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Urology/Urethral injury

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Question
Hello,

Today I had to urinate very badly.  I was not in a spot where I could just use the restroom.  I had a plastic water bottle in my vehicle so I decided to urinate it in.  As I attempted to urinate into the bottle my penis was contricted by my pants and I could not go.  Eventually I got it unconstricted from my pants and I was able to go. Afterwards I was experiencing some soreness due to the constriction.  Later that day when I went to urinate again I noticed blood on my underware.  I had slight discomfort when urinating but nothing significant.  I put some toilet paper in my underware to see if there was still blood coming from my penis and there is.  It seems to be from the residual urine and when that dries I dont see any more blood.  I think I may have damaged my membranous urethra.  Can you please advise me further.

Answer
Mike, bleeding from the urethra at the end of urination (terminal hematuria) or blood spotting from the penis on the underwear usually comes from the prostate gland.  It is generally due to a tear in one of the fragile veins of the prostate gland or an inflammation of the prostate (prostatitis).   Bleeding may occur during sexual excitation, ejaculation, from straining with bowel movements, or during urination (especially from the type of restricted urination you experienced.    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).  If in the semen, red blood indicates new and dark (brownish) discoloration indicates previous bleeding.  This type of bleeding is generally of a benign nature.

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.  These are not generally recommended in men less than 40-50 years of age.  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.  Good luck.

Urology

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

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 endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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