Blood in Urine and Urination Issues After Erection

Hematuria after erection, difficulty urinating after ejaculation, and macroscopic hematuria with blood clots?

Hello Doctor: The symptoms have persisted for more than two months.
After an erection, I experience visible hematuria.
During ejaculation, I feel a blockage and cannot ejaculate.
Following that, I have difficulty urinating, and when I force it, I pass bright red blood clots.
I also have lower back pain and a cramping sensation in my testicles.
However, these symptoms do not occur when I am not erect or after ejaculation.
Recently, I have noticed that my urination feels different; the urine output is somewhat reduced, and I experience cramping in my bladder.
I am unsure if this is caused by the aforementioned pressure.
Cystoscopy, prostate examination, urinalysis, and blood tests have all returned normal results, with no signs of inflammation or tumors.
I seek your advice.

Afu, 30~39 year old female. Ask Date: 2022/04/07

Dr. Lin Wenxu reply Urology

If you are unsure whether your semen contains blood (hematospermia), a semen analysis can be performed.
Based on your description, the possible cause of the bleeding may be from the superficial blood vessels in the prostatic urethra, which often resolves on its own.
However, to determine the exact situation, further examination is necessary.
Please visit the urology outpatient clinic.
Dr.
Lin Wen-Hsu, Urology Department, Nantou Hospital.

Reply Date: 2022/04/07

More Info

Experiencing blood in urine, especially following sexual activity, can be concerning and warrants careful evaluation. Based on your description, it seems you have been experiencing these symptoms for over two months, including visible blood in urine after erections, difficulty with ejaculation, and lower back and testicular pain. While you have undergone various tests, including cystoscopy, prostate evaluation, and blood and urine tests, all of which returned normal results, it is essential to consider several potential underlying causes and management strategies.

Possible Causes
1. Vascular Issues: The presence of blood in urine after erections may suggest a vascular issue, such as micro-tears in the blood vessels of the urinary tract or prostate. The increased blood flow and pressure during an erection could exacerbate any existing vulnerabilities in the vascular structure.

2. Prostate Health: Although your prostate evaluation was normal, conditions like prostatitis (inflammation of the prostate) can sometimes present with similar symptoms. Chronic prostatitis can lead to pelvic pain and urinary difficulties, even if no acute inflammation is detected during examinations.

3. Urinary Tract Issues: Conditions such as urethral stricture or bladder irritation can lead to bleeding, especially during activities that increase abdominal pressure, such as sexual activity. Even if imaging and cystoscopy did not reveal significant abnormalities, subtle issues may still exist.

4. Kidney Stones: While you mentioned that previous imaging did not show stones, small stones or fragments can sometimes be missed. They can cause irritation and bleeding, particularly during physical activities or sexual intercourse.

5. Psychological Factors: Anxiety related to sexual performance or the fear of pain can sometimes manifest in physical symptoms, including changes in urination patterns.

Management Strategies
1. Follow-Up with a Urologist: Given the persistence of your symptoms, it is crucial to maintain follow-up with a urologist. They may recommend further imaging studies, such as a CT scan or MRI, to rule out any subtle abnormalities that may have been missed.

2. Hydration and Diet: Staying well-hydrated can help dilute urine and may reduce irritation in the urinary tract. Additionally, avoiding irritants such as caffeine, alcohol, and spicy foods may help alleviate symptoms.

3. Pelvic Floor Exercises: Engaging in pelvic floor exercises (Kegel exercises) may help strengthen the muscles involved in urination and ejaculation, potentially alleviating some of the discomfort.

4. Medication: If inflammation or irritation is suspected, your doctor may consider prescribing anti-inflammatory medications or muscle relaxants to help ease symptoms.

5. Avoiding Strain: It is advisable to avoid straining during urination or ejaculation. If you experience pain, it may be beneficial to take a break from sexual activity until you can consult with your healthcare provider.

Recovery and Prognosis
The duration of recovery can vary significantly based on the underlying cause. If the issue is related to vascular or muscular strain, symptoms may improve with rest and conservative management. However, if there is an underlying condition that requires treatment, such as prostatitis or kidney stones, the timeline for recovery will depend on the effectiveness of the treatment provided.

Conclusion
In summary, while your initial tests have returned normal results, the persistence of your symptoms suggests that further investigation is warranted. It is essential to communicate openly with your healthcare provider about your symptoms, including any changes you notice. Keeping a symptom diary may also help your doctor understand the pattern and severity of your symptoms, leading to a more accurate diagnosis and effective treatment plan. Always prioritize your health and seek immediate medical attention if you experience severe pain, significant changes in urination, or any other concerning symptoms.

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