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Blood In Urine After Running. No Pain. CT Scan Negative. Cystoscopy Shows No Mass. What Should I Do?

Posted on Thu, 11 Apr 2013

Question: Hello I am a 55'year old healthy male. Exercise regularly. About 3 plus years go after a long jog on the beach I peed blood. It was a lot of blood and looked like a vein was cut. Went to urologist. Had ct scans and cystoscopy performed. All negative. The peeing of blood lasted about three pees and was gone. About 8 months later it happened again, also after a run. Same pattern and it was gone after several pees. 8 months or so later it happened again...went back to urologist. Same tests. Same negatives results. Although the ct scan said possible mass by bladder, the cycoscopy results said there was no mass. I went for a secnd opinion and he concurred with the first doctor and that its related to running. I therefore stopped running on the street and beach and confined my running to treadmills. Since then about 16 months passed and it happened again a few weeks ago after I stepped off the treadmill. Same pattern and it was clear pee after 3 or 4 pees. So now I have stopped running on treadmill all together......I stress out that the doctors are missing something. When the peeing episodes happen there is no pain at all but it's very in merging Is there something I should do? Look out for? Do you think the running can do this? Thank you

Answered by Dr. Dr. P. T. Patil (1 hour later)

Hello,

Thanks for your query. Based on the facts that you have posted it appears that you have repeated episodes of painless hematuria since last 3 years, and have consulted Urologist .

I shall be happy if you post few more details to comment on your problem.
1) Does your routine urine test show presence of Dimorphic Red Blood Cells in urine?
2) Was there proteinuria detected by dip stick test of Urine?
3) Was your Coagulation profile like Prothrombin time and PTCT study done to rule out any bleeding tendency?
4) Was your Ultrasound scanning done and what were the findings?
5) Have you ever taken opinion of a qualified Nephrologist to assess or to rule out any kidney disease (Pathology) for cause of bleeding? There are certain kidney diseases like IGA1 Nephropathy in which one gets exercise induced painless hematuria (This is confirmed only by doing Renal Biopsy.)

Painless hematuria is very challenging condition that needs detailed investigations to find out the source of bleeding and is a team work of both Urologist and Nephrologist. It needs systematic approach in deciding to investigate and work up.

If Urologist whom you have consulted are sure of bleeding not from any Urological cause, then you have to consult qualified Nephrologist for detail evaluation and investigation.

Hope I have answered your query.
Please revert back with whatever information that you have and feel free to ask if you have any more questions I shall be happy to help you.
Thanks with Regards.
Dr.Patil..

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Dr. P. T. Patil (32 minutes later)

I am not sure what Dimporphic red blood cells in urine means, but my urine tests routinely come back with traces of blood, which seems normal for me, according to the urologist. My GP also has run urine tests and shows small traces of blood...

No coagulation profile was conducted that i know of
ultrasound scanning was done on kidneys and bladder.. all negative
i have never seen a nephrologist

My urologist has conducted several tests and could not find a cause except to say its exercise induced......but it clearly does not happen every time i exercise. I exercise at least 5 days a week.....both weights and cardio. is it possible i am tearing something over a long period of time when i run?

i am concerned because i have never had a definitive answer as to my bleeding. I am greatly concerned about cancer, But i would assume since it happens so infrequently, it might not be a major issue?

I also have a problem with my penis suddenly taking a right curve. The urologist examined it and noted it was a mild and felt nothing of concern. I also have an enlarged prostrate.. not sure if all these are connected

Answered by Dr. Dr. P. T. Patil (58 minutes later)

Hello,

Thanks for follow up. If your Urologist has conducted many tests and could not find out the cause of bleeding, it is better to consult a Nephrologist when you get an episode of Hematuria. He will carry out necessary investigations to rule out the source of bleeding from Kidney Disease.

Ask your Urologist to do Cystoscopic examination during episode of hematuria. Sometimes you get hematuria in Enlarged prostate due to rupture of superficial blood vessels.

Please write to me again if you have more queries. I shall try my best to guide you.

Thanks and Regards.
Dr.Patil

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Dr. P. T. Patil (38 minutes later)

Thank you Dr...... I appreciate your assistance and guidance.
Should i wait for an episode to see a Nephrologist or make an appt now. The episodes only happen about once a year.... It makes sense about getting hematuria due to rupture of superficial blood vessels due to enlarged prostate.... that makes total sense to me. But i dont want to damage anything by this happening again, which is why i stopped running.. i would love to go back to running but the blood is too tramatic to go through again.

Answered by Dr. Dr. P. T. Patil (7 hours later)

Hello,

Thanks for writing again.

It is always better to get investigated when you get hematuria as the results of the tests done now will not be conclusive. However you can get Phase Microscopy of Urine done to see Dimorphic Red Blood Cells in urine which gives general idea of presence of Glomerular Disease of the kidney. This is a very simple test.

Please do not hesitate to ask if you have any more questions. I shall be pleased to help you.

Thanks and Regards.

Dr.Patil

Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.

Above answer was peer-reviewed by : Dr. Raju A.T