Q. I have extremely painful urination with blood, and I am taking antibiotics. Please help.

Answered by
Dr. Nagaraj Patil
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Nov 05, 2020

Hi doctor,

I have extremely painful urination with blood. The first three urine is clear with blood and pain. The fourth one is dark yellow with blood and more painful. I have a history of UTI, and I am taking antibiotics.



Welcome to icliniq.com.

Sorry for your inconvenience. I understand your concern and let me help you with my best. Though urinary tract infections are common in females, repeated infections call for detailed evaluation and specific treatment. I have a few questions to ask before I suggest anything.

1. You mentioned it as urination with blood. Does blood come first, then urine or urine followed by blood, or the entire stream is mixed with blood? Is the urine stream reduced?

2. Do you experience pain only during urination or constantly in the lower abdomen or pelvic area?

3. You said you had infections in the past as well. Was a detailed evaluation done to identify the cause of repeated infections? Do you have any past investigations reports? Can you tell me the gap between these infections?

4. Do you have a fever as well?

5. Is your period normal?

6. Do you experience any other symptoms/medical conditions other than those mentioned here?

7. Are you sexually active?

8. What medications or antibiotics you were taking earlier or presently or previously?

Let me know your answers. You need not have to pay for your reply. Take care.

Hi doctor,

Thanks for your reply.

The urine is followed by blood. I do have a lower back area with discomfort. For the first time, I got this infection when I was four years old, and the next two times, I got it when I was 18 years old. The second and the third time, I went through a urine test. I do not have any fever, and my periods are regular. I do not have any medical conditions other than this, and I am sexually active. I do not precisely remember it because it was two years ago. But the third case, I had to take a higher level of antibiotics since the doctor told me the previous “level” of antibiotics I took would not work on me.



Welcome back to icliniq.com.

That helps, but the report took two years back, which is of no use for me now. As the first UTI (urinary tract infection) happened when you were quite young and post that no repeated infections seen until 18 years of age, I am currently not considering any major anatomical abnormality in the urinary tract. Considering back to back infections two years back (not sure if you were sexually active then) and now this year, I assume it to be a routine UTI (commonly seen in young sexually active females). It could be a relapse of an old infection with the same bacteria or a new infection with other bacteria. In any case, I think you have cystitis (infection of the urinary bladder). Because this is repeatedly happening, I suggest you go for the urine sample's culture and sensitivity to identify the causative organism and use the right antibiotic (instead of a broad-spectrum one). Consult your doctor for the same.

Other possibilities could be urinary stones (mostly in the bladder, which may harbor bacteria to cause repeated infections) and the vesicoureteric reflux (milder form, which is nothing but a regurgitation of urine back into urine pipe or the ureter).

Other things to consider to avoid repeated infections are,

1. Maintain sexual hygiene after intercourse.

2. Not to hold urine for a long time.

I hope this helps. Take care.

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