Emphysematous cystitis (EC) is a rare type of urinary tract infection (UTI). It causes a buildup of gas in and around the bladder wall, and doctors usually treat it with antibiotics.

Although researchers do not fully understand how this accumulation of gas occurs, they know that certain bacteria play a role.

Research shows that three types of bacteria — Escherichia coli, Klebsiella pneumoniae, and several Enterobacter species — are common causes of EC.

Experts are still trying to learn more about this uncommon UTI. However, one challenge is the low rate of diagnoses. EC is difficult to diagnose because its symptoms resemble those of other conditions.

Read more to learn about EC risk factors, symptoms, treatments, and more.

A person has abdominal pain, a primary symptom of emphysematous cystitis.Share on Pinterest
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Certain individuals have an increased risk of developing EC. Factors that make a person more likely to get it include:


Experts consider diabetes the most common risk factor for EC. Research suggests that more than half of individuals with EC also have diabetes and that the UTI may be more likely to occur in those finding it difficult to manage their blood sugar levels.

Learn more about diabetes.


EC is more common in people over the age of 60 years. A review of 136 cases of EC showed that the average age for people with the condition was 65.7 for men and 69.3 for women.

Neurogenic bladder

This condition involves a lack of bladder control. Spinal cord, brain, and nerve problems can cause it.

It is often associated with neurological conditions such as Alzheimer’s disease, cerebral palsy, and multiple sclerosis. Nerve damage from other sources, such as diabetes, syphilis, or a herniated disk, can also lead to neurogenic bladder.

Learn more about neurogenic bladder.

Obstructive uropathy

Obstructive uropathy is a condition that blocks urine flow in the urinary tract. It can affect one or both of the kidneys.

Weakened immune system

A weakened immune system can make a person more likely to get EC. The reason for this is that having a weakened immune system puts people at a higher risk of all infections.

Learn more about having a weakened immune system.

Chronic urinary tract infections

A chronic UTI is an ongoing or recurring infection. Having a chronic UTI makes people more likely to develop EC.

Learn more about chronic UTIs.

Urethral catheter

People have a higher risk of EC if they have an indwelling urethral catheter. This type of catheter stays in place for a few months after its insertion.

Learn more about indwelling urethral catheters.

The main symptom of EC is pain in one or both sides of the abdomen. More than half of people with EC report abdominal pain.

Other symptoms of EC include:

  • urinary urgency, or needing to pee more frequently
  • dysuria, which refers to the burning, tingling, or stinging of the urethra
  • pneumaturia, which is the passage of air in the urine
  • fever

It is important to remember that EC can also be asymptomatic, which is when a person with the condition shows no symptoms. Therefore, people with EC risk factors should be aware of the symptoms of the condition and contact a doctor if they suspect that they have an infection.

Early diagnosis is essential, as it allows a person to receive the proper treatment in a timely manner. A delayed diagnosis can result in serious adverse outcomes.

However, the nonspecific signs and symptoms of EC mean that it frequently goes undiagnosed.

If a person thinks that they may have EC, they should contact a doctor.

The doctor will evaluate the person’s symptoms and conduct tests to diagnose the condition. They frequently use both urinalysis and imaging scans.

Urinalysis looks for the presence of:

Imaging tests look for the presence of air in the urinary tract and around the bladder. Doctors frequently use:

Imaging scans help doctors rule out other possible causes of abdominal pain. Doctors diagnose close to 80% of cases of EC using X-rays.

In most cases, doctors treat EC with antibiotics, although some people with advanced EC may need surgery.

Doctors begin with a course of broad-spectrum antibiotics that target a large set of bacteria. Once the lab results confirm the type of pathogen, they may prescribe specific antibiotics.

Common classes of antibiotics that doctors prescribe for EC include:

  • penicillin with beta-lactamase inhibitors
  • cephalosporines
  • fluoroquinolones
  • piperacillin/tazobactum

Treatment usually lasts 4 weeks, although the duration will depend on the infection severity, the person’s medical history, and whether there are any complications. Once the antibiotics resolve the infection, the body reabsorbs the excess gas. As a result, the person has no further discomfort.

In addition to treating the main infection, the doctor will address any comorbidities, such as diabetes. Treating these will prevent the infection from happening again.

The outlook for EC recovery is good, but people should not delay treatment. Untreated EC can lead to a life threatening kidney infection called emphysematous pyelonephritis. This infection increases a person’s risk of septic shock, bladder rupture, and death.

People should contact a doctor if they have symptoms of EC, particularly if they have other risk factors, such as diabetes.

Early diagnosis results in prompt management of the condition and generally positive outcomes. Although severe cases are uncommon, EC can be fatal. Research shows that about 7.4% of people with EC lose their life to the disease.

Contacting a doctor in a timely manner helps people get the treatment they need.

Emphysematous cystitis is an uncommon UTI. As its symptoms resemble those of other conditions, it often goes undiagnosed.

EC is more common among people over the age of 60 years and individuals with diabetes.

Early diagnosis and timely treatment are both essential to recovery. Delaying the diagnosis of EC can put people at risk of complications. People with risk factors for developing EC should be aware of the symptoms of the condition so that they can contact a doctor quickly if these arise.