Low Urine Output and Hematuria After Childbirth

Q: Low Urine Output and Hematuria After Childbirth

Hello： 1) Urine output can vary; generally, if one can void 200 cc with a post-void residual of less than 50 cc, it is considered acceptable. <br>However, it is recommended to maintain fluid intake of no less than 2000 cc, primarily through plain water and minimizing other bevera

Low urine output and hematuria issues?

Hello Doctor,
1.
Since giving birth, my urine output has significantly decreased and the flow is weak (slowly dribbling).
Especially in the morning upon waking, my first urination used to be around 300cc, but now it might only be about 100cc (for example).
My water intake has not changed much before and after childbirth.
Generally, I do not urinate much unless I drink a lot of water, which then leads to frequent trips to the bathroom.
This has been ongoing for four years (the urine color is normal, no泡沫, no pain or itching, and no lower back pain).
2.
Last month, I underwent a labor health check, and the urine test showed positive for hematuria (+), while urine protein and white blood cells were normal, and there was no visible blood in the urine.
Earlier this year, I had a CT scan (only of the pelvic area) where my kidney function was normal prior to the examination, as it was a follow-up for gynecological issues.
The CT report indicated no significant problems but mentioned "subtle bladder changes." I also have a history of endometriosis and am unsure if it has spread to other organs.
3.
In recent years, one of my urine reports indicated the presence of urinary crystals, and the doctor advised to drink more water without the need for treatment.
All blood tests have been normal.
I am unsure if the above issues are related to my bladder.
Can a pelvic CT scan detect urinary system conditions? Should I seek further evaluation in an outpatient setting? If so, should I see a nephrologist or a urologist? The change in my urine output compared to before is quite significant, and I am quite anxious about the possibility of a tumor.
Thank you, Doctor.

Ms. Zheng, 20~29 year old female. Ask Date: 2018/04/10

Dr. Du Shixi reply Urology

Hello: 1) Urine output can vary; generally, if one can void 200 cc with a post-void residual of less than 50 cc, it is considered acceptable.
However, it is recommended to maintain fluid intake of no less than 2000 cc, primarily through plain water and minimizing other beverages.
2) The presence of occult blood in urine is an abnormal finding that does not necessarily indicate a problem; some individuals may have normal results upon re-testing.
However, if the urine appears red or if occult blood is consistently detected in each test, or if proteinuria is found, it is important to be vigilant.
If red blood cells are present in the urine, the source may be the kidneys, ureters, bladder, or urethra.
(Pelvic examinations typically only allow visualization of the bladder and part of the ureters.) If there are significant concerns, it may be advisable to consult a urologist for further evaluation; if there are no concerns, regular monitoring is sufficient.
Wishing you good health.

Reply Date: 2018/04/10

More Info

After childbirth, it is not uncommon for women to experience changes in urinary output and flow. Your concerns regarding low urine output and the presence of hematuria (blood in urine) are valid and warrant further exploration. Let’s break down your situation and address your questions.

1. Low Urine Output: You mentioned that your urine output has decreased significantly since childbirth, particularly in the morning. This could be attributed to several factors. Postpartum changes in the body, including hormonal fluctuations and potential changes in bladder function, can affect urine production. Additionally, if you are not consuming enough fluids, this could lead to concentrated urine and lower output. However, since you have maintained a consistent fluid intake, it may be worth investigating further.
2. Hematuria: The presence of blood in your urine, even if it is not visible to the naked eye, is concerning. A positive test for hematuria can indicate various underlying issues, including urinary tract infections, kidney stones, or even more serious conditions such as tumors. Given that your CT scan did not reveal any significant issues but noted "unremarkable bladder," it suggests that while there may not be an obvious structural problem, further evaluation is necessary.

3. Potential Causes: Your history of endometriosis could potentially contribute to urinary symptoms, especially if there is any involvement of the bladder or surrounding structures. Endometriosis can lead to inflammation and scarring, which might affect bladder function. Additionally, the presence of urinary crystals could indicate dehydration or an underlying metabolic issue, which should be monitored.

4. Next Steps: Given your symptoms and the findings from your tests, it would be prudent to consult with a urologist. A urologist specializes in urinary tract issues and can perform further diagnostic tests, such as a urinalysis, urine culture, and possibly imaging studies like an ultrasound or a more detailed CT scan focusing on the urinary system. This will help rule out any significant pathology, including tumors or structural abnormalities.

5. Pelvic Imaging: While a CT scan of the pelvis can provide some information about the urinary system, it may not be comprehensive. If there are concerns about the bladder or kidneys, specific imaging studies targeting these organs may be more informative.

6. Monitoring and Management: In the meantime, ensure you are adequately hydrated. If you notice any changes in your symptoms, such as increased pain, changes in urine color, or any new symptoms, seek medical attention promptly.
In summary, your concerns about low urine output and hematuria are important and should be addressed with a urologist. They can provide a thorough evaluation and determine if any further testing or treatment is necessary. It’s essential to stay proactive about your health, especially when experiencing changes that deviate from your normal patterns.

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