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About Arthur 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
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You are here: Experts > Health/Fitness > Urology > Urology > bleeding during urination
Urology - bleeding during urination
Expert: Arthur Goldstein, M.D. - 11/9/2009
Question
My husband was urinating after waking. He sneezed before he was unable to stop the stream. He began to urinate blood. The bleeding continued and decreased throughout the day. He says it is nothing to worry about, that the sneeze caused it. Is this true? He had a lot of blood on his underwear at the end of the day. It has not bled since. He is a 32 year old man that does not take medication.
Answer
Brianne, the most likely source of your husband's bleeding was from the prostate gland. This organ often has veins on its outer surface called "prostatic varices". These are fragile and prone to bleeding from minor events such as a sudden sneeze. However, there are many other causes for urinary bleeding and because of this, I suggest he get checked by a urologist. To follow is a "macro" I have written on this problem:
There are many possible causes for blood in the urine (hematuria). The origin of the bleeding can come from the upper (kidneys or ureters) or lower (bladder, prostate, urethra) urinary tract. Blood seen only under the microscope (microscopic hematuria) is usually of a benign nature whereas gross hematuria is potentially more serious. With gross hematuria, it is important to note the relationship of the bleeding to the urinary stream. If at the beginning of urination (initial hematuria), the source of the blood is almost always in the urinary canal (urethra). If at the end of urination (terminal hematuria), the source is usually the prostate gland in men or the bladder neck in men and women. Bleeding throughout the entire stream (total hematuria) is due to bleeding that is initiated in the urinary bladder or upper urinary tract (kidneys and/or ureters).
Some of the common causes of hematuria include infection, tumors, stones, and trauma (injury). In order to look for the cause, it is necessary to consult a urologist. A history, physical examination, urine cytology, and other laboratory tests are done. Visualization of the kidneys by imaging studies (ie IVP, ultrasound, CT or MRI) and examination of the lower urinary tract with a cystoscope are usually required.
Microscopic hematuria is often due to inflammatory disorders of the kidney, so called nephritis, of which there are many types. Even with studies, frequently no specific cause is found for microscopic hematuria and this is termed “essential hematuria”. The American Urologic Association has recently revised their guidelines for the evaluation of microscopic hematuria. This is defined as 3 RBC or greater per high power field in at least 2 of 3 properly collected specimens. If no cause is found for the hematuria on initial evaluation, the patient is followed for 3 years with periodic urinalysis, urine cytology and BP determinations. Thereafter, they no longer need to be followed if stable. The exceptions would be those persons with increased risk factors for cancer such as smoking, history of gross hematuria, irritative voiding symptoms, exposure to chemicals or dyes (benzenes or aromatic amines), urinary tract infections, history of pelvic irradiation, analgesic abuse, and age greater than 40.
In summary, consultation with a urologist is needed to determine the cause and seriousness of the hematuria. Good luck!
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