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What Is The Cause And Treatment For Hematospermia?

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Posted on Tue, 23 Dec 2014
Question: hello doctor. i wrote you 2 years ago on this site.

i had a recurrence of hematospermia again 5 weeks ago. i had sex three times and ejaculated blood every single time. i urinated after having ejaculated and blood came out with a clot at the end. i then had sex 2 weeks later and no blood appeared. i had sex today and blood appeared again in the semen. i haven´t urinated since the ejaculation yet.

differences that i noticed: i was very erect the times i ejaculated/urinated blood. the time i didn´t was when my penis was not fully erect. i have tried to find a cause, changed my eating habits, gone to shamans, mediums, tried acupuncture, macrobiotics, exercise, etc. no one has found any thing to be wrong with my urinary system apart from a high psa in 2005 (when the problem began). a cystoscopy performed on one of the days that i bled found no blood anywhere. the last physician i saw said its a mechanical problem. i have found no pattern when it comes to alcohol abuse, bad eating, feeling nervous, etc. could it be that this is actually a mechanical problem? ie that a blood vessel pops? i ask because i had hematuria twice after an erection. i did not ejaculate before or after. i just had an erection and went to urinate and blood came out. this perhaps might be the ´´catch´´. i do psa tests and rectal examinations minimum once a year. the prostate is not abnormal in size, i have no std or bacteria (i doubt the bacteria would be around since 2005).

i felt pain and discomfort in the groin and anus 2 weeks prior to ejaculating blood this time. i actually ´´felt´´my body and was waiting for the blood to appear again. usually i feel buzzing sensations and other feelings associated to ´´prostatitis´´during the blood cycle. for the first time i felt these things prior to ejaculating blood. i usually ejaculate a lot quicker when i am in this phase and urinate a lot..at times it feels like i urinate more than i drink. i had a prostate biopsy done on me in 2005. last cystoscopy was 2 years ago. could it be that my immune system is letting me down or that i need something to strengthen my blood vessels?

today is the first time it took me more than 1 hour to urinate for the first time after ejaculating.
hematospermia before today was always followed by dark red urine and a clot at the end.
today the urine came out brown with a minute clot.
i understand why it came out brown but cannot fathom the small size of the clot as compared to when the blood was dark red.
i mention again that he only thing i notice is that blood appears when i am very erect and sexually excited. i do not recall having passed blood in my semen after masturbating.
doctor
Answered by Dr. T Chandrakant (18 hours later)
Brief Answer:
as detailed please.

Detailed Answer:
Hello

Thanks for your query and an elucidate history, to the point and the accurate, specific observations you have noted. I have noted important points out of your questions for my reference so that I should not miss on anything..
Thanks again for your good observation...
...................................................................................................................................
((I only suspect that a full erection causes blood to appear. When I masturbate and my penis is not fully erect during sexual intercourse, I do not pass blood.

I had sex three times and ejaculated blood every single time. I urinated after having ejaculated and blood came out with a clot at the end.

Differences that I noticed: I was very erect the times I ejaculated/urinated blood. The time I didn´t was when my penis was not fully erect.

Could it be that this is actually a mechanical problem? i.e., that a blood vessel pops? I ask because I had hematuria twice after an erection. I did not ejaculate before or after. I just had an erection and went to urinate and blood came out. This perhaps might be the ´´catch´´

I felt pain and discomfort in the groin and anus 2 weeks prior to ejaculating blood this time

Could it be that my immune system is letting me down or that I need something to strengthen my blood vessels?

I understand why it came out brown but cannot fathom the small size of the clot as compared to when the blood was dark red.

I mention again that the only thing I notice is that blood appears when I am very erect and sexually excited. I do not recall having passed blood in my semen after masturbating.))

.........................................................................................................

From reading and re-reading the history you have provided and correlating things to each other, I could think of the following possibilities...

The most probable reason can be prostatic congestion wherein a very small blood vessel at the bladder-neck gets ruptured on full erection causing hematospermia and also blood in the urine with a clot.

I think your catch is absolutely right. The very small blood vessel gets popped up causing hematospermia as well as hematuria twice after an erection.

Your another point that you had pain and discomfort in the groin and anus 2 weeks prior to ejaculating blood > this is very well a symptom of prostatitic congestion, increasing the edema and predisposing for the very small blood vessel to pop, rupture and cause you the symptoms only on full erection. It may be due to increased local blood pressure during full erection in this area to cause a rupture and bleeding, part of it going into the bladder causing hematuria also; when a small blood vessel rupture, particularly the vein, the bleeding is slow enough for the clot also to form- which you could detect. In one particular incidence the clot was small, it can be of varied size every time, so does not matter much.

You question about Immune System:: I do not thing that immune system can cause any problem like this at a particular spot only. It is not letting you down.
Yes you can certainly take some medicines like multivitamins which act as anti-oxidants to strengthen blood vessels.

Dear friend, I have tried my best to cover all the points of your concern, please feel free to ask for more if you feel I have missed on some points.

Thanks for patient reading.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. T Chandrakant (6 hours later)
dear dr t chandrakant,
thank you very much for your insight.
do you suggest i look into a diet, or perhaps chinese medicine?
in acupuncture people relate this problem to eating habits, ´´heat´´in certain areas and ´unclean blood´´.
i know this is a site that deals with western medicine, but nowadays there is no black and white situation and i have not found a cure through it.
regards

ps should i do a testicular doppler if i bleed again, on the same day?
would this perhaps show where the blood comes from?
doctor
Answered by Dr. T Chandrakant (40 minutes later)
Brief Answer:
Per-rectal USG and Color Doppler may help.

Detailed Answer:
Hello again.
Thanks for your appreciation.

I would not suggest any change in diet as you have already tried it as per your history, unless you have noticed about a particular diet has caused this problem. As a general rule you can certainly avoid anything which contain preservatives or such components we do not much know about. On a personal basis I would advise to go for a home-cooked fresh food.

Chinese medicines: I really do not know anything about it.

Acupuncture or acupressure: this is like yoga, a 'great way of life', keeping you yin and XXXXXXX in harmony, thereby keeping the body and the soul in good shape and alleviating many of the dis-orders or dis-eases away. Please contact someone doing this.

Bleeding is certainly ''heat'' in a certain area, here in your case the prostate most probably. Theory of 'unclean blood' is not really palatable to me.

Testicular doppler may not be of much help.
You may please discuss about doppler for prostate and preferably through a trans-rectal route if your Sonologist has the facility. This may give the best clue. Since I can not discuss this with your Sonologist , you will have to. You will be lucky if He / She has this facility. Please also discuss about contrast enhanced MRI study whether it will help to get a proper diagnosis or not. (I really do not know whether this (discussion) is possible in your country, we do in our set-ups and the Radiologist / Urologist would be happy to assist)
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. T Chandrakant (46 hours later)
Dear Doctor,
Thank you for your help.
I have done transrectal ultrasounds and Mri scans.
Every result came out normal.
Today I took a one-hour nap.
I woke up with the urge to urinate. It was not however a strong urge, nor did I have an erection that men tend to have when they wake up in the morning.
I had sex last week and have not been sexually stimulated since that day.
Today's urine contained a lot of blood and a clot.
I really cannot understand what is going on.
The last few days I feel weak and want to sleep a lot.
This is the first time that my bleeding lasts such a long time. Soon it will be seven weeks since this last outbreak. I cannot understand why this last outbreak started with pain before I bled. Before what caused the pain was bleeding. Now its the other.way around. I felt pain in the groin and anus and then the blood appeared in the first ejaculate.
Regards
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
Cysto-urethroscopy.

Detailed Answer:
Hello.
Got the reports of transrectal ultrasound and MRI were normal.

Now the recent episode today:
Nap- not so strong urge to urinate- no erection - not sexually active for 1 week - Urine contained a lot of blood and 'a clot'. feeling weak and want to sleep a lot for the last few days - 7 weeks since the last outbreak- >
This history is suggestive of a bleeding point, most probably at the bladder-neck which oozed the blood in the bladder, mixing with urine, the bleeding being slow to form a clot too.
I would request to seek for cystourethroscopy to find the point and get coagulated / cauterized.
IT is possible that this time too something may not be found, but this is the best chance to find one. You may need a repeat scopy.

You history in the last paragraph : ((I cannot understand why this last outbreak started with pain before I bled. Before what caused the pain was bleeding. Now its the other.way around. >> I felt pain in the groin and anus and then the blood appeared in the first ejaculate.))
Was there a pain this time before you felt the urge? Is it that you had pain in the anus and groin for a few days before today?
Pain and then blood in First ejaculate ? I could not get this , whether you talked about the first incidence 7 weeks back or today ?

I have a feeling you should get the Cysto-urthroscopy done again as other reports are normal.
We too face such situations in a few cases where getting the correct diagnosis may need repeated tests or procedures.
I hope this time the exact cause / place of bleeding be found and be treated properly.

Wishing you all the best for getting the right / correct diagnosis and proper treatment.

Please feel free to discuss more if I have missed on some points or if there is a gap of communication.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. T Chandrakant (2 hours later)
Dear Doctor,
I have been bleeding on and off without any type of pattern for approximatelt 7 weeks. I began to feel pain in the anus and groin about a week before I started to bleed. This pain has continued on and off. The pain increased yesterday morning and I have felt sleepy for the past 3-4 days. I bled again today.
I felt little pain from 2005 till 2013. This pain was felt after the outbreak of blood. Whereas this time I felt pain before the blood outbreak, 8 weeks ago and today.
So do you suggest only a cystoscopy? How about a kidney check? My Psa is normal, so I doubt that my prostate is larger or harder.
Regards
doctor
Answered by Dr. T Chandrakant (10 hours later)
Brief Answer:
This is usually evaluation of the whole Genito-urinary tract.

Detailed Answer:
Sorry for a bit late.

Thanks for your feedback. Got my doubts cleared.
This time you have felt the pain before the outbreak of blood- 8 weeks ago and yesterday / today...
This is an indication that there is congestion in the said area followed by bleeding.

I thought of what you mean by- Kidney check. I think they must have reviewed the kidneys and ureters in Ultrasonography / MRI studies. Please check the reports.

Secondly the pain you feel in the groin and above the anus (( H/O- i felt pain and discomfort in the groin and anus 2 weeks prior to ejaculating blood this time.)). This type of pain usually comes in the problems of the bladder-neck area including the prostate of course.

You are right : you may please request / ask for ureteroscopy if your Urologist has the facility / if he thinks so, along with Cysto-urthroscopy just to rule out any problem in the ureters as direct visualization has an added advantage with any of the other investigations.

I too am getting worried till we can get a proper diagnosis and a correct treatment.

Just a thought:
Is it possible to have regular emptying of the prostate and seminal vesicles at least alternate day by sex and / or masturbation as this will definitely help reduce the congestion; it worthwhile to see the results too.
You may please start or continue on an antibiotic like Oflxacin or Doxycyclin on empirical basis, as these can be taken for a longer duration of time and works well for any occult infection which is not found out on regular tests already been done.
This of course is the prerogative of your Urologist or a Family Physician as you need a prescription.

Per-rectal ultrasound and MRI can definitely find if the prostate is larger or not and a per-rectal digital examination by a Urologist / General Surgeon can get most important information about the - consistence, hardness, irregularity, nodularity, tenderness.
In older times we (Surgeons) used to do prostatic massage for relief of congestion- to get a sample of prostatic fluid for gram staining, culture and sensitivity. This is in times when USG / CT / MRI were not available or not affordable for the masses. I really do not know whether this practice is going on in your / many countries.

Again in continuity of your previous discussion about Chinese medicines : about which I really do not know anything as I said. Do you have facility of Ayurveda in your area ? (May I just know your are / country of residence so that I too can do some research about possible extra help if possible from my side).



Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. T Chandrakant (2 hours later)
Dear Doctor/friend,
I will try everything you suggested. Some doctors advised to obstain from sex in order to heal, but i agree more with what you say. I live in sao paulo, brazil.
Regards
doctor
Answered by Dr. T Chandrakant (5 minutes later)
Brief Answer:
Thanks

Detailed Answer:
Thanks for your feedback.
Thanks for accepting the regular emptying of the prostate so that the congestion will be reduced.

Brazil: great land, I heard. Let me see if I can do something more in your case. Do you have Ayurveda Medicines shop nearby you ?


Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. T Chandrakant (2 hours later)
Hi.thanks for your message.
Brazil is blessed with natural beauty and good people. It is however doomed by violence and social inequality. I pray that these problems be resolved asap.
As for ayurveda medicine: i will have to check online and through friends. I will start yoga in january so someone at the school might know. What should i look for?
regards
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
link as given

Detailed Answer:
Hi.
Indeed, The problems of all countries are omnipresent.

Well, I tried to edit in the last answer, could not. Giving you a link to find the availability in your country or online. BUT DO NOT BUY NOW, let us wait till all other investigations and medicines are over and only if they fail to give you relief or cure.

Please visit - http://www.ayurvikalp.com/product/Alarsin-BANGSHIL100-tablets-for-Genito-Urinary-Tract-Infection-Prostate-Enlargement

There are 2 medicines: Bangshil and Fortage ... I will consult my Ayurvedacharya friends and discuss about it.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. T Chandrakant (3 hours later)
Ok thank you very much.i have tried alphablockers,cipro antibiotic for 6 weeks, every saw palmetto product available, more than 5 herbal remedies, and macrobiotics..nothing worked. I will do the scans again although i doubt any abnormalities will be found. I feel heat and pressure in the groin and anus (and urethra sometimes).this is the pain i refer to, as if i had something inside me that needs to exit the body. This must be what you mean when you say ""congestion". Acupuncture eased the pain as did a visit to a medium that prescribed passiflora. but then the outbreak occured again. I pray that your method helps me because the western approach is not the solution in my case, although i am open to anything and respect all approaches.
doctor
Answered by Dr. T Chandrakant (22 minutes later)
Brief Answer:
Congestion is accumulation of fluid.

Detailed Answer:
I can understand the plight when the problem is not solved in spite of all the medicines you have tried.

Endoscopies can help... Scans may not, as the endoscopy (Cysto-urethroscopy) alows the direct visualization and chance for cauterization of the bleeding point.

Yes, congestion is basically used in Medical terminology as extra accumulation of fluid from the blood in a particular field / area / organ. Your symptoms of feeling heat and pressure in groin and anus, urethra sometimes- the pain you refereed to as if there is something inside that need to exit the body- and bleeding as explained can be due to congestion in the prostate , bladder-neck and area around.

This congestion blocks the veins and lymphatics as they have no pressure in them but the arterial supply continues to pump-in as it has a high pressure. The weakest of the blood vessel- vein / venule ruptures as it is very thin and bleeding occurs. This is repeated every time the congestion appears. This can appear due to minute arterio-venous malformation, small enough to be missed on ultrasound, color doppler or MRI. It can detect only if they are large enough or are congested exactly at the time of investigations.

Yes, ultimate aim is to get a complete relief and cure by whatever means or XXXXXXX

Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.

Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. T Chandrakant

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What Is The Cause And Treatment For Hematospermia?

Brief Answer: as detailed please. Detailed Answer: Hello Thanks for your query and an elucidate history, to the point and the accurate, specific observations you have noted. I have noted important points out of your questions for my reference so that I should not miss on anything.. Thanks again for your good observation... ................................................................................................................................... ((I only suspect that a full erection causes blood to appear. When I masturbate and my penis is not fully erect during sexual intercourse, I do not pass blood. I had sex three times and ejaculated blood every single time. I urinated after having ejaculated and blood came out with a clot at the end. Differences that I noticed: I was very erect the times I ejaculated/urinated blood. The time I didn´t was when my penis was not fully erect. Could it be that this is actually a mechanical problem? i.e., that a blood vessel pops? I ask because I had hematuria twice after an erection. I did not ejaculate before or after. I just had an erection and went to urinate and blood came out. This perhaps might be the ´´catch´´ I felt pain and discomfort in the groin and anus 2 weeks prior to ejaculating blood this time Could it be that my immune system is letting me down or that I need something to strengthen my blood vessels? I understand why it came out brown but cannot fathom the small size of the clot as compared to when the blood was dark red. I mention again that the only thing I notice is that blood appears when I am very erect and sexually excited. I do not recall having passed blood in my semen after masturbating.)) ......................................................................................................... From reading and re-reading the history you have provided and correlating things to each other, I could think of the following possibilities... The most probable reason can be prostatic congestion wherein a very small blood vessel at the bladder-neck gets ruptured on full erection causing hematospermia and also blood in the urine with a clot. I think your catch is absolutely right. The very small blood vessel gets popped up causing hematospermia as well as hematuria twice after an erection. Your another point that you had pain and discomfort in the groin and anus 2 weeks prior to ejaculating blood > this is very well a symptom of prostatitic congestion, increasing the edema and predisposing for the very small blood vessel to pop, rupture and cause you the symptoms only on full erection. It may be due to increased local blood pressure during full erection in this area to cause a rupture and bleeding, part of it going into the bladder causing hematuria also; when a small blood vessel rupture, particularly the vein, the bleeding is slow enough for the clot also to form- which you could detect. In one particular incidence the clot was small, it can be of varied size every time, so does not matter much. You question about Immune System:: I do not thing that immune system can cause any problem like this at a particular spot only. It is not letting you down. Yes you can certainly take some medicines like multivitamins which act as anti-oxidants to strengthen blood vessels. Dear friend, I have tried my best to cover all the points of your concern, please feel free to ask for more if you feel I have missed on some points. Thanks for patient reading.