Dr. Gupta Aman Manoharlal
Urology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 40-year-old female. I went to my doctor a year before because I had a little blood in my urine when I wiped. He did a urine analysis, and some blood work and everything came back fine. There were no problems until three days ago. I peed then a few minutes later it felt like it still had to go so I went back to the toilet but I just got only blood. There was a lot this time, and it was fresh blood and small clots. It is hurting while passing the blood but that is all that came out though I had just emptied my bladder a few minutes before that. The only other symptom I seem to be having is all of a sudden there will be an immediate need to pee out of the blue but then when I go it is not a full bladder of pee just like half but the onset was very sudden, or I am going to pee my pants. These are my only symptoms. I do have a long history of stones, but I am confident this is not due to that, because I have had blood from stones but not this amount of blood. And every time I have ever had a stone, it hurts worse than childbearing, and I am not in that kind of pain. I feel whatever is going on is the same thing I went to the doctor last year, but he found nothing. What is likely to be wrong with me? I am currently on Coumadin, Lanoxin, Coreg, and Propylthiouracil. Laboratory tests performed are urinalysis, hemoglobin a1c, CBC (complete blood count), fasting lipid panel, and fasting glucose.
Hello,
Welcome to icliniq.com.
A bladder infection (cystitis), stones and overdose of Coumadin (Warfarin), all three can be the likely reason for your bleeding. In case of any such bleeding, an ultrasound is a must. I prefer to start with a short course of antibiotics (mostly Nitrofurantoin and Cipro or Levofloxacin are given) for five days depending on sensitivity patterns. Blood clotting parameters need to be checked to see if you are on the overdose of Coumadin. Ultrasound is a must to rule out any other serious causes of bleeding like a tumor. Since antibiotics are not available over-the-counter in your place, you need to get back to your general physician. Moreover, even for getting an ultrasound and clotting parameters to check the overdose of Coumadin, you need the help of your general physician. Please do at the earliest.
Patient's Query
Thank you doctor,
I bled only twice. First was about a year ago and it was a little pink when I wiped, so I went to the doctor the next day. He ran blood work and urinalysis and said everything came back fine. So I forgot about it, and I had no problems since five days ago. One time only after I peed right away I still felt like I need to go, so I sat back down to pee. That is when all that came out was fresh blood and a few small clots. Now nothing since again but this time was much worse than the first time a year ago. I had a history of stones and those hurt so bad I have had no pain like that. These are the pictures I took for my doctor.
Hello,
Welcome back to icliniq.com.
I saw the pictures (attachment removed to protect patient identity), and it is significant blood which should not be ignored. I am not sure if your doctor checked the clotting parameters. Moreover, even if urine tests were normal last year, a bladder infection could still happen. In any case, visible blood in urine warrants an ultrasound and your doctor would agree to it. Painless bleeding in urine warrants investigation.
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Urology
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