OpenHealth Q&A

Experiencing Occasional Hematuria: Seeking Guidance

Greetings, medical professionals. I appreciate your assistance with the following situation. **Patient Overview:** - **Age:** 47 - **Gender:** Male - **Height:** 6 feet - **Weight:** 202 pounds **Symptoms Overview:** Approximately three months ago, I began to observe small traces of blood in my urine. It's a minimal amount, usually just a couple of drops occurring at the end of urination. I do not suffer from any pain, fever, chills, or urinary difficulties. Initially, I suspected that this could be linked to kidney stones or exercise-induced hematuria, as I maintain a rigorous exercise routine spanning two hours daily, seven days a week. My workouts alternate between strength training 3-4 times a week and cardio exercises, including rowing, treadmill use, the elliptical, stair climbing, and jump rope. After several weeks, I also observed tiny tissue-like fragments in my urine, prompting me to consult a doctor, as I suspected a urinary tract infection. Although I have an enlarged prostate, my physician considered it a benign issue, attributing the swelling to the potential chain reaction of a UTI leading to bladder infection and subsequently causing prostate inflammation. **Diagnostic Tests and Outcomes:** I underwent a comprehensive metabolic panel, which included tests for glucose, BUN, creatinine, and various electrolytes. All results fell within normal ranges, with the exception of a low BUN/creatinine ratio (8). Additionally, I received a Creatine Kinase (CPK) test, which returned normal results. A complete blood count (CBC) with differential was conducted, showing all parameters, including WBC, RBC, and hemoglobin, to be normal. Urinalysis reflected negative findings for GLU, BLO, NIT, and LEU. However, it indicated a small amount of bilirubin, a ketone level of 15, a specific gravity of 1.025, a pH of 5.5, and a protein level at 30. Uric acid levels were 8.1, within normal limits, though an inflammatory marker was mildly elevated. A sedimentation rate (Westergren) displayed a slight elevation at 19 (normal range is up to 15). A CT scan of the abdomen and pelvis with contrast yielded several findings: - **Lung Bases:** A few small pulmonary micronodules were noted, but otherwise clear. - **Liver, Spleen, and Pancreas:** All appeared normal without lesions. - **Kidneys:** Normal with no stones or masses. - **GI Tract:** The stomach was mildly distended, but otherwise normal with stool presence noted in the colon. - **Pelvis and Vascular Structures:** Solid organs and vessels appeared normal. - **Other Findings:** Prominent inguinal lymph nodes were potentially reactive, alongside a small left inguinal hernia. **Follow-Up Treatment:** Following these evaluations, my physician prescribed sulfamethoxazole for a duration of 28 days. I adhered to the regimen fully, and while undergoing treatment, all symptoms subsided completely. However, this occurred about a month ago, concluding in late December. **Current Situation:** This evening, after my workout, I noticed the return of blood traces in my urine. While I do not experience pain, I have difficulty with bowel movements, feeling persistently constipated regardless of food intake. This change coincided with a mild tearing sensation during exercise on the adductor machine. Additionally, I have developed a reddish rash on both arms, which had resolved during the antibiotic treatment but has now reappeared. Previously, this rash was effectively treated with prednisone, leaving me unsure if this is connected to my earlier symptoms. **Concerns:** I worry that standard medical tests might overlook a significant issue affecting my prostate, colon, or urinary system. My insurance policy does not cover colonoscopy or prostate evaluation, and I have been advised to consider these procedures, though they would cost nearly $7,000 out of pocket. While I understand the necessity of these assessments if needed, I prefer to seek a second opinion before committing to such expenses. It's important to note that there is a family history of cancer, primarily lung cancer. I welcome any advice or insight into my case and will provide any additional details you may require.

Answers (1)

2/8/2026, 12:30:40 AM

OpenHealth AI

Main Points: You're experiencing occasional hematuria (blood in urine) and other symptoms after completing antibiotic treatment. It's understandable to be concerned about what this could indicate, especially with the family history of cancer. Fortunately, there are steps you can take while considering further medical evaluation.

Explanation: Hematuria can arise from different issues, ranging from benign (like exercise-induced changes) to more serious conditions. Since your prior urinalysis did not show indications of infection and your CT findings were mostly normal, it's reassuring, but the return of blood in your urine does warrant attention. The difficulty with bowel movements and rash may also suggest an underlying inflammatory or systemic condition that might be worth exploring further.

Given your exercise routine, it might also be helpful to evaluate if certain intense activities exacerbated the situation. Consistently high-impact exercises can sometimes lead to microtrauma in your body, especially in the pelvic region, which might cause blood to appear in your urine.

Specific Next Steps:

1. Hydration & Diet: Ensure that you are well-hydrated, which can help dilute your urine and reduce irritation. Additionally, consider a diet high in fiber to address your constipation, including fruits, vegetables, and whole grains.

2. Monitor Symptoms: Keep a detailed diary of your symptoms, including the presence of blood, any pain, and your bowel habits. Note the timing concerning your workouts and any specific exercises you think may trigger symptoms.

3. Adjust Exercise Routine: Consider temporarily reducing the intensity of your workouts or crossing out specific exercises (like those targeting the adductor muscles) that you suspect may be causing strain until your symptoms stabilize.

4. Rash Management: Since your rash resolved with prednisone previously, consider any triggers that may correlate with its recurrence. Discuss topical treatments or a follow-up plan for the rash with your healthcare provider, especially as the rash's return coincides with the resurgence of your urinary symptoms.

5. Seek a Second Opinion: Given your concerns about overlooked issues and family history, pursuing a second opinion is sensible. Look for a healthcare provider who can evaluate your complete history, ideally one familiar with your symptoms, to develop a targeted plan or suggest less invasive investigations if cost is a concern.

6. Explore Cost-Effective Evaluations: Talk to your healthcare provider about the risks and benefits of colonoscopy or prostate evaluations and discuss potential alternatives or financial assistance programs available for care.

7. Understand Your Family History: Share any new developments in your family history with your healthcare provider, as this may influence their approach to testing and diagnosis.

Taking these steps should help in managing your symptoms while giving you more clarity on your health situation. If your symptoms worsen or change significantly, prioritize seeking medical attention sooner rather than later. Let me know if you have any other questions or concerns!