Sunday, June 7, 2009

Running: Physiologically Speaking
Why Am I Peeing Blood After My Long Run?

Oops, it happened again, today, to a running friend after she ran 12 miles. Something weird. Something unexpected. And yeah, it freaked the living daylights out of her.

The first time it happened to a friend, I was there, with F.L., when she came out of the bathroom right after the Boston Marathon. She was somewhat freaked as well.

In both circumstances, I happened to be at the right place at the right time and luckily, I miraculously did not fall asleep when they covered this topic in medical school. Go me! On the other hand, I wonder how much running-related medical information I must have missed out on because I used to sleep through all the lectures. Damn, if only I knew I’d be a runner way back when…

Lam, stay on topic, so what is thing that happened to F.L. and your running friend? They both started peeing blood right after their runs. I thought it was obvious from the post title.

Maybe that’s obvious. But why? They both had E.I.H.

What’s E.I.H.? Is that the name of a new designer steroid for performance enhancement? No, no, no. E.I.H. stands for exercise induced hematuria. It is the appearance of blood in the urine (gross or microscopic) occurring after a period of intense exercise in people who have no other evidence of kidney or urinary tract disease. It goes away with rest.

Are there any associated symptoms? No. The key feature of E.I.H. that separates it from everything else is that it occurs in the absence of any disease. As such it is completely asymptomatic, well aside from the residual muscle soreness as a result of the intense exercise of course.

How long does it usually last? It usually resolves within 24-48 hours.

What if it doesn’t? If the hematuria persists beyond 72 hours or you’re having other symptoms, such as pain or fever, then you’re not dealing with E.I.H. and should get checked out by a doctor. It could be a urinary tract infection that requires antibiotics or rhabdomyolysis that may lead to kidney failure or something else.

Why causes E.I.H.? No one really knows. One theory is that constant jarring of the bladder wall during exercise causes bleeding and leakage of blood into the urine. Another more physiologic theory is that when there is intense vasoconstriction of blood vessels into the kidney during prolonged exercise, some of the cells responsible for filtered the blood inside the kidney can die from ischemia and get filtered into the urine. Usually, this slight alteration in kidney function is reversible and not of any clinical consequence, but in cases where the kidneys are already artificially clamped down (as is the case after ibuprofen ingestion…hint, hint...) the effect can be multiplied and result in some degree of kidney ischemia and kidney failure.

How common is E.I.H.? Statistics vary, but according to some studies, about 20-30% of runners were found to have some degree of hematuria after a marathon. Most cases are microscopic though, which means they are not visible to the naked eye.

Is it preventable? Because no one knows what brings it on, no one knows how it can be prevented. There is general consensus though that dehydration plays a key role, so make sure you drink plenty of fluids before, during, and after your runs if you don’t want to see red in your pee.

Where can I go to learn more about this? You can read about it here and here. Someone also wrote a blog post about it here.

Hope you all learned something today. From now on, no more freaking out if you see a little blood in your pee after a long run, you hear? Good. Class dismissed.


ECrunnergirl said...

That was great information Lam.....question....would that also be the case with someone who had blood in their stool as well? My running buddy got that last summer. It was a one time only deal but it freaked her out big time!

Marci said...

Hi Dr. Lam, Great information, thanks for sharing! I also have the same question as the poster above. I have experienced small amounts of blood in stool after a marathon on two occasions. Should I be concerned?

carpeviam said...

That was so much better than googling EIH! Well presented, Doc. And, thanks for taking out most of the medical jargon and putting it into layman's terms. ;) It's never happened to me (that I know of), but it's bound to happen to someone I know, at some point.

nwgdc said...

Can you cover running with Hemorrhoids next, Doc?
Not for me...for a friend :)

Jamie said...

Thanks doc for the well presented info! Now if all my science course had been presented like that I too may have listened more :)

The Happy Runner said...

Thanks a lot for the info.

J said...

We are girls, we freak out when stuff like that happens!!

Thanks for explaining this.

X-Country2 said...

Great info. I'd have FREAKED out if I hadn't read it happened to FL and you weren't too concerned about it. Even better to read a little more about it.

Frayed Laces said...

Great info! Yeah, a little freaky, but it's good to hear its nothing I shouldnt be too worried about.

Running and living said...

Great info. Never happened to me so far, but have heard of cases in ultrarunners. Ana-Maria

The Laminator said...

Hey! For those who are wondering about post-marathon hematochoezia (bloody stool)'s similar, but not exactly the same thing. There are a lot of other possible causes. I'll try to get into it in the next installment of this running series!

Thanks for the question!

Xenia said...

Thanks, Doc.

Sorry I have been so behind. Seeing the titles of your post in my Google Reader made me save them until I had time to read your important lessons on training and speedwork. Then everything started to pile up so I said to hell with work and just caught up on all your posts.

Thank you for all the great info. I never get the chance to do proper research on running myself so I rely a lot on you guys to point me in the right direction and I can't thank you enough for that.

Hope all is well with you now. Take care.

carrie said...

I had this after a 20-mile training run last summer, and while I was confident it had something to do with running rather than needing a kidney transplant, it wasn't easy identifying the issue. You can Google a lot of things and still not find much! Maybe now your post will pop up.

Thanks for the great info! I enjoy reading your posts.

lindsay said...

thanks doc :) always so informative, what would i do without you! i hope i never pee blood 'cause i think i would still be weirded out even though i am all educated now.

for your next lecture you need to explain/cure those darned night calf/feet cramps. i get them all the time!

Reluctant Runner said...

Uh oh ... you've opened the flood gates with this excellent information. No (pee-related) pun intended. :-)

Run For Life said...

Great info, thanks!

aron said...

thanks for the info as always :) you give us so much awesome info!

sarah said...

how can you tell if it's blood rather than myoglobin (ie, from rhabdo)? just a brighter red rather than brownish color?

i had one or the other after one of my marathons and despite my medical background it still freaked me out! i thought it was myoglobin rather than blood at the time, but now reading your post i'm not as sure!

Clicky Web Analytics