may not be that noticeable. The only way to know if there is protein in the urine is to have a urine test. The test for protein in the urine measures the amount of albumin in your urine, compared to the amount of creatinine in your urine. This is called the urine albumin-to-creatinine ratio (UACR). A UACR more than 30 mg/g can be a sign of kidney disease.
When the kidney damage gets worse and large amounts of protein escape through the urine, a person may notice the following symptoms:
- Foamy, frothy or bubbly-looking urine when you use the toilet
- Swelling in the hands, feet, abdomen or face
Having these symptoms indicate that the kidney damage may already be severe. The doctor will determine what may be causing the symptoms and what treatment is best under the circumstance.
TREATMENT
Drinking water or clear fluids and taking oral medication may treat the causes of foamy urine. Treatments for foamy urine will depend on the underlying cause.
If a person is dehydrated, they should drink more clear fluids, until the urine is pale yellow or nearly transparent.
If the underlying cause is diabetes, the doctor may prescribe oral medications or insulin injections to reduce blood glucose levels. Patients may need to check their levels regularly to ensure that they are within acceptable ranges.
A doctor may prescribe medications for people with early kidney disease. The doctor may also recommend positive lifestyle changes, such as:
- Exercising regularly
- Eating a healthy, low-sodium diet
- Not smoking
- Controlling high blood pressure effectively
- Managing blood sugar levels
Patients with severe kidney disease or kidneys that function poorly may require dialysis, a procedure that cleanses the blood of excess waste.
Treatment for proteinuria
If an individual has diabetes or high blood pressure (the most common causes of kidney disease), it is important to make sure these conditions are under control.
Controlling diabetes will mean checking the blood sugar often, taking doctor prescribed medicines as required, and following a healthy eating and exercise plan. If you have high blood pressure, your doctor may prescribe medicine to help lower the blood pressure and protect the kidneys from further damage. The types of medicine that can help with both blood pressure and proteinuria are called angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs).
If protein in urine is confirmed, but the patient does not have diabetes or high blood pressure, an ACE inhibitor or an ARB may still help to protect the kidneys from further damage.
Treatment for diabetes and high blood pressure
When the foamy urine is caused by kidney damage, that person will need to treat the cause. Diabetes and high blood pressure often cause kidney disease. But the progression of kidney damage can at least be slowed down by managing these two conditions well.
The doctor will recommend a balanced diet and plenty of exercise to help treat diabetes. Regular and frequent test for blood sugar to make sure it is staying within healthy range.
For high blood pressure, one will also want to watch their diet and stay active, while limiting the salt and protein intake in the diet. These can both bring down blood pressure and prevent the kidneys from having to work too hard.
The doctor can also prescribe calcium channel blockers, diuretics, or other drugs that lower blood pressure.
Two drugs that lower blood pressure and protect the kidneys from additional damage are Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.
Treatment for retrograde ejaculation
Retrograde ejaculation does not need to be treated unless the patient wants to father a child or the dry orgasms are a bother. The doctor can treat this condition with drugs that are approved for use for other conditions but which can also close the bladder neck so that semen will not get inside the bladder.
Off-label use (I. e. a drug that's been approved by regulatory authorities for one purpose is used for a different purpose for which it hasn't been approved) of the following drugs can help treat this condition:
- Imipramine
- Pseudoephedrine
- Chlorpheniramine
- Ephedrine
- Phenylephrine
However, a doctor can still use the drug for that purpose because the approval authorities regulates the testing and approval of drugs, and not how doctors use drugs to treat their patients. So, doctors are allowed to prescribe a drug however they think it is best for the patient's care.
THE OUTLOOK
Foamy urine may not be a problem if it happens once in a while. Should it continue, it could be a sign of kidney damage. Usually, this symptom appears at the late stages in kidney disease, so immediate treatment is crucial.
A few times, it could be a sign of retrograde ejaculation in a male, or it could be an effect of a drug a person is taking. In both cases treating the condition or stopping the drug that may be causing it should stop the foaming.
Most of the time, foamy urine is not much to worry about. Often, foamy urine can be relieved simply by drinking more water.
However, people should see their doctor if:
- The foamy urine doesn't go away within a few days
- You also have other symptoms like swelling, nausea, vomiting, appetite loss, and fatigue
- The urine is also cloudy or bloody
- A male's, orgasms produce little to no fluid or a man has been trying to get your female partner pregnant for a year or longer without success.