To put it simply, blood is a necessary substance in the human body. It carries oxygen to tissue and fights infection, for example. But it has a usual location in the body: veins and arteries. Seeing blood in urine, semen or feces can be worrying.
Keep in mind, though, it's not always a sign of a serious health complication. In fact, hematuria, the presence of blood in urine, is common enough that 1 in 10 people experience it at some point.
Diana Londoño, M.D., a urologist in Glendora, California, and the founder of Physician Coach Support, said blood in urine or semen is the primary reason people schedule visits with her. Londoño assures her patients that most cases are benign, depending on the amount of blood, their age and risk factors. Treatment, however, can still help.
Blood in semen
Hematospermia, or blood in semen, is an issue that typically affects men ages 30 to 40. It's not usually an indication of cancer, but Londoño said men of appropriate age or with risk factors should still be screened for prostate cancer with a rectal exam and a prostate-specific antigen (PSA) test. At the very least, prostate cancer can be ruled out, providing some assurance to patients.
The good news is that hematospermia is rarely a sign of something urgent and resolves on its own most of the time. The most common causes include:
- Urinary tract infections (UTIs)
- Foreign objects introduced into the urinary tract
- Excessive bike riding
- A history of scar tissue in the urethra
- Kidney stones
- Vascular malformations
- A history of surgeries
"The caveat is that from the time you see the blood the first time, it may take up to two months to clear up," Londoño explained. "The color may also change. It can be red, rusty, brownish or any variation in between. Just remember, two months on and off may be part of it."
The primary treatments for hematospermia include antibiotics to clear up the infection and anti-inflammatory medications to treat the underlying cause. In many cases, though, the cause is not obvious and the issue clears up by itself. But if you notice an increase in the volume of blood or a lack of improvement, make an appointment with your urologist immediately.
Blood in urine
Blood in a person's urine is not usually tied to blood in semen, but the two conditions share some similar causes. Blood in the urine may be visible or classified as microscopic hematuria, meaning it can't be seen with the naked eye.
"It is important to note that a simple in-office check with what they call a 'dipstick' is not sufficient to diagnose microscopic hematuria," Londoño said. "It must be checked under the microscope to detect the threshold of greater than three red blood cells under the microscope; anything less than that, no further testing, workup, referral or worry is needed. There is no consequence to it. If more than three blood cells are seen or you see blood in your urine in the absence of a urine culture-proven infection, then a referral to a urologist is needed."
The main causes of blood in urine include the following:
- Infection of the urinary tract (including tuberculosis)
- A blockage in the kidney, ureter, bladder or urethra
- Kidney stones
- Trauma or injury to the urinary tract
- A clot that forms in the main blood vessel to the kidney
- A disorder of the blood, such as sickle cell or bleeding tendencies
- Tumors or cancer of the kidney ureter, bladder, prostate or urethra
- Medications or foods, such as beetroot or red food coloring, that alter the color of urine
While blood in the urine isn't always a pressing issue, it should be investigated as soon as possible. If microscopic blood is found, the chance of cancer being the cause is 4 percent, Londoño explained, saying this increases to 23 percent if the blood is visible. Up to 43 percent of the time, no obvious cause is found, but it's still important to investigate it.
When blood is present, some tests that should be carried out include a complete urinalysis with microscopy, a urine culture, a blood test, a CT urogram and an in-office cystoscopy.
Blood in feces
Bloody stool usually means there is bleeding somewhere in the digestive system, said Harvey Hamilton Allen Jr., M.D., a board-certified gastroenterologist and the medical director at Mohawk Valley Endoscopy Center in Utica, New York.
"One simple way to understand gastrointestinal bleeding is to divide it into two entities: visible and& nonvisible," he said. "Visible is rectal bleeding, bright red blood per rectum [BRBPR]. One of the most common causes is hemorrhoids. Hemorrhoids are inflamed veins in the anus and rectum and can be internal or external."
The main causes of hemorrhoids in men include straining during bowel movements, obesity, prolonged sitting, constipation and a low-fiber diet. You may experience other symptoms such as itching, feeling like you have an incomplete bowel movement, mucus after wiping or pain around your anus. Hemorrhoids are often treated with a cream to ease the pain, along with dietary changes such as increasing fiber and water intake.
Nonvisible bleeding, on the other hand, can have many different causes, Allen Jr. explained. A patient who presents with iron-deficiency anemia should undergo a complete evaluation to rule out cancer. The diagnosis is made with an upper and lower endoscopic procedure, the most common causes being peptic ulcers and diverticula (pockets in the intestinal lining). Peptic ulcers can be treated with acid suppression, while diverticula are usually treated with dietary changes, medicine or surgery.
Even if you see blood in urine, semen or feces only once, contact your primary doctor to rule out potentially dangerous conditions. While it's not often serious, it can be, and treating it early often provides the best outcome.