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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20139
Experience:  I am fellowship trained specializing in general urology and reconstructive urology.
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Two months ago I noticed blood when wiping but could not

Customer Question

Two months ago I noticed blood when wiping but could not immediately determine the source. I thought it was haemorrhoids as I do suffer from these. A few weeks later I noticed a white long piece of tissue with a red blot of blood on the end. I called my doctor waited one month for appointment. (I am in Canada). Urinalysis done and no infection. This past weekend when I urinated I noticed black spots in my urine that also lined the toilet bowl. Looking back I remember that I had darker urine on two occasions that had a strong odour. I of course thought it was just dehydration and was not initially concerned. Pain in my bladder and a sense of great urgency and the feeling of not being able to fully relieve my bladder brought me to the ER on the weekend. Urinalysis had traces of blood, urine leukocyte was CA 15 and blood work showed my urea at 7.3. Creatine level was normal. I have an appointment with urologist next month. I feel malaise, my blood pressure is higher than normal (usually 110/70) and now its 130/93 and I am also dizzy at times. My question is could these symptoms be as innocuous as a stone? Does IC of the bladder ever cause bleeding. I do have dull back pain as well. Most of my discomfort in in my bladder. And pelvic area. A LOT of pressure but no pain on urination. Please help. I am exhausted and scared. Had a transvaginal and pelvic ultra sound on the weekend and all was normal. Only remark was that there is moderate post void residual of 45 cc.
Submitted: 2 months ago.
Category: Urology
Customer: replied 2 months ago.
I do not typically drink a lot of water and am on a high protein diet. I drink a lot of caffeinated tea but no alcohol. Non smoker all my life.
Expert:  Dr. Arun Phophalia replied 2 months ago.

Hello! My name is***** to JustAnswer. I'm reviewing your question now, and will post back with the reply momentarily.

Expert:  Dr. Arun Phophalia replied 2 months ago.

I am writing you the answer. It may take 4-5 minutes.

Expert:  Dr. Arun Phophalia replied 2 months ago.

Your symptoms are highly suggestive of two causes;

1) A stone disease

2) Urinary tract infection.

I am not sure if your urine culture was done anytime and you were prescribed an antibiotic. If not, these should be done till you consult the urologist.

Interstitial cystitis is other diagnostic possibility but a bleeding is not common symptoms for it.

Following approach for the chronic / recurrent urinary tract infection may be helpful;

1) An estimation of residual urine. In a high residual urine following investigations would be done;

a) CMG (cystometrography); this tells about the bladder muscle and sphincter functions. A problem in these would not let the bladder empty properly and thus the recurrent UTI.

b) Pelvic floor EMG; tells about the pelvic muscle dysfunctions and help in above.

These will need medications to improve bladder emptying.

2) Medications which alter urinary pH helps in eradicating the recurrent or chronic UTI with the antibiotics.

3) Culture for the mycobacterium; this if grown will need different kind of medication regime specifically for the mycobacterium bacteria which do not respond to the antibiotics.

4) Gynecological examination; to see for the major cystocele (bladder prolapse). This also predisposes for the recurrent UTI.

5) If above do no help the other investigation contemplated are;

a) Cystoscopy; camera exam to look for bladder diverticulum or any other abnormality.

b) MR urography (magnetic resonance urography to look for infective nidus elsewhere in the urinary tract).

Please feel free for your follow up questions.I would be happy to assist you further, if you need any more information.Thanks for using Just Answer.