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Going to see the uro - a bit o' blood... Radiation keeps on giving...

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Posted 11/4/2014 12:04 AM (GMT 0)
So, this never happened before. Yesterday, my urine looked orange which I thought was due to not enough fluids. Later, after urinating sitting down, there was a distinct bright red track on the porcelain, so definitely blood in the urine. Nothing later in the evening, or this morning, but at 5pm today another rather colorful event.

It has me rattled a bit, but I've read that this can happen from little capillaries in the bladder being "brittle" after radiation therapy. Radiation, the gift that keeps on giving. It's 14 months since my RT finished. I didn't have surgery, so it's not from that.

So, we'll see what the uro wants to do. Have any of you RT folks had this happen? Perusing old threads, it seems this can happen anywhere from a year to 3 or more years out from RT. Woo hoo.

Jerry
Posted 11/4/2014 12:27 AM (GMT 0)
It's not happened to me, but it is one of the risks. Best to get it checked out.

Andrew
Posted 11/4/2014 12:40 AM (GMT 0)
Jerry, I haven't had noticable blood in my urine, but I have been told, following urine tests, that there is a small amount of blood there, however I suspect that is a result of a damaged urethra rather than anything in the bladder.

In fact after a recent cystoscopy, I was told that the damage to the urethra could be necrosis following EBRT.

Also had some blood on toilet paper, and not sure if that is from external or internal radiation burns or possibly from a small haemorrhoid. Had moderately bad external burns just after RT finished.

Like you say, RT just keeps on giving. Hopefully your little bleed will clear up soon.

Chas
Posted 11/4/2014 1:23 AM (GMT 0)
Jerry, best wishes to you and Connie.

I have not had any urinary distress, but was on pins and needles as I crossed the 2 and 3 year mark since I had so much radiation with brachytherapy and IMRT. I trust that it is something else as it seems acute rather than chronic. Hopefully it is something simple and minor that will clear quickly.

Jack
Posted 11/4/2014 2:01 AM (GMT 0)
Jerry,
Sorry to hear about this development. Hopefully it is something that will pass without any intervention needed.
I had a significant amount of blood in my urine (totally red) as a symptom that resulted in my diagnosis. Same thing after cystoscopies.
I had IMRT and finished in August and have wondered sometimes if my urine has had a reddish tinge to it but I usually load up on water and that seems to "clear" things up. Sounds like your issue could be different than this... Again, hope it's nothing!
Good luck with Uro
Posted 11/4/2014 2:46 PM (GMT 0)
Jerry..

My RO told me up front that RT can cause lots of extra capillaries to grow in bladder and rectum. They may show bleeding at some point. He also said that if it happens to come back to him, as he knows how to remedy the situation. He said not to just have them cauterized by someone else. You might check with your RO.
Hope this help and your situation is temporary.

Carl
Posted 11/4/2014 4:10 PM (GMT 0)
Redwing57 -

We had a thread of similar topic back in January of this year, and I posted the following there to describe my own blood-in-urine experience. (Yes, indeed, RT truly is the gift that keeps on giving):

I'm a radiation guy (9 weeks of IMRT, spring-summer of 2012) and blood in urine is something that I have experienced post treatment a number of times.

However, in my case there was always a pattern (which I will ask if your husband has in a minute), and when I asked my uro about it, he explained what was going on in my case.

The pattern was that the blood (bright red, not dark, that makes a difference according to my uro, more on that in a minute) would show up in my urine at the first urination I would have following any kind of heavy lifting, vigorous exercise, bike riding, etc., that stressed the muscles in my lower abdomen.

Here's what my uro said: the radiation treatments had repeatedly burned capillary veins in my bladder wall, causing them to become brittle following so many exposures to the radiation.

Therefore, any body movement of mine following radiation that put a lot of pressure on my lower abdomen would break those now brittle capillaries, causing them to spill blood into the urine then in my bladder, which I would of course then see at the next urination. The brittle capillaries would eventually repair themselves (although it would take time because they were now brittle) and the problem would clear itself up, but maybe reappear the next time I did any exercise, etc. that would cause movement of those muscles, breaking the brittle capillaries, and repeating the cycle.

My uro referred to the problem as one of "capillary fragility as a result of radiation exposure."

So, does your husband notice the blood in the urine soon after he has exercised, done heavy work, etc., that may have stressed his lower abdominal muscles? If so, he may have the problem I have which I have just described.

One other note: my uro said if the blood is bright red, it's likely directly coming from the bladder area. But if it's darker in color, that's a sign that it's probably coming from higher up in the body (which may or may not be more serious).

So the question to ask is, do you notice this kind of pattern to the blood-in-urine, that it seems to appear following exercise or muscle stress to the abdominal area? If so, then maybe what I have described is the cause.

My uro also said there's really nothing that can be done about the "capillary fragility" problem except to reduce stress on the abdominal muscles. He added that as long as the pattern of abdominal-muscle-stress-blood-in-urine continues, that's probably what's going on.

So now whenever I see blood the first thing I do is to think if I have stretched or stressed those muscles in any way.

Ah, yes, RT, the gift that keeps on giving. <ugh>

Hope this helps.
Posted 11/4/2014 4:39 PM (GMT 0)
Jerry,

Most of the time a bit of blood in the urine is not a big deal for men who have had radiation. Occasionally it can cause trouble (as per 142's recent posts) so do see your doctor. But aside from that my best advice is that it will probably stain so don't pee on anything you want to keep.
Posted 11/4/2014 5:11 PM (GMT 0)
Thanks guys, I appreciate the thoughts (and always the levity, brother Peter!).

81GyGuy - I found your earlier post about physical activity kicking this off which makes a lot of sense. Actually, Sunday I went out for a ride on my Gold Wing bike, which I keep on a sort-of rollaround center stand dealy. Getting it onto that, and then pushing it in my garage takes about all the strength I have, so definitely a strenuous event and the discoloration I'm pretty sure was noticed after that. It seems quite possible.

I talked to the urologist's office today, and they're having me come in pretty soon (after conversation deciding non-emergency, so in a few days). They said they'll do a 'scope then too so they can verify where the blood's coming from (um, gee, yay).

Their questions were pretty much in line with what you said, Peter, to identify if it was serious or not. Like, if it looks like ketchup, has clots, or if I'm dizzy or light-headed, it's an emergency situation. But occasional discoloration and streaking like I'm seeing is tolerable, yet does need to be checked out.

I have a little more empathy for what our friend 142 has been coping with. Yikes.

Jerry
Posted 11/6/2014 1:46 AM (GMT 0)
Might possibly be radiation cystitis, which the cystoscopy will find out. It happens sometimes 3 to 4 yrs out of radiation. It may look like bloody blisters in the bladder. Start slamming the water. If it's an intermittent thing, then don't worry too much about it. If it becomes persistent, then treatment is recommended by several sessions in a hyperbaric chamber. I had the same thing happen last year and I still get some bloody urine every month or so.

Bob
Posted 11/6/2014 4:21 PM (GMT 0)
This has been an ongoing issue for me as a victim,, er, I mean patient, of SRT back in 2007. I had blood in bowel movements post SRT which was checked by docs and colonoscopy and attributed to radiation proctitis. Treated with suppositories for awhile and eventually diminished but I still have an occasional episode to this day.

Blood in urine was more a result of two procedures to relieve urethral strictures which were aggravated by RT. The second involved scraping necrotic tissue from the bladder as well. This was followed by months of painful bladder spasms and passing copious amounts of blood and clots. This too eventually diminished but still reappears on occasion, usually a drop or two of bright red blood as I finish urinating, especially if I strain a bit. I can't always point to a trigger, but there does seem to be a correlation with vigorous exercise or sex or a long day on my motorcycle or farm equipment. I'm in the process of having it checked out again since there seems to be a recent uptick in frequency of blood in urine episodes and SRT was a long time ago, but rectal or bladder cancers can be among the gifts it keeps on giving.

Sorry that this is more bitter rant than useful advice, but SRT was all side effects and no treatment value for me and I need to vent occasionally. It does seem that your symptoms are similar to the collateral damage many of us have experienced.
Posted 11/14/2014 11:38 PM (GMT 0)
Update - Well, I saw the urologist this afternoon. As expected, he said it's very likely due to the radiation therapy, but there are a couple other things to rule out. Such as kidney issues, kidney stones, even though I don't feel anything like that. Also, lower probability things like some other cancer forming in the bladder (yikes), or prostate cancer activity in the urethral tract somewhere (double yikes), but with an undetectable PSA that's really, really unlikely.

So, in a couple of weeks I'll have a CAT scan to look at kidney things (and I suppose anything else that could be suspicious in the general pelvic area). And a couple weeks after that I'll see him again for a cystoscopy to look for anything going on in the urethra or bladder.

If anything really exciting develops in the meantime, like a fully red stream ("ketchup"), or clots, or pain, then that's an ER trip and immediate analysis.

Probably all will add up to nothing, at least that's my expectation. So, with a plan, we relax about it until there is new information! Carry on, y'all!

Jerry
Posted 11/14/2014 11:43 PM (GMT 0)
Hopefully it will be nothing but good you're getting it checked out.

Hope it's not kidney stones. A friend of mine just went through that. Non-fun.

Andrew
Posted 2/28/2016 1:28 PM (GMT 0)
Well, this old thread was just referenced in another one, so I'll make an update to it. Left it here back then with lots of open questions.

This bleeding has never repeated, not since the first two times it happened back in Nov 2014. So, it seems to have been a one-off issue for whatever reason. I had been shoving my Gold Wing touring bike around the garage, so pretty heavy exertion the first day. The second one, a week later, was completely unprovoked, thus no idea if related or not.

Following the last entries in this thread, I did have a cystoscopy (not much fun, but not terrible). Everything was normal.

Also, had an abdominal CT scan for a urological study. Very cool, 3D image of the whole urinary tract from kidneys to bladder. There was no evident cause for urinary bleeding, no anomalies seen in the urinary tract itself. There was however a rather large renal cyst on my right kidney. (Oh and I totally freaked myself out by looking at the images on the CD they gave me. Next time, wait for the report! It looked quite scary, but really isn't). The cyst was not complex enough to clearly be cancerous, but it's suspicious (Bosniak Score IIf). They said something like 50% of the population over age 50 has renal cysts, so nothing to be overly worried about (well, ok). So five years of follow up monitoring is in order.

Six months later they did another CT scan, showing no changes at all. So, dial down the worry-meter some more. Switch to annual monitoring, and do it by ultrasound rather than CT. So, next July I'll have a renal ultrasound to see if the various walls and calcifications in the renal cyst have changed noticeably. That's the only diagnostic criterion they have. If it changes enough, then they'll likely remove the kidney. Hey, we have two anyway, right?

They said these renal cysts are almost always found while looking for something else.

So, for anyone doing thread searches on the forum, a urinary bleed may or may not mean anything, and may or may not ever recur.
Posted 2/28/2016 1:48 PM (GMT 0)
Good luck
Posted 2/28/2016 6:32 PM (GMT 0)
I had blood about two years out along with burning and frequency issues. cleared up in a couple of months and recently I experienced similar symptoms but to a lesser degree. not a big deal i'm told.

the blood was dried and clotted.

ed
Posted 2/28/2016 9:16 PM (GMT 0)
Redwing,

I'm glad you updated this thread. What you experienced is called a "late term" side effect (as opposed to an acute side effect that occurs in the first 3 months). Late term SEs usually occur with 1-2 years of radiation, and as with you (and me) they are almost always transient, rather than chronic. It is very rare for SEs that aren't chronic to recur after 2 years. I think that's important for patients to understand so they do not continue to worry.

- Allen
Posted 3/1/2016 2:44 AM (GMT 0)
I had the same issue last summer. Some where between 18 months to 2 year post SRT . Not only did I have blood but I also had extreme urgency to pee along with a burning sensation. The Uro gave me 2 different pills to help with the urgency. I can't remember the name but 1 I took daily and the other a couple times a day. The one a day works best. After about a month or 2, the issue just went away.
The other pill turned my urine a dark orange. One night after one of my fishing trips to my favorite lake, and peeing every time I stood up ( always in the same place), that area looked like a crime scene. Since it's a pay lake , I would have loved to see the faces of the people the next day who was fishing in my spot!!!
Radiation.... the gift that keeps on giving!!!!
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