Blood Streaks After Urination: Potential Causes and Concerns

Blood streaks observed after urination?

Hello Doctor: Over the past month or two, I have noticed blood streaks when wiping after urination.
Since I am unsure whether the blood is coming from the vagina or the urethra, and I have also experienced a dull pain in my lower abdomen these past few days, I was quite worried and went to see a gynecologist.
The first doctor I visited immediately diagnosed me with an infection after I mentioned the blood when wiping, confirmed I was not pregnant through a urine test, and prescribed medication for urethritis without any further examinations.
Unsatisfied, I sought a second opinion from another gynecologist, who conducted a thorough abdominal ultrasound and a pelvic exam, as well as a Pap smear.
After the examination, the doctor stated that there were no issues found and no signs of bleeding from the vagina, advising me to wait for the Pap smear results before going home.
After visiting both doctors, I am still filled with uncertainty about what the problem might be, especially since my menstrual cycle is very irregular, occurring roughly every three to four months.
The first doctor mentioned that if my period does not come by the end of August, I should return for a follow-up.
I am now unsure whether I should take the medication for urethritis prescribed by the first doctor, as I have no other symptoms of urethritis apart from the blood streaks when wiping.
Additionally, a few years ago, a doctor mentioned that I have polycystic ovary syndrome (PCOS), but I have not been actively treated for it.
I would appreciate your help in clarifying my concerns.
Thank you, Doctor.

Bengbeng, 20~29 year old female. Ask Date: 2017/08/15

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In the past couple of months, I have noticed blood streaks when wiping after urination.
Since I am unsure whether the blood is coming from the vagina or the urethra, and I have also been experiencing a dull pain in my lower abdomen for the past few days, I was very concerned and went to see a gynecologist.
The first doctor I visited immediately diagnosed me with an infection after I mentioned the blood when wiping, confirmed I was not pregnant through a urinalysis, and prescribed medication for urethritis without conducting any further tests.
Unsatisfied, I sought a second opinion from another gynecologist, who conducted a thorough abdominal ultrasound and a pelvic exam, as well as a Pap smear.
After the examinations, the doctor found no issues and did not identify any bleeding from the vagina, advising me to wait for the Pap smear results before going home.
After visiting both doctors, I am still filled with uncertainty about the underlying issue, especially since my menstrual cycle is very irregular, occurring approximately every three to four months.
The first doctor mentioned that if my period does not come by the end of August, I should return for a follow-up.
I am now unsure whether to take the urethritis medication prescribed by the first doctor, as I have no other symptoms of urethritis besides the blood streaks when wiping.
Additionally, a few years ago, a doctor mentioned that I have polycystic ovary syndrome (PCOS), but I have not undergone any active treatment for it.

Answer: 1.
Take the urethritis medication prescribed by the first doctor and wait for the Pap smear results from the second gynecologist.
2.
Since my menstrual cycle is very irregular, occurring approximately every three to four months, I should go to a larger hospital for a thorough examination and treatment.

Reply Date: 2017/08/15

More Info

Blood streaks after urination can be concerning, especially when accompanied by symptoms such as lower abdominal discomfort. In your case, it seems you have already taken proactive steps by consulting two different gynecologists, which is commendable. Let's break down the potential causes and considerations regarding your situation.

Potential Causes of Blood Streaks
1. Urinary Tract Infection (UTI): This is one of the most common causes of blood in the urine. Symptoms typically include burning during urination, frequent urination, and lower abdominal pain. However, you mentioned that you do not have other symptoms of a UTI, which makes this less likely.

2. Vaginal Bleeding: Since you are experiencing blood streaks and have irregular menstrual cycles, it is possible that the blood is coming from the vaginal area rather than the urinary tract. Irregular periods can be caused by various factors, including hormonal imbalances, stress, or conditions like polycystic ovary syndrome (PCOS).

3. Injury or Trauma: Sometimes, minor injuries to the vaginal or urethral area can cause blood to appear. This could happen due to vigorous activities or even during sexual intercourse.

4. Polycystic Ovary Syndrome (PCOS): Given your history of PCOS, it is essential to consider that this condition can lead to irregular menstrual cycles and potential bleeding issues. Hormonal imbalances associated with PCOS can also contribute to abnormal bleeding.

5. Other Gynecological Issues: Conditions such as fibroids, endometriosis, or even infections could cause abnormal bleeding. The thorough examination you received from the second gynecologist, including an ultrasound and Pap smear, is a good step in ruling out these conditions.

Recommendations
1. Follow-Up on Test Results: Since you are waiting for the Pap smear results, it is crucial to follow up with your healthcare provider once they are available. This can provide more insight into any potential issues.

2. Monitor Symptoms: Keep track of any additional symptoms that may arise, such as changes in your menstrual cycle, pain, or any other unusual signs. This information can be helpful for your healthcare provider.

3. Consider Medication: Regarding the medication prescribed for a urinary tract infection, if you do not have any symptoms of a UTI, it may be worth discussing with your healthcare provider whether you should take it. It’s essential to avoid unnecessary antibiotics unless there is a clear indication.

4. Seek a Specialist: If your symptoms persist or worsen, consider consulting a specialist, such as a urologist or an endocrinologist, especially given your history of PCOS. They can provide further evaluation and management options tailored to your situation.

5. Lifestyle and Management: Managing stress, maintaining a healthy diet, and regular exercise can help regulate menstrual cycles and overall reproductive health. If stress is a contributing factor, consider stress-reduction techniques such as yoga or meditation.

Conclusion
In summary, while blood streaks after urination can be alarming, they can arise from various causes, including urinary tract infections, vaginal bleeding, or hormonal imbalances related to conditions like PCOS. Since you have already consulted two doctors and undergone some tests, it is essential to await the results and continue monitoring your symptoms. If you remain concerned or if your symptoms change, do not hesitate to seek further medical advice. Your health is paramount, and being proactive is the best approach.

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