Urine with foam in women: causes, possible diseases

Surely, at least once in a woman’s life, foamy urine appeared. The causes of this symptom can be many things. Such a phenomenon will not always indicate any pathology. Physiologically, such foam occurs when the body is dehydrated, in the first trimester of pregnancy, and also when eating excessive amounts of protein. But if women experience foamy urine, the cause may also be more dangerous, especially if the symptom recurs repeatedly. In this case, we will be talking about the development of some serious disease that needs immediate diagnosis and treatment. In the article we will take a closer look at the causes of foamy urine in women and the features of therapy.

Pressure

As you know, urine is released from the urethra under strong pressure. This happens especially often if a woman has had the urge to urinate for a long time. In such situations, the liquid begins to mix with air, causing bubbles to form. Outwardly they look like foam. In this case, you should not fear for your own health. However, you should pay attention to the fact that prolonged and frequent ignoring of the urge to urinate will be harmful to your health. If you constantly do this, the walls of the bladder will become thinner, which may impair the functions of this organ. In other cases, this cause of white foam in the urine of women does not pose any threat.

What do bubbles in urine mean?

Pneumaturia in clinical medicine is the process of releasing gas bubbles along with urine. The phenomenon is quite rare, but very dangerous, usually caused by several factors:

• During catheterization, a fairly large amount of air enters the bladder along with the inserted device;
• When preparing a patient for cystoscopy, bubbles may appear in the urine, since a number of examinations require the introduction of carbon dioxide or oxygen into the urinary cavity. This may be necessary with cystography (X-ray equipment) or a fiber-optic cystoscopic device;
• The use of oxygen or carbon dioxide in preparatory procedures before examination for pneumopyelography;
• If there is a fistula in the urethral canal, through which a large amount of air penetrates inside, and constantly;
• For fistulas in one of the intestinal sections, penetrating into the cavity of the urinary tract, entero-urinary or vesico-vaginal passages;
• In diabetes mellitus, the patient experiences increased formation of gases in the bladder cavity, since glucose is too high and colibacteria and other microorganisms cause the breakdown of this substance in pathology.

More on the topic: How is bladder cystalgia treated?

Polyuria

Drinking large amounts of liquid provokes intense secretion. In this case, urine comes out of the urethra under strong pressure. When it mixes with air, foam forms. In addition, women may experience signs of foam in the urine after consuming diuretics or other products that have this property. If this happens rarely, then there is no need to fear for your own health. However, you should pay attention to the fact that persistent polyuria can cause dysfunction of your bladder.

Conducting a survey

If kidney function is impaired, or there is a change in the color or composition of urine, you should contact a urologist, nephrologist or gynecologist. To determine why urine foams in women and men, a specialist will prescribe the following list of tests:

• General examination of urine to analyze the composition, density, color, smell of urine.
• A general blood test to assess changes in composition: increased levels of leukocytes, erythrocytes, lymphocytes, ESR.
• Biochemical examination of blood to determine the level of albumin (protein) and creatinine.
• Gynecological smear to determine STDs, infectious and fungal pathologies.
• The Zimnitsky test is the main diagnostic method for assessing kidney function and changes in urine depending on the time of day.
• Bacterial culture from the urethra to determine pathological strains of bacteria that cause inflammatory processes in the body.
• Ultrasound of the kidneys, bladder, thyroid gland, ovaries to detect organ dysfunction, the presence of tumors, cysts.
• Manual or instrumental examination of the prostate to assess the size of the organ, detect inflammation, stagnation of secretions, adenomas and malignant neoplasms.

Depending on the accompanying symptoms, it is necessary to undergo angiography, x-ray, cystoscopy, and take the Reberg-Tareev test. When neoplasms are detected, a tissue biopsy is taken from the tumor or cyst and local lymph nodes, and an MRI of the pelvis is also performed.

Dehydration

We continue to understand the reasons why women have foamy urine. The reason may lie in normal dehydration of the body. If a representative of the fair sex is in conditions where she experiences increased fluid loss, for example, in a hot climate, in the gym, or the woman does not drink enough water, then foam may form in the urine. It should be noted that the concentration of excreted substances will be maintained, and the amount of liquid will decrease. Typically, this phenomenon is temporary, and the urine will have a chemical odor. However, you should pay attention to the fact that frequent dehydration is very harmful to the body; this can provoke irreversible processes.

Bacterial causes of blisters

In the distal part of the urethral region and at the very entrance to the urethra, a number of bacteria are normally present that do not cause harm to the body. These include Corynebacterium sp., S. faecalis, Lactobacillus sp., Bacteroides sp., S. epidermidis, E. coli, Treponema sp., Proteus sp. and others.

When the urinary tract is injured, as well as through the hematogenous tract, these microorganisms can penetrate into the upper parts of the genitourinary system. The activity of some types of bacteria is accompanied by the release of gas, which causes flatulence and increased gas formation and the penetration of bubbles into the excreted urine.

Escherichia

The most common infections occur when the urinary system is affected by Escherichia. These are E. coli, saprophytes, which every person has in the intestines, even with normal microflora. Reproduction and growth of bacteria occurs in the colon, usually without harm to the body. But there are some strains that cause severe inflammatory processes and diseases - escherichiosis.

The mechanism of action is quite simple - hemolysin acts on cellular lysosomes, which increases their permeability. The function of the cells themselves is disrupted due to the production of enzymes without controlling its quantity. If there is increased glucose in the blood, then colibacteria and other bacteria increase the intensity of its breakdown, releasing H2 and CO2 gas. In this case, the patient observes gas bubbles in the urine.

Proteus

Infections in the urological area often appear when affected by Proteas. Most often it affects the organs of the genitourinary system Pr. Mirabilis, the only indole-resistant bacterium in this group.

Proteus bacteria belong to a very large group of enterobacteria, which are divided into three large categories - penneri, vulgaris and mirabilis. The last two varieties most often form lesions with the accumulation of pus, inflammation and other symptoms of pathology. The reproduction of these organisms occurs at 36-37 degrees, in acidic conditions of no more than 7.4 pH. Proteuses, as a result of their activity, produce glucose containing gas and acid.

More on the topic: What is the danger of having renal epithelium in the urine?

Microorganisms of this group are often found in complex forms of pyelonephritis, congenital malformations, and after certain surgical interventions. Proteas contain urease, which decomposes urea into ammonia. The breakdown product is extremely toxic to the renal system, causing necrosis. The bacteria are very invasive and can multiply in the kidney tissue without hindrance.

An organism affected by Proteus is often characterized by inflammation in the genitourinary system, and the picture of clinical symptoms will be very similar to cystitis or pyelonephritis. If you do not provide sufficient hygiene for cuts or scratches, wounds and other injuries, then Proteus infection causes immediate suppuration. In this case, healing becomes permanent due to weeping phenomena.

When is a symptom dangerous?

Why does foam form in the urine of women and when is it necessary to seek help from a specialist? Before answering this question, you should pay attention to the fact that doctors explain the formation of foam by the presence of a large amount of protein in urine. A urine test should normally exclude the presence of this substance in the discharge. This pathology indicates impaired filtration in the kidneys, and the disease is called proteinuria. In addition to kidney disease, the cause may lie in diseases of other systems and organs. As a rule, this causes cloudy urine with foam in women. Next, you should familiarize yourself in more detail with other ailments that are accompanied by similar symptoms.

There is too much protein in your urine due to kidney problems

Consistently high levels of protein in the urine are a sign that more protein than needed is passing through the kidneys into the urine. The two most common causes are diabetes and high blood pressure.

Both type 1 and type 2 diabetes can cause high blood sugar, which damages the blood vessels in the kidneys, making it difficult for them to function. As a result, too much protein is formed in the urine. High blood pressure is a similar story—pressure on the blood vessels weakens them over time, preventing them from doing their job.

There are many other health conditions that can cause proteinuria, such as pregnancy, preeclampsia, rheumatoid arthritis, lupus, heart disease, and sickle cell disease.

Other reasons

Quite often, foamy urine is observed in women during menopause. As a rule, the reasons are exactly the same as in ordinary cases. In addition, the reasons for this symptom may be as follows:

1. Prolonged stress.
2. Serious concussions.
3. Dysfunction and injury to brain structures.
4. Heart problems.
5. Advanced diabetes mellitus.
6. Injuries.
7. Impaired metabolism, excessive overeating.
8. Taking certain medications.

Pathological causes

Elevated protein levels may indicate a decrease in the functional activity of the urinary organs. The kidneys cleanse the blood of toxic substances and metabolic products, and then remove them from the body with each bladder emptying. In the presence of pathologies, proteins are not evacuated, but enter back into the bloodstream. The result is a violation of filtration - high molecular weight proteins accumulate in the urine.

Glomerulonephritis, pyelonephritis

Glomerulonephritis is a kidney disease characterized by damage to the glomeruli. This condition often manifests as proteinuria. As well as pyelonephritis, or a nonspecific infectious pathology of the kidneys caused by various bacteria. It is necessary to seek medical help if, in addition to white foam, the following symptoms of inflammation occur:

• severe paroxysmal pain in the lower back, spreading to the sides;
• headache;
• temperature changes several times a day;
• weakness, apathy, increased fatigue;
• urinary disturbance.

Damage to the renal glomeruli by glomerulonephritis causes the regular appearance of foam in the urine.
The infectious and inflammatory process progresses rapidly. So, if left untreated, the disease becomes chronic. This means that sooner or later a person will face kidney failure and (or) kidney necrosis.

Cystitis

Often urine foams in acute or chronic cystitis, which is always accompanied by urination disorders. The complicated course is associated with the ascending spread of infection and the development of pyelonephritis (the so-called “reflux pyelonephritis”).

The disease manifests itself in the acute stage as follows:

• pain and burning when urinating;
• increased sweating;
• feverish state, chills.

In addition to foam, urine often contains pus and mucous secretions. This indicates significant damage to the mucous membrane of the bladder and its deeper layers.

Sexually transmitted infections

The reasons for the increased protein content in the urine are often specific infectious urethritis. And almost all sexually transmitted diseases can provoke its development:

• chlamydia;
• gonorrhea;
• trichomoniasis;
• mycoplasmosis;
• candidiasis.

Foam in the urine often occurs when the urethra (urethra) is inflamed by bacteria and viruses.

Also, acute urethritis develops with the activation of human papillomaviruses and herpesviruses. Specific inflammation of the mucous membrane of the urethra is accompanied by symptoms characteristic of sexually transmitted pathologies.

Less common causes

Foam appears in all diseases complicated by a lack of fluid in the body, metabolic disorders, and inflammatory processes. This is a nonspecific symptom of such pathological conditions:

• circulatory disorders in the brain;
• diseases of the cardiovascular system;
• disruptions in the functioning of the central nervous system;
• hypertension combined with kidney damage;
• oncological pathologies;
• liver diseases - hepatitis, fatty degeneration.

Urine begins to foam with cholelithiasis, the formation of a fistula between the bladder and the ileum. And almost always with a complicated course of diabetes mellitus - a chronic metabolic disorder, which is based on a deficiency in the formation of its own insulin and an increase in blood glucose levels.

NOTE: whitish foam in the urine may indicate chronic intoxication of the body with salts of heavy metals.

Dehydration is typical for almost all infections caused by viruses, bacteria, protozoa, and fungi. They affect the urogenital or gastrointestinal tract. As well as the upper and lower respiratory tract.

In pregnant women

If we talk about the appearance of foam in the urine of women during pregnancy, then experts consider this case separately. This sign may indicate the occurrence of preeclampsia. This condition is characterized by swelling of the legs, a large amount of protein in the urine, headaches, and increased blood pressure. Without treatment, this condition is dangerous for both the fetus and the expectant mother. Other causes of foamy urine in women during pregnancy are as follows:

1. Strong pressure from the fetus and uterus on the bladder. In this case, urine comes out under strong pressure due to a physiological factor. If a woman endures the urge to urinate for a long time, urine will begin to be released under pressure. This causes urine to mix with air, resulting in the formation of foam.
2. Polyuria. Large fluid intake during pregnancy can cause increased urine output. Under pressure, urine mixes with air and begins to foam.
3. Dehydration due to toxicosis. Losing a significant amount of fluid can affect discharge.

If such a symptom appears once, then the woman may not contact a specialist. If a pregnant woman regularly experiences foam during urination, she should definitely report this symptom to her gynecologist.

Why does foam appear in urine?

Normal urine is transparent, free of impurities, foreign odors and foam. You can tell a lot about human health by its color, appearance and composition. If the urine foams, this is a sign of pathological processes in the body.

Causes of foam in urine in men

This does not always happen due to illness; foam in the urine may have other reasons:

1. Jet pressure. If it was not possible to empty the bladder in time, a lot of fluid accumulates in it, which comes out with strong pressure.

2. Excess proteins. A high-protein diet may cause your urine to become cloudy and foamy. In this case, it is enough to adjust the diet.

3. Proteinuria. Characterized by the presence of protein in the urine.

The last point requires special attention, since normally there are no proteins in urine. The appearance of impurities indicates diseases such as:

• urinary tract infections;
• inflammation of the prostate gland;
• kidney disease;
• diabetes;
• disorders in the circulatory system.

A man needs to undergo examination and start treatment on time. Sometimes protein can be detected in a man’s urine if the test was taken after sexual intercourse. For an accurate diagnosis, several procedures will be required.

Why does urine start to foam in women?

Some of the reasons for the appearance of this symptom in women are similar to those in men. This:

1. Strong jet pressure after a long period of abstinence, most often happens in the morning after a night's sleep. The reason for the appearance of foam is a large amount of oxygen that mixes with the liquid. Although there is nothing to worry about, it is better to avoid situations where you have to wait a long time before emptying your bladder. This can lead to deformation of the walls of the organ.

2. Polyuria. Urine becomes very foamy if you drink too much liquid or take diuretics. The volume of liquid increases, and with it the pressure increases.

3. Dehydration. And in this case, the urine may be foamy due to the retention of the concentration of substances when fluid is removed from the body. This may cause an unpleasant chemical odor.

You can detect foam in the urine for the most trivial reason, when there is a small amount of detergent left in the toilet. Mixing with it, urine begins to foam. The reasons for the appearance of foam in the urine during pregnancy are classified into a separate category:

1. Preeclampsia. In addition to foam in the urine, this condition is accompanied by symptoms such as swelling in the legs, surges in blood pressure and headaches. Women in such a situation should not cope with pain on their own; the help of a doctor is required.

2. Enlarged uterus. Changing in size, the fetus gradually begins to put pressure on neighboring organs, including the bladder. Because of this, the urge to urinate becomes more frequent, and the pressure of the fluid increases.

3. Toxicosis. If nausea is regular, it leads to dehydration, which is one of the reasons for foamy urine.

If foam appears in the urine of a pregnant woman once, there is no reason to worry. If the symptom does not go away for some time, you should consult a doctor.

Alarming symptoms

Foamy urine does not always mean a serious illness. When the disease occurs, there are other symptoms that you should pay attention to. The fastest way to check your health is to take a urine test, and men will also need a semen analysis. Normally, there should be no protein in urine. The appearance of proteins and foam is a sign that the following pathological processes are occurring in the body:

+ Kidney diseases. Protein can get into the urine due to a dysfunction of the filter membrane. This often occurs with pyelonephritis, glomerulonephritis, etc.

+ Infection in the genitourinary system. In infectious diseases, the number of leukocytes increases sharply. In addition, itching, burning, and pain may occur when going to the toilet.

+ Fistula in the bladder. When a fistula forms between the bladder and intestines, an unpleasant odor from the urine, as well as feces, may appear.

+ Autoimmune diseases and disruption of the endocrine system. In these cases, the kidneys are often affected, which leads to foam in the urine.

Foamed urine itself is not a disease, but only if this phenomenon is one-time in nature. In the presence of diseases, especially infectious ones, other symptoms are added to the foam:

• pain in the urethra;
• urinary incontinence;
• frequent urge to go to the toilet;
• pain in the groin;
• impurities of blood or pus;
• specific smell;
• increased body temperature;
• nausea;
• weakness;
• diarrhea.

Foaming urine in a child may indicate liver problems. In some cases, foam appears if the baby is stressed. Normally, this phenomenon goes away in a couple of days. In other cases, especially if the symptoms listed above are present, you should consult a doctor.

Treatment

If the urine foams, it means pathological processes may be occurring in the body. What to do if foam periodically appears when urinating:

• take urine and blood tests;
• do an ultrasound of the kidneys.

To exclude diseases of the testicles and prostate, men will need additional examination. Treatment methods depend on the cause of foam in the urine:

1. Dark urine with foam often occurs due to dehydration. To normalize urination, you need to establish a drinking regime and drink at least 2 liters of water per day. If this problem cannot be resolved within 5 days, you should contact a specialist.

2. If protein is elevated, it is worth changing the nutrition system. This is especially true for overweight people.

3. If there is a large amount of sperm in the urine after sexual intercourse, you should consult a urologist. Depending on the complexity of the problem, he will prescribe medications for men or surgery.

4. For kidney diseases, antibiotics, anti-inflammatory drugs, painkillers and diuretics are used for treatment. Specific medications are prescribed only by a specialist.

5. If a urine test shows the presence of sugar, this is a sign of diabetes. In this case, comprehensive diagnosis and treatment is necessary.

6. Inflammatory or infectious diseases of the bladder. In this case, treatment is based on drug therapy. For inflammation of the bladder, treatment should not contain any heating procedures. There is a high probability that the inflammation will only intensify.

Foamy urine in women during pregnancy requires observation by a doctor only if there are other unpleasant symptoms. This may indicate that the development of gestosis has begun. If this is an isolated incident, there is nothing to worry about.

Important! Regardless of the reason for the appearance of foam when urinating, you should not self-medicate. Traditional methods can relieve symptoms, but the disease itself will progress.

Preventive actions

To maintain the normal state of the human body, you need to know how to avoid unpleasant diseases. Many genitourinary tract infections and other diseases are easier to prevent than to deal with the consequences. As a preventative measure, experts recommend:

1. Monitor your diet and control the amount of protein foods.
2. Maintain water balance in the body.
3. Do not spread any infectious diseases.
4. Go to the toilet on time.

It is important to monitor symptoms closely. At the first sign of a change in urine color, smell, consistency, etc., you should consult a doctor.

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Diagnostics

To check the true cause of this symptom, a specialist will prescribe a general urine test. Based on its results, the presence or absence of protein in urine is determined. In addition to urine, patients also undergo a general blood test. As a rule, the total amount of creatinine and albumin is checked, after which the results are compared with the norm. If a man asks for help, then it is necessary to determine the presence of sperm in his urine.

During the study, the patient's water balance must remain normal, so it is recommended to drink enough water. If patients are using any medications, this should be disclosed during consultation with the doctor. Some drugs can cause foam in the urine. It is also necessary to avoid physical activity before the examination.

To make a reliable diagnosis, it is necessary to undergo an ultrasound examination of the kidneys.

So, in order to make an accurate diagnosis, you should take a urine test, a blood test, and also do an ultrasound.

Features of foam occurrence

It is absolutely not difficult to determine that urine does not have any problems. A healthy person has urine without foam and a yellowish color, and there is no strong pungent odor in it. For this reason, if the color of the urine changes for no reason or a characteristic odor appears, accompanied by a considerable amount of foam, this phenomenon may indicate the occurrence of certain health problems. In this case, you should definitely start identifying them and getting rid of them.

Modern medicine makes it possible to easily answer the question: why does urine foam in men? There are few reasons for this, namely one – protein getting into the urine. The latter are surface-active components that can provoke the formation of foam.

We must not forget that a healthy person cannot have protein in his urine. Otherwise, this indicates that the body has some deviations from the norm, which can be either minor or serious, with an infectious nature.

The presence of foam indicates that urine contains such organic substances. However, the appearance of the liquid is not enough to completely determine the cause of their appearance. There are also no accompanying symptoms in this case. Only a doctor can detect this with appropriate laboratory research. This means that if you suspect this pathology, you should immediately seek help from specialists.

Thus, the condition when the urine foams is called “proteinuria”. It does not belong to the category of diseases, but is only the result of manifestations of certain diseases, pathological conditions of the human body.

There are such forms of proteinuria:

1. Transitional. It is considered the simplest and does not require any treatment; it can go away on its own. There are few reasons for its occurrence - overwork, stress, injury, depression, and a sharp increase in temperature.
2. Static. Foam is formed due to any disease or infection. Here you need to pay enough attention and start timely treatment. Among the symptoms, experts identify fever, severe headaches, pain, swelling, and a feeling of constant thirst.
3. Orthostatic. This form is very rare and therefore poorly studied in medicine. Foam in this case occurs without protein, because it is completely absent from the urine.

Experts note that a person can determine the presence of proteinuria on his own, namely with the help of a special test, which is available in almost any pharmacy.

The test is a standard strip showing the presence or absence of protein in urine.

Features of therapy

Treatment will be selected depending on the main cause of the appearance of such a symptom. The foam remover is prescribed strictly individually for each patient. During treatment, the doctor recommends avoiding physical activity.

If kidney disease has been identified, treatment includes the use of antibiotics and other medications.

In case of glomerulonephritis, the patient is prescribed hormonal therapy. After this treatment, the patient gets rid of the symptom, and the functioning of the kidneys improves.

If a man has been diagnosed with retrograde ejaculation, he is prescribed drugs that can relieve this disease. Such medications are prescribed only by a urologist.

In the case of urogenital ailments, antibacterial and antifungal drugs are used as therapy.

If the appearance of foam in the urine is associated with an inflammatory process or stress, then the specialist will prescribe the use of antidepressants or antibiotics.

Diagnosis of vaginal fistulas

Diagnosis of any vaginal fistula begins with a thorough collection of medical history and gynecological examination of the patient. In the case of low-lying vaginal fistulas, when examined in the speculum, you can see a retracted scar (ostium), from which urine or intestinal contents are released. The height and direction of the fistula tract is determined using probing with a button probe. To clarify the localization of urovaginal fistulas, urethrocystoscopy and chromocystoscopy with indigo carmine are performed.

In the diagnosis of vaginal fistulas of inflammatory origin, ultrasound of the pelvis and ultrasound of the kidneys, laboratory tests of blood and urine are indicated. For difficult to diagnose high and pinpoint urovaginal fistulas, excretory and retrograde urography, renography, cystography, and, if necessary, vaginography are additionally performed. In the case of rectogenital fistulas, a rectovaginal examination is performed to determine the size, consistency of the fistula, the amount of scar damage to surrounding tissues, the degree of anal sphincter insufficiency, the presence of infiltrate, and the possibility of developing an abscess.

A mandatory endoscopic examination that clarifies the location of vaginal and intestinal fistulas is sigmoidoscopy, and if necessary to differentiate the diagnosis, colonoscopy. For complex fistulas, contrast radiographic studies are performed: irrigoscopy, fistulography, which help to see the branches and leaks of the fistula tract.

Diagnosis of vaginal fistulas may include cytological or histological examination of affected tissue taken during biopsy, CT scan. The rectoanal reflex is assessed using instrumental methods - sphincterometry, electromyography, anorectal manometry.

Symptom prevention

So, we have figured out what the reasons are, as well as the features of diagnosis and treatment. However, everyone knows that it is easier to prevent a disease than to treat it later. Therefore, it is necessary to adhere to some preventive measures. As a rule, experts advise consuming various meat dishes in moderation for this purpose, as well as adjusting the fluid balance in your body.

In parallel with this, you should adjust your diet and avoid severe overeating. To do this, it is best to visit a nutritionist who will adjust your diet and regimen. The daily menu should contain substances such as fats, carbohydrates and proteins in appropriate amounts.

Tips to reduce foaming

Tip #1

One of the most common causes of foamy urine is insufficient rinsing of the toilet bowl to remove disinfectants. It makes sense to rinse it again and check the result.

Tip #2

There are many pathologies, one of the symptoms of which is foaming. A timely visit to a doctor will help you start treatment at the initial stage of the disease and avoid the development of complications.

Tip #3

Dehydration is also provoked by the consumption of foods with a diuretic effect, strong coffee, and alcoholic beverages. Often, after stopping them, the urine stops foaming.

Why urine foams in women: causes, prevention during pregnancy

The condition of urine, its consistency, color and the presence of impurities indicates various pathologies that begin to develop in the human body.

That is why it is worth consulting a doctor at the first deviation.

A very frequently asked question: why urine foams in women can only be answered correctly by an experienced specialist after examining the patient and assessing the test results.

Why does this phenomenon occur?

A small amount of foam in the urine once is practically harmless.

Sometimes this may indicate a large amount of protein in the urine, the level of which increases from the consumption of certain foods or other minor factors. Their exclusion normalizes the condition of the excreted fluid.

But if foamy urine is a constant factor when urinating, you should start worrying. This development of events signals pathologies:

• diabetes,
• high blood pressure,
• heart disease,
• renal failure,
• lupus,
• sarcoidosis and other diseases.

In women, urine can also foam due to problems with the genital organs and their inflammation. The exact cause can be found out by going to the clinic and having a full examination.