Q. I am getting a few drops of blood at the end of urination without pain. Is it a concerning issue?

Answered by
Dr. Gokul Vignesh Kandaswamy
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 27, 2020

Hello doctor,

I use toilet paper to soak up excess urine after going to the bathroom. I run my finger along the base of my penis to help get out the excess after the stream ends. The last couple of times, I noticed some droplets of blood on the toilet paper. The urine itself was not red or discolored. There is not a lot of blood, I would say anywhere between 4-10 small blood droplet spots. I am not having any discomfort or pain during urination. This has never happened before and it is worrisome.



Welcome to icliniq.com.

You have not mentioned your age which is key. It looks like you are doing urethral milking which is usually adviced for post-void dribble. I suspect it is because of your age, which would mean you are above 50 at least.

Anyway, blood per urethra is not normal and needs further evaluation. Milking is nontraumatic and hence cannot be put down as a reason. I reckon you would need a few basic investigations including prostatic examination, PSA (Prostate-specific antigen) check, checks for STI (sexually transmitted infection), and a flexible cystoscopy under local anesthesia. As part of these, your symptoms need to be analyzed as well.

I would hence recommend to see a urologist in person to sort these out. Idea is to check for sinister causes but generally, they are not common. We need to go through your history in detail, medications, etc.

The Probable causes:

Inflammation. Enlarged prostate. Cancer changes - prostate / bladder.

Investigations to be done:

STI, PSA, flexible cystoscopy.

Probable diagnosis:

Enlarged prostate.

Preventive measures:

None in particular. Check the milking technique when seeing a Urologist.

Thank you doctor,

I am 36 years old, but physically probably much older than that because, I am currently around 420 pounds. There is a good chance I have diabetes, although I have not been tested for that or take any medication. The first time I noticed blood was about a day and a half ago (the first time was the most blood) and over the course of the next 24 hours the amount of blood did decrease. And some times there was no blood on the toilet paper. Is it necessary to see a doctor if there is still very little blood (about 1-4 small drops) every couple of trips to the restroom? Is it possible it might go away on its own? Just wondering how critical of a situation this might be or if I can kind of see how it goes and then go to the doctor if it gets worse.



Welcome back to icliniq.com.

Thanks for all the details. One good thing is your age. However, the American Urology Association recommends evaluation even in patients above 35. While European panels recommend after 45.

In your case, with other potential health problems possible as you say, I would still recommend to get it checked. The chances of finding sinister causes like cancers are very low, but still, quite a few benign (non-cancerous) conditions are likely and some of them might need to be treated before it causes significant issues in the future.

I am not sure of exact pathways in American healthcare. A primary care physician evaluation for basic checks is the least you should do but ideally my previous recommendation. The camera examination is not a painful procedure. The vast majority tolerate it well. It only takes 1-2 minutes or so, with results straight away. I probably am not saying what you want to hear, but medically the advice is in your best interest.

The Probable causes:

Inflammation. LUTS (lower urinary tract symptoms). Malignancy.

Investigations to be done:

As mentioned before.

Preventive measures:

Weight reduction.

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