Rhabdomyolysis: Symptoms, Risks, and When to Seek Help

Q: Rhabdomyolysis: Symptoms, Risks, and When to Seek Help

Hello, RC： <br>1. <br>"Because of hematuria, I visited the urology department at Mackay Memorial Hospital last week, and I have completed a urinalysis (which showed a positive reaction for blood)..." Here, "positive reaction for blood" refers to either the presence of red blood c

Rhabdomyolysis

Hello Dr.
Wu, I would like to ask the following question.
As an avid runner, I suspect that I might have rhabdomyolysis.
I researched related symptoms online and my reasons for suspicion are as follows: Recently, I have been running and walking approximately 30 kilometers daily (in the morning and evening).
After exercising continuously for 90 days, I noticed blood in my urine, which is dark in color, and I have mild pain in the left lower abdomen (near the hip joint, especially after completing a 10 km run).
Currently, these are the only two symptoms I have, but I do not have other symptoms such as urinary retention; I believe my urine output is normal, and I do not experience weakness or pain during urination.
As for my current management, due to the hematuria, I visited the urology department at Mackay Memorial Hospital last week.
I have completed a urinalysis (which showed blood), X-rays, and a renal ultrasound, and the doctor said everything is normal.
A few days ago, I also underwent a renal scan and a urinary cytopathology examination, and I am still waiting for the reports.
The doctor prescribed me some medications: UROPRIN, DOLCOL, COSPANON, and CATAFLAM.
Initially, after taking the medication, the hematuria resolved by the second day, but it reappeared after a week, as I continued to exercise during that week, albeit with reduced intensity.
Since the doctor initially prescribed only two days' worth of medication, I requested a continuation, and I have maintained normal urine color for four days now.
However, I still experience mild pain in the left lower abdomen when walking long distances; the pain seems to be superficial rather than visceral, as pressing firmly does not elicit pain from the internal organs.
My medical history includes: 1.
Left inguinal hernia (which has been repaired), 2.
Small kidney stones (which were passed several years ago), and 3.
Left-sided varicocele (which only causes mild pain after prolonged standing).

If the urologist cannot identify the cause, as the doctor mentioned that some runners may experience hematuria of unknown origin, should I pursue an investigation for rhabdomyolysis? If so, which specialty should I consult? Or do you have any other recommendations? Thank you, RC.

RC, 40~49 year old female. Ask Date: 2014/08/30

Dr. Wu Jiyu reply Internal Medicine

Hello, RC:
1.
"Because of hematuria, I visited the urology department at Mackay Memorial Hospital last week, and I have completed a urinalysis (which showed a positive reaction for blood)..." Here, "positive reaction for blood" refers to either the presence of red blood cells (RBCs) or a positive occult blood test? If it's the former, it indicates that there is indeed blood in your urine; if it's only the latter, it doesn't necessarily mean hematuria.
Hemoglobin is the substance that gives red blood cells their color, and the laboratory has designed test strips that react to hemoglobin (which is the positive occult blood test).
However, myoglobin can also cause a positive reaction (positive occult blood test), so when rhabdomyolysis occurs, damaged skeletal muscle releases myoglobin, which can make the urine appear reddish.
If you want to investigate rhabdomyolysis, you can schedule an appointment with a general internal medicine clinic and describe your concerns to the physician, who can arrange for a blood test to check the myoglobin levels in your blood.
2.
If it is indeed hematuria (red urine does not necessarily mean there is blood in the urine), as you mentioned, please have the urologist look for possible causes.
If none are found, you can follow up with a nephrology clinic, as certain types of glomerulonephritis, such as IgA nephropathy, can present with hematuria symptoms.
Thank you!

Reply Date: 2014/08/30

More Info

Rhabdomyolysis is a serious condition that occurs when muscle tissue breaks down and releases its contents, including myoglobin, into the bloodstream. This can lead to kidney damage and other complications. Understanding the symptoms, risks, and when to seek medical help is crucial, especially for individuals who engage in intense physical activities, such as running.

Symptoms of Rhabdomyolysis
The classic symptoms of rhabdomyolysis include:
1. Muscle Pain and Weakness: This is often generalized but can be localized to specific muscle groups that have been overexerted.

2. Dark Urine: The urine may appear tea-colored or cola-colored due to the presence of myoglobin.

3. Fatigue: Generalized fatigue and malaise can occur.

4. Swelling: Affected muscles may swell.

5. Nausea and Vomiting: Some individuals may experience gastrointestinal symptoms.

6. Confusion or Altered Mental Status: In severe cases, confusion can occur due to electrolyte imbalances.

In your case, you mentioned experiencing dark urine and mild left lower abdominal pain after extensive running. While these symptoms can be concerning, especially the presence of blood in the urine, they do not definitively indicate rhabdomyolysis without further investigation.

Risks and Causes
Rhabdomyolysis can be triggered by several factors, including:
- Intense Physical Activity: Particularly in untrained individuals or after a sudden increase in exercise intensity.

- Dehydration: Insufficient fluid intake can exacerbate the condition.

- Medications and Substances: Certain medications, alcohol, and illicit drugs can increase the risk.

- Underlying Medical Conditions: Conditions like metabolic disorders or muscle diseases can predispose individuals to rhabdomyolysis.

Given your history of extensive running and the symptoms you've described, it's important to consider the possibility of rhabdomyolysis, especially if you continue to experience dark urine and abdominal pain.

When to Seek Help
You should seek immediate medical attention if you experience:
- Severe muscle pain or weakness.

- Dark or discolored urine.

- Swelling in the limbs.

- Nausea or vomiting that persists.

- Confusion or altered mental status.

Since you have already consulted a urologist and undergone various tests, it is essential to follow up on the results of those tests. If the urologist cannot find a definitive cause for your symptoms, it may be prudent to consult a specialist in sports medicine or a neurologist who can evaluate for rhabdomyolysis or other muscle-related disorders.

Next Steps
1. Follow Up on Test Results: Ensure you receive and understand the results of your kidney imaging and urine pathology tests.

2. Monitor Symptoms: Keep track of any changes in your symptoms, especially regarding urine color and abdominal pain.

3. Reduce Exercise Intensity: Consider reducing your running distance and intensity until you have a clearer understanding of your condition.

4. Hydration: Ensure you are well-hydrated, especially during and after exercise.

5. Consult a Specialist: If symptoms persist or worsen, consider seeing a sports medicine physician or a neurologist for further evaluation.

In conclusion, while your symptoms could suggest rhabdomyolysis, they could also be attributed to other factors related to your exercise regimen. It is essential to continue working with your healthcare providers to determine the underlying cause and to ensure your safety as you continue your running activities.

Similar Q&A

Understanding Rhabdomyolysis: Symptoms, Risks, and When to Seek Help

Hello Doctor, I would like to describe my symptoms: I perform sit-ups 30 times, jog for 30 minutes, and pedal an exercise bike for 40 repetitions about 3 to 4 days a week. Could this intensity potentially lead to rhabdomyolysis? After experiencing groin pain on November 18, I c...

Dr. Du Shixi reply Urology
Hello: 1) Rhabdomyolysis occurs only in certain individuals and is not experienced by everyone; diagnosis requires blood tests and urine analysis. 2) As for abdominal pain, a doctor's diagnosis is necessary (it cannot be diagnosed without examination in this setting). 3) Cur...

Caring for Patients with Rhabdomyolysis: Essential Tips and Recommendations

For a patient with rhabdomyolysis, proper care is crucial, especially when resources are limited. Here are some recommendations: 1. Hydration: Continue to encourage the patient to drink plenty of fluids, preferably water or electrolyte solutions, to help flush out toxins and...

Dr. Yang Jun reply Internal Medicine
Hello: In response to your question, the causes of rhabdomyolysis may include heat stroke, severe trauma, prolonged local tissue compression, or drug-induced factors. It is essential to first eliminate the underlying cause and provide ample hydration along with diuretics to preve...

Understanding Rhabdomyolysis: Symptoms, Risks, and Hydration Tips

Hello Doctor, I would like to ask, after exercising the day before yesterday, I feel like I might be experiencing rhabdomyolysis. My urine is slightly darker than usual, and my muscles have not recovered yet (besides these two symptoms, I have no other symptoms such as oliguria, ...

Dr. Wu Hongjie reply Internal Medicine
Drinking plenty of water after exercise helps in the elimination of metabolic waste, including muscle enzymes, so it is recommended to stay hydrated for muscle recovery. It is important to wait until lactate and other waste products are completely removed. In case of any exercise...

Understanding Muscle Strain vs. Rhabdomyolysis: When to Seek Medical Help

Hello, doctor. On August 14, I strained my neck muscles due to chiropractic treatment. Recently, I came across symptoms and causes of rhabdomyolysis online, so I have some questions for you. My muscle strain has not healed yet. When I initially got injured, I felt dizzy all day (...

Dr. Yao Quan reply Internal Medicine
Hello, I apologize for the delayed response to your email. Rhabdomyolysis is a condition caused by damage to skeletal muscle, leading to the destruction and dissolution of muscle cells, which release myoglobin and other harmful substances into the bloodstream, affecting the entir...