AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Expert: Arthur Goldstein, M.D. Date: 8/6/2008 Subject: darker blood and tiny pieces of blood clots in seamen
Question Hello, I am in my early 20s and was diagnosed with hematospermia almost 4 weeks ago now, my only 2 symptoms of blood in seamen and increased urination are still there, I have tried to refrain from prostatic excitment in hopes this would help the problem and about a week and a half ago my urination frequency returned to normal and I had 2 ejaculations with no blood, though it looked like the seamen was clumpy, then about a week ago the symptoms came back (they were not gone but a day or two) and I tried to refrain from ejaculation again and once when I urinated at the end of urination some a drop of blood came out with some tiny pieces of blood clots since then I have ejaculated about 3 times to try and empty the prostate and have had blood in seamen looks darker(not brown but close) as opposed to the bright red color the 1st few times it happened. What do the tiny pieces of clotted blood indicate? I know from reading previous answers that the darker color indicates the blood has been in there longer so does this mean whatever the problem was has healed and now I just need to get the remaining blood out of the prostate or would it be a bad idea to continue to try and empty the prostate and should I go back to trying to refrain from frequent ejaculation? Thank you for any answers you can give me.
Frank
Answer Frank, I don't know if you have read my entire "macro" on hematospermia, so before I answer you specific questions, let me follow with the "macro".
This type of bleeding usually comes from the prostate gland. It is due to a tear in one of the fragile veins of the prostate (prostatic varices). It may occur from straining with bowel movements, or during urination or ejaculation. The prostate is the organ that produces the majority of the seminal fluid in response to sexual stimulation. When the prostate contracts at the time of ejaculation, a vein may tear and blood mixes with the semen (hematospermia). Red blood indicates new and dark (brownish) discoloration indicates previous bleeding.
In addition, prostatic bleeding frequently is associated with gross blood during urination. This typically will occur with initiation or at the end of urination (as opposed to being throughout the entire stream). With the latter, it is often manifest as spots of blood on the underwear, pajamas or bed sheets. Irritation of the gland (prostatitis) can also cause it to become inflamed and predisposed to bleed. An inflamed or congested prostate gland, especially one with varices, can start bleeding if ones strains during a bowel movement. This occurs because hard stool can actually push on the adjacent gland precipitating bleeding or straining in itself may cause the varices to rupture.
Some factors leading to inflammation include too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, excessive alcohol or spicy foods, prolonged sitting or bike riding, etc. The prostate may then become secondarily infected and require antibiotic therapy for cure. Sometimes as the prostate gradually enlarges with age, friable veins called varices develop on its surface. These are also prone to tearing. In such cases, Proscar or Avodart is sometimes prescribed to shrink both the prostate and the veins. Although hematospermia is not a typical sign of prostate cancer, its presence may indicate an increased risk of prostate cancer. Therefore, it is advisable to seek consultation with a urologist to evaluate this condition.
The blood clots merely mean that that some blood collected either in a prostatic duct or in the prostatic urethra and congealed. It is of no more specific meaning the other types of bleeding you have noted (ie red blood, dark blood, blood in semen or at end of urination, etc.). The aim of treatment is NOT to try and empty the prostate of the blood. The aim of treatment is to restore your prostate to health. The fact that you have any symptoms (bleeding, frequency of urination, etc.) means there is still a problem. The first step would be to see a urologist in consultation. He can determine that your prostate is benign (at your age this would almost always be true) and see if you have prostatitis. The latter would need treatment (usually antibiotics). In the interim, you should ejaculate only in moderation (perhaps 1-2 times a week) & follow the other instructions in the preceding paragraph. In refractory cases of bleeding, medications such as Proscar may be necessary but this would be unlikely at your age. Good luck.
