Blood In Your Urine

For guys, blood in your urine can be related to a number of things. The younger and healthier you are, the more likely it is not a serious problem. The older you are, the more likely it is a serious issue. When it comes to going to the ER for new blood in the urine, context matters.

A 45-year-old male came in last night after noticing blood in his urine (and mixed in with his ejaculate) after sex. He and his wife promptly came to the ER because this was obviously very concerning to them. He had no other symptoms. He had previously passed a kidney stone (which, of course, came with the usual amount of pain), but tonight, aside from this concerning finding, he had no symptoms to speak of and hadn’t had any recently. This had never happened before. He was otherwise healthy.

This does not need an ER visit. A one-off event like this is most often not serious. Since he was already in the ER, I checked his urine for signs of infection, but without any prior symptoms, fever, or history of infections, the likelihood of finding an infection was already very low before we even got the sample. And of course, he did not have an infection.

From a patient’s perspective, I can see why this would be alarming. This has never happened before. You’re clearly in a different state of mind after sex when you suddenly see blood coming out of your penis. The thought that immediately goes through your mind is probably something like, “What the hell is that? That has never happened before! What if something exploded? What if I can’t have sex next time? What if my dick is broken??”

But this is where it’s important to take a breath. Despite not knowing what might be causing it, have you ever heard of anyone dying from blood coming out of the penis? Most likely you haven’t had that conversation—your best friend may have had the same problem, but he probably wouldn’t share it unless he’d had quite a few beers. So this issue is probably not on your radar.

Take a breath and realize you’ve never heard of anyone dying from this. Take stock of what else is going on: you have no other symptoms, no pain whatsoever. Before calling 911 or heading to the ER, give it a couple of hours. Go to the bathroom again. If things are getting better or have resolved, call your doctor the next day to make an appointment and talk about it in detail—you’ll probably hear exactly what I’m telling you now.

This is most likely related to some irritation of the urethra, prostate, or seminal vesicles (i.e., the parts of your plumbing that make your swimmers). It is much less likely to be the first sign of prostate cancer, kidney cancer, or bladder cancer. It’s not something to ignore completely, but it does not require the ER.

Here’s something else you wouldn’t know (and the reason I’m writing this post): in the middle of the night, no one is doing anything urgent about this. You may know that urologists are the specialists who handle this sort of thing, but I’m not waking them up at 2 a.m. to tell them about it. They don’t care at that hour. I save my wake-up calls for my specialists for things that really matter—life, limb, eye, or penis-threatening conditions. Some blood in your urine (or ejaculate) in the absence of any other symptoms does not qualify.

So if this happens to you, finish up in the bathroom, clean yourself off, resume your position as the big spoon, and go to bed.