Fecaluria

Fecaluria is the passage of fecal material in the urine, indicating an abnormal communication between the intestinal tract and the urinary system, most often an enterovesical fistula between the bowel and bladder. The presence of stool-like material or a feculent odor in urine is a characteristic sign prompting further evaluation.

Most commonly caused by diverticular disease with a sigmoid colovesical fistula, fecaluria can also arise from Crohn's disease, colorectal or bladder cancer, pelvic surgery or radiation, trauma, or infection. Fistulas may involve other segments such as ileovesical or rectovesical, depending on disease location and prior interventions.

Clinically, fecaluria is accompanied by pneumaturia (air in urine), recurrent urinary tract infections, dysuria, abdominal pain, or urinary urgency. Some patients report a fecal odor in the urine. The combination of symptoms should raise suspicion for a bowel–urinary fistula.

Diagnosis relies on imaging and endoscopy. Computed tomography with contrast (CT cystography) is commonly used to visualize the fistulous tract and associated organ involvement. Colonoscopy and cystoscopy help identify the source and exclude malignancy. Additional studies such as MRI or contrast enema may be employed to delineate anatomy and plan repair.

Management centers on eradicating infection and repairing the fistula. Surgical treatment typically involves resection of the diseased bowel segment with restoration of continuity and repair of the bladder, often performed in a single operation; a temporary urinary or fecal diversion may be required in select cases. Medical therapy addresses underlying diseases (for example, Crohn's) and perioperative infections.

Prognosis depends on underlying disease and fistula complexity. With appropriate surgical management, outcomes improve, though recurrence can occur, particularly in Crohn's disease.