Exercise Induced Gross Hematuria (blood in urine)

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  • #20490

    I’m a 37 y/o male category 1 athlete about 28 weeks into my first season of structured training, following the 24 week mountaineering plan (plus extending the base period by about 8 weeks). Everything has been going really well. I feel as fit as I’ve ever been, put away a 4 day hut trip as the first of my “A goal” trips, and now in the midst of more specific work as my “A goal” volcanoes start coming into season.

    A couple days ago immediately after a normal zone 1/2 workout of about 2 hours, I was peeing in a very disturbing red/cola color. It freaked me out, and I thought perhaps I was running into rhabdo (which I felt would have been crazy due to the low intensity of the workout). I went straight to urgent care. After a blood and urine test, they identified blood in the urine but no other underlying issues and sent me home. I have a follow up with a urologist to exclude some possible but unlikely causes. It seems most likely that I had an episode of exercise induced hematuria.

    While the PA and Urologist had no immediate concerns (including my asks about exercise and the occasional beer), I was wondering from the endurance athlete perspective, how worried do I need to be? Is this a symptom of overtraining? It seems like peeing blood is a red flag of my body saying “yo this is too much”. At the same time I feel great and feel like I’m ready for my A goals for the season. There is sparse information on the web about it, but it does seem like it’s something that happens with vigorous exercise or endurance athletes.

    Do I scale it back a bit? a lot? or is this really just something that kind of happens occasionally to some folks?

Posted In: Injury & Rehab

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    Anonymous on #20505

    Thanks for writing in with this question. I’m not in a position to give any medical advice. I have never had any experience with hematauria, either personally or with anyone I have coached. I’ve never heard of it as a symptom of overtraining either. If the docs didn’t find anything medically amiss I guess I try a gradual return to training over the course of a few days and see if it reoccurs. I’m sorry I do not have any better suggestion for you. Maybe someone else here will have had experience with this.


    Pete Dickinson MS,PT on #20533

    I have heard of this with impact related activities such as running. Its for sure a cautionary symptom which you should monitor going forward. Good job getting it checked out. With the lack of definitive diagnosis, I would return to training with continued observation of your response.

    todd.struble on #21354

    To close the loop on this, I had my follow up after taking a CT scan of my urinary tract. Everything appears normal. Doc cleared me for exercise, confirming that “runner’s hematuria” is something that happens to endurance athletes, particularly runners, during or immediately following exercise. Doc suggested that if you took a urine sample from everyone who crossed the finish line at a marathon, it’s likely the majority would show micro hematuria (non-visible red blood cells in the urine).

    No long term concerns, and doc actually encouraged me to a full return to vigorous exercise, saying that if it’s something besides runner’s hematuria (and presumably more serious), coaxing a repeat of symptoms would be helpful in catching it.

    For what it’s worth (probably not much), upon further internet sleuthing, there’s a hypothesis that it’s caused by voiding and then running before your bladder has had a chance to refill and thus the walls bump and cause a tear. I’m not sure that comports with my experience or all the other numerous times I have paused to pee on a tree before immediately resuming running. But I have started drinking a bit of water and waiting a few minutes before taking off now.

    From my perspective, in case someone else is reading this and panicking about it: From speaking with the urologist, definitely get it checked out, but if you don’t have any other symptoms or risk factors, you can probably keep training as normal while waiting for results.
    I scaled way back and just did Z1 <1hr for a few days before feeling more confident that the symptom wasn’t recurring, but now I don’t think it was necessary.

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