Hematuria (he·ma·tu·ria)

If you have read my journals or looked at some of the pages on this site, you may know that one of the reasons we had to pull out early was that I was passing blood in my urine, also known as hematuria. It started on Day 9 with the pull out of Muir Trail Ranch to Sallie Keyes Lake. The use trail from Muir Trail Ranch to the JMT is quite a pull and the rest of the hike up to the lake is a pull as well. At the campsite that night was when I first noticed the blood. Over the next few days the condition would come and go but was getting worse. Not much fun being a ways from medical help and not knowing why I was bleeding the way I was. The day up to Silver Pass was the worst and we both decided it was better to pull out at Red's Meadow then to try and push ourselves to Tuolumne Meadows.

I was able to get some needed rest on the days immediately after the trip at the cabin outside of Yosemite, so was not in a rush to get to the local medical clinic or county hospital. I waited to get home and made an appointment with my urologist. He sent me for a battery of tests in the following weeks and today I went for the final tests and results. I had blood tests, urine tests, Cat-Scans, ultrasounds, x-rays and today capped it of with cystoscope! If you have never had a cystoscope, it is a camera that is inserted up the urinary tract and they take a look inside your bladder. For a male the shortest route is on the front side, and for me it was quite short! The results all came back clean and my body looks to be in good shape. No issues with the bladder, kidneys, or any of the other vital organs in that region. I also got good results from the Cat-Scan on my heart and lungs, so was glad to have that side benefit. I asked the doctor and he was not sure of the exact reason as to why I had these issues on the trail but he mentioned that sometimes when you are dehydrated and doing strenuous exercise you will break down the walls of your bladder and start to pass blood. My neighbor who is a pharmacist also mentioned the same thing.

Now I am aware of the need to keep hydrated on the trail but did not know it would have these types of side effects as well. I got home from the doctors office and started to do some searches on the web and came across some interesting information on hematuria, which is the sign of blood in the urine. There are two types of hematuria, microscopic and gross. Microscopic is blood that is in your urine but can only be seen with laboratory equipment and testing. Gross hematuria is visible blood in the urine and can range fro a tinge of red to bright red (all of my symptoms). There are many causes for hematuria, including tumors, kidney problems, viruses, and excessive or strenuous exercise. Sport's, Exercise, Jogger's or Runner's hematuria fit into this category and can be common among long distance runners or athletes after excessive exercise. Prior to the popularity of running, military personnel during World War II would experience "March" hematuria caused by long and strenuous marches in the field. The cause is most commonly referred to now as either "Jogger's" or "Sport's" hematuria. In some studies or marathon runners, 20 to 90 percent of the test cases exhibited signs of this form of hematuria.

"Sport's" hematuria can be caused by the lack of fluid in the bladder along with constant long term pounding of the bladder, or can be caused by a sharp blow to the kidneys or bladder. The bladder has no fluid to cushion the walls and they will tend to rub against each other and cause internal bleeding or a breakdown of the red blood cells along the wall of the bladder. The end result is that when you urinate, blood is mixed in with the urine from the bladder. When there is not enough fluid in the bladder, caused mainly by dehydration, the only thing that can be passed is the blood. The level of urine or fluid in the bladder will determine the extent of the discoloration. Most doctors recommend that the long distance runner not empty their bladder before they run and stress the importance of maintaining the proper amount of fluid intact to prevent dehydration. Blood thinning drugs and anti-inflammatory prescription drugs will also exaggerate the symptoms. Sport's hematuria will generally go away within 24 to 72 hours after the strenuous activity. The diagnosis of Sport's hematuria is exclusionary, which means all other causes have been ruled out.

In looking back at the conditions I was under, knowing about Sport's hematuria, I feel that is the most likely cause of the blood in my urine. The times when the blood was present was after a long pull up the hill or after some strenuous hiking. While I was always trying to keep myself hydrated, I did notice that during these strenuous times, my hydration was less than ideal. The worst day was the 3,000 foot climb up Silver Pass and it was not until we were resting and I was able to drink a lot of water did the urine start to clear. It is interesting how your body depends so much on fluids in all areas.

I provide this information for a number of reasons. First to let all of you know that I am doing fine and my test results came out fine. Second to let each of you know that this is not an uncommon situation and while may not be prevalent in the backpacking community it is not uncommon to come across. Third, do not rely on my diagnosis to determine your cause if you happen to have these symptoms. Many of the searches I came across had people going through tests only to find out something else was wrong. In all of the information I was able to find, each and everyone stressed the importance of seeing a doctor as soon as possible to determine the exact cause. This is why Sport's hematuria is exclusion diagnosed. From what I have read I was very lucky with my results. And last but not least, monitor your urine to make sure you are properly hydrated. Dehydration is a factor in many ailments in the backpacking community.

Thanks again for looking, thanks for all of the warm wishes and thoughts and take care to all!

For a detailed account of our trip please refer to the Journals section of this site!