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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3682
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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:I am a male, 73 years old. I do not smoke.About

Customer Question

Hi:
I am a male, 73 years old. I do not smoke.
About 18 months ago, I had bleeding with my urine and underwent all the ghastly comprehensive tests in hospital that showed that my bladder, kidneys, and rest of the urinary tract were fine but that the bleeding had merely been caused by a ruptured blood vessel on my enlarged prostate gland. I had a PSA reading of 4,2 and my prostate gland reading was "90". The specialist cauterized the blood vessel (which by then had stopped bleeding some weeks ago) and I was put on Avodart and Tamsul combination.
Incidentally, blood tests at at doctors room had shown no blood in the urine which I would presume meant that the blood was only present when the ruptured vessel emitted some blood and not at the doctors room.
I have since then used Avodart and, sporadically, Tamsul also as I understood that because my urine flow was not slow, Tamsul was not essential and played no role in shrinking the prostate. So I have now used Avodart for about 18 monhts. I have not been for a PSA reading since and have had no problems in that region.
Now on Saturday evening, before urinating there was just a single drop of blood before the clear flow started. This happened twice and then, prior to my third urination, a tablespoon of blood flowed before the clear urine flow. The symptoms were identical to the time the blood vessel had ruptured.
Then for 48 hours,drinking lots of water, the urine flow was clear. However, unexpectedly last night during one of many urinations, a teaspoon of blood preceeded the clear, no-blood flow. Since that one urination, again clear clean urine.
I found the hospital tests very traumatic and the insertion of the camera into my penis was particularly painful afterwards. I am not sure if the most modern equipment was used for the tests and the urologist was an absolute abrasive 'pig' - no other word to describe him.
My questions to you:
1. I suspect and hope that the new bleeding is again the result of a ruptured prostate vessel, perhaps smaller this time as the bleeding is far less than the last time. Could the rupture have been caused by excessive masturbation and if I am prone to a bleeding prostate should I rather abstain from masturbation?
2. How long does such a ruptured vessel normally take to heal on its own? The urologist last time cauterised it but by then the bleeding had stopped some weeks ago in any event.
3. In view of the 'clear' tests 18 months ago, can I relatively safely monitor the situation for a few weeks and avoid the horrific tests and allow the vessel to heal on its own?
4. Can I do exercise eg play singles tennis and run while there is a ruptured vessel?
5. Is it essential to use the entire combo of avodart and tamsul?
6. Could the avodart have shrunk the prostate too much, causing new problems? I know I should have had my PSA checked by now. About six weeks after starting on avodart/tamsul the PSA reading was 79 so some shrinking had already taken place.
7. Would drinking lots of water help in a case like this?
8. I am on Norvasc and Ziak for blood pressure, and Dynator for cholesterol. Are any of these anti-coagulents?
9. Is there a drug that can be prescribed to make the prostate less inclined to bleed (5 alpha reductase?). Or will the prostate be less inclined to bleed as the avodart makes it smaller?
10. I had stopped taking blood pressure pills for a few weeks prior to the latest bleeding as the readings seemed OK on my home monitor. Could undetected high blood pressure in between readings cause the prostate vessel to rupture?
I would appreciate your comments.
Thank you so much
Jan
Submitted: 2 years ago.
Category: Urology
Expert:  Dr. Tharun replied 2 years ago.
Hi

Yes, the bleeding could be from rough or excessive masturbation which could injure the inner lining of urethra which can present with bleeding like this.You should abstain from masturbation till the bleeding settles and for another week or so. After this period you can resume but not excessively.
Usually it takes 48 - 72 hours to heal, but trauma and excess movements can induce bleeding again for a week or so.

You can avoid all the tests now as studies have shown that after a complete work up for blood in urine it remains negative for at least 6 years. Of course you can do non invasive tests like urine cytology and ultrasound scan of the kidneys and bladder.

Avoid strenuous activities while there is an active bleed.

There is no need for tamsulosin if the urine flow and good and you have no symptoms.

Reduction in size of the prostate will not cause any problems.

Hydration always helps.

None of the drugs are anti-coagulants.

Avodart is 5 Alfa reductase inhibitor and it has shown to decrease the incidences of prostatic bleed.

Undetected high blood pressure can cause bleed from the prostate theoretically but is almost unheard off.

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3682
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
Dr. Tharun and other Urology Specialists are ready to help you
Customer: replied 2 years ago.

Thank you Doctor. Your answer is, I suppose, reassuring in that all those ghastly tests probably wont be needed.

May I just ask a few more questions:

1. Tamsul seems to make my ankles swell. Have you ever encountered this? So if my urine flow is good, perhaps I should just take avodart?

2. Do people at my age take avodart for the rest of their lives and just gets on with it, or should I regularly have my PSA checked to see if I still need the drug?

3. What do you mean by the following: 'a complete work up for blood in urine it remains negative for at least 6 years'. ??

4. I do what my wife regards ***** ***** exercise for a man of 73, playing singles tennis with pros for about four to five hours a week. My doctor has given me the go ahead and says I am unusually fit. But can this not make my urine bloody - or will it then be bloody all the time and not just every second day or so, as now?

Thank you so much, Doctor!

Expert:  Dr. Tharun replied 2 years ago.
HI

Ankle swelling is almost unheard of with tamsulosin.

The drug is taken to decrease the complications of the enlarged prostate - total block in urine , bleeding etc and not for decreasing the PSA. Drug is usually taken for year and then it can be stopped. But there is no harm in taking it also.

Studies have shown that once you have a done a complete work up for blood in urine, the chances of a repeat work up showing something positive is almost negligible for next 6 years.

There is no harm in playing sports when there is no bleeding. But during these episodes it is better to avoid it.

Dr.Tharun
Customer: replied 2 years ago.

Thank you....just after sending my reply to you, there was again a small amount of blood at the start of my stream, including a tiny clot. It was just momentarily and then the urine was clear. If the injury is in the urethra would it also produce clots, like my prostate bleeding did last time?

Also the bleeding seems to come at the end of the day, after sitting with my feet up - anything significant in that?. And after passing the urine, there is a slight burning sensation in my penis (nothing painful) - would that reinforce your theory about the urethral damage?

I have now urinated small amounts of blood in just one or at the most two urinations for four days...is that to be expected, and part of the healing process? Can it last up to a week? I have just been sitting still today, typing, and yet there was now again small amount of blood in my urine.

Should I use anti-biotics?

And, finally, if the bleeding is from a ruptured blood vessel in either urethra or prostate, does it heal itself in time?

I thank you for your patience and expertise.

Expert:  Dr. Tharun replied 2 years ago.
HI''

Bleeding which starts at the beginning of the urination and then clears out suggests bleeding either in the prostate or the urethra. Clot can occur if the blood stays long enough in the urethra.
Burning sensation can be seen in infection of the bladder, prostate or the urethra. It is a very common symptom.

It will take some timefor the bleed to completely stop. It is the normal process.

Do an urine test and if there are pus cells then use antibiotics.

It should heal with time.

Dr.Tharun
Customer: replied 2 years ago.

Hi Doctor:

The bleeding seems to have stopped (hopefully) - 1,5 days with only clear urine, thank heavens.

May I just ask if, even without excessive masturbation for example, some men still have prostate bleeding occasionally? Are some men more prone to it that others? I have now had it three times after turning 70, about every two years. Is there anything I should take to make it less prone to bleeding or is the avodart the only remedy?

And how long should I continue with avodart? I have now been using it for 18 months.

Thanks so much

Expert:  Dr. Tharun replied 2 years ago.
HI

Bigger the prostate gland more prone is it to bleed.
At present avodart seems like the only option.

There is no fixed period or protocol for avodart. It is usually doctor preference.

Dr.Tharun
Customer: replied 2 years ago.

Hi Doctor:

I am VERY happy with your service but still don't want to part ways completely for now, if you will bear with me!

There has now been no bleeding for four days. May I resume my fairly strenuous tennis on Monday or would you advise a break for say another week? I play for an hour with a pro coach three times a week. At the age of 73, could such work-outs make the prostate bleed again....or could the hard tennis even have started the bleeding in the first place? I have heard that athletes get blood in the urine sometimes...?

After 18 months of avodart, should the prostate not have shrunk enough not to be prone to bleeding....or is avodart shrinkage a slow process....can it take years? The reading came down from 90 to 79 in just two months, surely by now the prostate weight must be substantially less, or does it not work that way?

I also do not understand why I still have a strong urine flow, never get up at night to urinate etc....yet still seems prone to bleeding...?

I have decided to stop using Tamsul seeing you say it is there just to help with faster urination.

Thanks so much!

Expert:  Dr. Tharun replied 2 years ago.
HI

You can resume your sports activities , but take it slow and don't rush.

Athletes do get blood in urine - not before the urination.

Avodart is supposed to get its maximum effect by 9-10 months, after that its just maintenance of the achieved affect.

Prostate can be big without causing urinary symptoms. It depends up on how much of the gland has grown into the urinary passage. Sometimes prostate can grow without compromising the urinary passage.

Dr.Tharun

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