Experience From - Suzi "T" Cope , Jay Hodde , George Beinhorn , Alan Cabelly , Tom Andrews , Kevin O'Neall , LeRoy , George Beinhorn , Rich Schick , Karl King
Chris Hall wrote:
"Dear Runners: After running the AR50 last Saturday, I experienced a new problem. Maybe someone else has had this same problem and can advise me what I am doing wrong. I know if I go to the doctor, he will just tell me to stop running 50 miles. About mile 45 two noticeable things happened with my urine. 1. There was very little of it. 2. There was blood in it. The next day there didn't appear to be any visible blood, but the color was still dark. After the race there was some pain in both my kidneys. Should I drink more water? less water? drink something besides water? do not do runs that have so much asphalt as AR 50? ideas? "I certainly don't pretend to know what your condition was, but I can tell you about mine, for a little insight. About mile 10 I realized I had pulled a classic beginner move, gone out quickly, had fun, and had not consumed enough fluids. The day was cool and the pace was hot. By mile 15 my hydration had dropped to the point of zero urine output, with frequency, which means the feeling that you have to pee, but no urine produced. This is not good.
The next thing that happens, (and did) is the empty bladder walls rub against each other causing discomfort, irritation, and minor bleeding. Left untreated this is a great way to get a nasty bladder infection which can also ascend to the kidneys for a far more serious problem. The treatment is H2O. At the next aid station I stood and downed one full water bottle, and filled a second one for the next 3 mile section. It took me a total of almost 20 miles to rehydrate, clear the urine, and feel comfortable again.
I'm sure if I had never experienced this before I might have been more concerned, but I have seen it, treated it, survived it, and knew I had a good chance of doing so again. By mile 32 I was back on a good pace, feeling fine and moving well. I can honestly brag that I stopped to pee on the climb to the finish, and it was good volume, clear color.
Wow, the things we find impressive. I might add that rehydrating was the key, but I also used Karl King's electrolyte capsules during the run and feel confident they helped balance all that water consumption with the hard running the first and last 20 miles. It was just a "bad patch" for about 10 miles there in the middle.
In regards to Chris's post:
I am not a physician, but from my experience and knowledge in athletic training and physiology, I can offer a couple of comments.
Hematuria (blood in your urine) is not all uncommon in runners. IT can be harmless, or it can be *very critical*. Amount of blood is an issue, too, but realize that minute amounts of blood can taint the urine a deep red (ie, it doesn't take much.)
If this was the first incidence of blood that you ever noticed, I'd get it looked at if the color doesn't return to normal after about 24 hours. This is assuming that you are continuing to produce urine.
Urine volume is also an issue. If there is little of it, you might have been dehydrated to the extent that the bladder walls were rubbing together. This could lead to the blood. Dehydrating to the point that the kidneys aren't producing urine is not a good sign. My first question is: Did the urine flow return immediately following the race, and did you continue to drink?? These are important things to note.
You should continue to drink after an event to keep the kidneys operating normally. It helps flush out waste. If the urine flow doesn't return soon after the finish, be sure to get it checked out by an MD. There have been reported cases of kidney shutdown due to dehydration and ultra endurance exercise, so this isn't an issue to take lightly.
For many runners, slightly bloody urine is normal. For many others, it is not. For me, it is uncommon, so the first sign of blood is a warning for me to be sure I'm rehydrating properly. This includes ample fluid and electrolyte replacements. If the red becomes more pronounced, I stop and save myself for another day.
I had blood/pain in my "kidneys" a while back during a long training run and went to a specialist who took x-rays, stuck a laser up my wanker, his finger up my other orifice, and did all manner of other expensive jiggery-pokery.
Conclusion: just what Dr. Timothy Noakes says: many runners get blood in their urine when they don't drink enough. The bladder walls rub together and begin to bleed. My kidneys showed up as being very healthy in the lab tests, and the doctor told me the kidneys are actually quite high in the abdominal cavity--not down near the pelvic brim where the pain could mimic "lower back pain."
So, I suspect what I had was actually bladder pain. This seems to be confirmed by the fact that I would "often" have the same pain late in a long run, but it would go away when I finished and went to the health food story and got a smoothie.
However...that much said, the doctor told me that blood in the urine can be caused by probably 100 different things, some of which are quite serious. He said I had done the right thing by getting a checkup, especially at my age (55).
About 3 years ago, 3 days after a 50-miler, I urinated blood. Scared the bejeebers out of me. At the emergency room that night they did very little. I then went to a doc, and we agreed to be very conservative. I was probed from the front, probed from the rear, had pictures taken, and probed from the front again. NONE of it was at all pleasant (understatement); none of it showed anything serious.
Result: the doc speculated that I had a bruised bladder. He told me that, in spite of our greatest desires, we should NOT totally empty our bladder, that an empty bladder is more susceptible to injury (By The Way, in a prior life, he had been a long distance runner, and had once had blood in his urine, so he knows of what he speaks). He also told me to get scoped from the front IMMEDIATELY if it ever happens again, that they should have done that in the ER room that night. They need good information, and that's the best way of finding out. It's serious stuff; scary.
I was running trails 10 years ago and pulled something or tore something that caused me to urinate blood. At the time of the running I was very worn down from having pushed myself over a period of weeks, and I guess something had to give.
In my case, after the "injury" and finishing up during that run I felt like I needed to urinate but nothing was coming out. Later that evening I urinated a wine colored fluid. The hospital that I checked it out with told me I had blood in my urine ( I knew that already).
The bottom line was they told me to maybe not run as much for awhile (I knew that already too.) $250 for backup advice. The other aspect of this is there are a lot of reasons one could urinate blood and they could have run many tests. Since I thought I knew what the cause was (overdoing it and tearing something on a trail run) I elected to take a "wait and see" attitude. I healed up in a week and haven't had any problem since, so evidently I was correct in my guess that there were no other factors to blood in my urine.
Was the urine red or dark? Each suggests a different problem. Bright red blood in the urine means something is leaking. It could come from anywhere in the urinary system. High doses of NSAIDS coupled with not enough water intake can damage kidneys and cause blood to leak. I think drinking so much water that the bladder is over-filling while you run, can stress the bladder muscle and cause bruising. Bruising of the bladder or bladder stones can cause blood to leak into the bladder.
Coffee-colored urine and kidney pain are classic signs for myoglobinuria. Intense, prolonged physical activity can damage muscle enough to release muscle protein into the bloodstream, where it collects in the kidneys.
Noakes' Lore of Running, page 689, mentions a study done on Comrades runners: 57% had myoglobinemia and 14% had myoglobinuria. It can lead to kidney failure. It doesn't mention any prevention methods.
In race horses, it is a common problem. It's treated with NSAIDS, muscle relaxers, IV fluids and rest. Although it's not proven to work as a preventative, many vets and trainers swear that Vitamin E and Selenium taken orally will help prevent myoglobinuria.
I had a similar occurance in the Bismark Marathon (sorry it wasn't a longer race). I had to pee too often and it was at 20-22 mile mark three brown drops. Very different but it turned out to be a bladder infection and a 102 temp. (About this time most men say "Huh?" and most women laugh). My doctor, on the phone, ordered me to emergency. The infection could have progressed to my kidneys and been really huge trouble.
While the brown urine in question (earlier post) was post race and probably (May I make a value judgement?) something not to be passed off no matter when it occurs. I suspect Dan's question is very appropriate. Besides blood in the urine what else would cause brown coloration?
Dan Baglione wrote:
George Beinhorn writes of brown urine. George, I'm no doctor; but did all those tests include a test for RBCs in the urine soon after the event?
No, it was several days after. Dr. Bob Lind, one of the principal WS100 race physicians, told us a the prerace medical briefing that brown pee is a very dangerous sign, indicating that myglobin, a large molecule protein, is being released from damaged muscles, and can clog the kidney filters, resulting in acute kidney collapse, medevac by helicopter, dialysis, permanent kidney damage. I preferred to DNF. :-)
The evaluation of brown urine during or immediately after extreme forms of exertion is critical. The discoloration can be caused either by blood or by myglobin a waste product that occurs with muscle tissue death. The presence of blood can be totally innocent due to a phenonema known by various terms, most commonly post exertional hematuria or "march Hematuria" as it was first described in military personnel after long periods of marching. It is recurrent in some individuals and results in no long term problems. Once the diagnosed, individuals can continue the activity without need for further evaluation unless new symptoms such as burning with urination or unexplained back pain should occur. Blood in the urine can also represent a symptom of urinary tract infection or other renal (kidney) disease.
Myoglobinuria is always a big problem. Myoglobin is a big sticky molecule. The kidney is a filter. Too much myoglobin can permanently clog the filter. For the patient this translates to frequent visits to a dialysis center until a renal transplant becomes available - not a good deal. One of the biggest pitfalls is that many physicians are not well versed on the subject. On the standard dipstick test of urine, myoglobin will be reported as blood. If the physician or lab don't look at the urine under a microscope and see that there are no red blood cells, the diagnosis will be missed. There are also specific chemical tests available but many labs don't have these immediately available. The treatment is to flush the kidneys out using a combination of lots of fluids, oral and IV and the use of diuretics which result in increased urine output. This needs to be started as soon as possible.
In short, if you get brown urine have not been properly evaluated in the past go directly to an Emergency Room, and specifically ask the MD if he has checked for myoglobin in the urine before you depart. In severe cases waiting even 12 hours can lead to long term problems.
If urine is brown from myoglobin it may be a sign of incipient rhabdomyolysis. If that is taking place, the kidneys may not be able to filter water in a normal way. That might lead to weight gain regardless of sodium status.
I'm not a doctor nor an expert on rhabdo. Don Davis wrote an interesting account of his experience with it in UltraRunning. If he is on the List, he can probably add his perspective.