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Noticed blood after urination. Prostate normal. No pain. Noticed blood after a bowel movement. Bladder cancer?

May 2014
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I am a 23 year old non smoking male. About a year ago I noticed that I had blood at the end of my urine stream. It happened several times. I went to the doctor and they tested my urine. Everything came back normal, and my prostate was also normal. It stopped for about a year, but has recently come back. It has happened quite a few times, but I feel no pain at all and its always at the end of my urine. I also noticed that it tends to happen after a bowel movement, and I have been constipated recently. I am worried about cancer, but is it really possibly for someone my age to get bladder cancer? Whats your advice?

Thank you
Posted Mon, 15 Jul 2013 in General Health
Answered by Dr. Vivek Chail 2 hours later

Thanks for writing in.

Your symptoms are that of terminal hematuria (blood at the end of urine stream). It might be important to know that if bleeding occurs at the start of urination, the cause is in urethra. If bleeding is present throughout urination, cause is in kidneys and if bleeding is at the end of urination, as in you then cause must surely lie in the bladder.

Causes of terminal hematuria are as follows:

1. Injury to your lower abdomen: Some injuries go unnoticed and the only symptom might be that of terminal hematuria.

2. Infections: Infections of the lower urinary tract are responsible for terminal hematuria in many patients. These can be retrograde infections that enter the urethra and then ascend into the bladder.

3. Stones in bladder: Some of the stones are sharp enough cause abrasions in the wall of the urinary bladder which may lead to bleeding at the end of urination.

4. Bladder parasites (Bladder fluke): The eggs invade the bladder wall and invade the lumen of the bladder and may cause terminal hematuria.

5. Enlarged prostate: This is an uncommon cause at your age. You have already undergone tests which confirm a normal prostate.

6. Cancer of bladder is uncommon at your age but not unheard of. There is no need to panic as investigations like cystoscopy exist in which the entire urinary bladder can be visualised from inside and any abnormal area can be biopsied to confirm or rule out and cancerous or inflammatory condition.

Keeping in mind your relation of terminal hematuria with bowel movement, it can be that there is pressure on the bladder which indirectly is leading to little bleeding on some occasions, the main cause being in the urinary bladder wall or lumen.

I suggest you consult an urologist and get your urine examined for any traces of blood (microscopic hematuria) and blood cells. If blood cells are confirmed, a cystoscopy followed by ultrasound scan, CT scan and MRI scan may be done as found necessary. While cystoscopy will give information on the inside, the scans will rule out any abnormalities above the bladder and on the outside of the urinary bladder or elsewhere along the urinary tract.

Hope your question is answered.

If you have no questions, I request you to please close this thread.

Dr Vivek
Above answer was peer-reviewed by
Follow-up: Noticed blood after urination. Prostate normal. No pain. Noticed blood after a bowel movement. Bladder cancer? 7 minutes later
Thank you for your response.

Is it possible that it could be nothing at all and they cannot find what causes it? I am just concerned because I know that it cannot be an infection because my urine was tested 3 times and I have had no pain. If it was bladder cancer would I be feeling any sort of pain since this started happening over a year ago.

Also, why would a bowel movement cause pressure on my bladder? Is there anyway that can be fixed or will that heal on its own?
Answered by Dr. Vivek Chail 13 hours later
Welcome and thanks for writing in once again.

An acute infection may be ruled out but there are few things that need to be surely excluded. The absence of pain makes your condition even more essential to be investigated further.

One trivial cause of terminal hematuria can also be a small tear in one of the thin veins of the prostate gland (prostatic varices). This has a clear association with straining due to bowel movements, during urination or ejaculation. This is due to the contraction of the muscles. If detected, there is treatment of prostatic varices.

There could be some small harmless finger like projection growth within the bladder known as polyp. It could also be a benign growth called papilloma which is present intraluminally.

The possibility of cancer is very rare however cannot be ruled out 100% without further investigation by cystoscopy and ultrasound scan. I re assure you that a cancer is very rare at your age and needs compulsory evaluation. Bladder cancers are curable when detected early.

There is no incident of terminal hematuria reported after taking Adderall.

Hope your questions have been answered.

If you do not have any questions, I request you to please close this thread and post a feedback.

Wishing you good health.

Dr Vivek
Above answer was peer-reviewed by
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