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Q. My 72-year-old mom is bleeding whenever she urinates. Please suggest some medicine.

Answered by
Dr. Sravanthi Nuthalapati
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 27, 2020

Hello doctor,

My mother is 72 years old. She has BP, sugar, and thyroid. Since four days she is bleeding. We thought it is a urine infection at first but now we do not know the reason. Kindly suggest some medicines as she is elderly we do not want to take her to clinics due to the current COVID situation.

She is currently on Amlovas 5, Telsartan 80, Ecospirin, Glucomet 500 mg, Insulin injection, and Thyroid 25 mg tablet. But sometimes she skips the tablets.

#

Hello,

Welcome to icliniq.com.

First of all, I would like to tell you that it is very important to establish the exact cause of the bleeding in this case of your mom. Does she bleed only while passing urine or is it like periods requiring a vulval pad to be kept? Also is the bleeding like spotting or heavy flow?

If the bleeding is not from the urinary passage, then it could be vaginal bleeding too. It is important in such scenario to rule out cervical or uterine endometrial cancer which can be done only after an examination by her gynecologist and getting appropriate tests like pap smear and endometrial aspiration biopsy with pipelle done and the cells examined by the pathologist.

Even though the most common causes of post-menopausal bleeding in women is due to thinning of the uterine lining due to hormonal deficiency. There are 10-15% chances that it could be because of a cancerous or pre-cancerous cause, and which cannot be known unless examined. And the management significantly changes with the diagnosis established after a thorough evaluation.

Alternatively, there is also a possibility of piles or external hemorrhoids causing bleeding through the anal passage which can be mistaken for the vaginal bleeding. Do check with her if the bleeding happens while passing stools, or if the stools are blood-stained if she is severely constipated and passing hard stools which can cause fissures and thus bleeding while passing stools.

Please do get an ultrasound abdomen and pelvis to see for any uterine causes like cancerous thickening of the lining of the uterus, fibroids or any polyps, etc., which can sometimes be detected through an ultrasound examination.

I hope this helps.


Investigations to be done:

Ultrasound abdomen and pelvis. Urine routine and microscopy. Pap smear. Endometrial aspiration biopsy along with endocervical curettage. Gynecological check up. FBS (fasting blood sugar), PPBS (post prandial blood sugar), and HbA1C (gycated hemoglobin). TFT (thyroid function test).

Differential diagnosis:

Endometrial atrophy. Precancerous or cancerous lesions of cervix. Cancer endometrium. Fibroids or polyps. Hemorrhoids.

Thank you doctor,

She is bleeding only while passing urine. Kindly suggest some medicines for temporary relief.

#

Hello,

Welcome back to icliniq.com.

If she is bleeding only while passing urine, please get a urine test for routine and microscopy. Also, check if she complains of any burning or pain while passing urine. If so then the cause can be a urinary infection and also the probable cause of any stone in the renal tract needs to be ruled out. Culture and sensitivity will determine the causative microorganism for the infection and respective antibiotics can be started after checking the reports.

Per se there are no medications to stop the bleeding unless the cause is identified or if the bleeding is too heavy. But in your case, the bleeding is not heavy too so no point of the medications.

If she complains of pain, she can be given the analgesics for pain relief. As per the recent telemedicine guidelines by the Government of India, medications cannot be prescribed without knowing the exact nature of the condition of the patient without having any interaction with the patient. Please get the investigations done as advised and consult your physician through phone or video chat for the necessary definitive medications. In the meanwhile, she can take pain-relief medications if she has burning while passing urine. Please find these medications for pain-relief in the below columns.


Investigations to be done:

Check the color of the urine sample collected in a container, if clear, then most likely it could be vaginal bleeding rather than bleeding through urine and it becomes important to rule out cancer as a cause for the bleeding.
If the urine is blood tinged then please get these tests. Do Urine routine and microscopy. Urine culture and sensitivity. Ultrasound abdomen and pelvis.

Treatment plan:

Tablet Meftal spas (Mefenamic acid and Dicyclomine HCl) sos in case of pain. Syrup Citralka two teaspoons thrice daily in a half glass of water for three days if she experiences burning while passing urine. Drink plenty of water and fluids.


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