Adventure Stories - Field Notes 82: Braving the Void

Splitboarding, climbing, skiing and mountaineering can be terrifying, but throw in some genitourinary problems and you really never know how it’s going to turn out. We review what to do when you see blood in your urine and at what point you may want to call it quits.
(This episode contains adult language - for good reason!)

Adventure Storytellers: Alana Schick, Adam Kochanek
From: Calgary, Canada

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This week's featured adventure stories

Alana Schick in the Canadian back country, as she prefers.

Alana Schick's Adventure Story: Peeing blood.

Alana, a geneticist in Calgary, Alberta has joined us at several of our events in the Great White North, and each time she tells a story, we know it's going to be both amazing and irreverent. The photo above is from a previous adventure that she told us about in one of our most popular early episodes, Episode 10: "Swim and have sex, but don't run for your life," and we love it so much that we used the image on our business cards.

In this week's episode though, she shares a story that covers a touchy but common subject in the outdoor/endurance world - blood in your urine! In the podcast, Angel addresses what to do if you should find yourself in a similar situation to Alana's in the back country, but we have also included some more information here because it's a topic that we know is relatively common, a bit uncomfortable to talk about, and potentially serious!

Blood in my urine during exercise: What's (probably) happening and what should I do?!

"Oh no! I've been exercising hard, and now I'm peeing blood!"

First off, don't panic. As Alana said, you can pee blood and not be dying. It's not a good thing, but it is relatively common among endurance athletes for reasons that haven't exactly been nailed down by science. What you can know for sure is that some tissue along the path that urine travels has experienced enough trauma that it's started to bleed. That could be your bladder, or your urinary tract, or your kidneys.

If the problem resolves within three days, and you don't have any other symptoms, you likely don't have anything to worry about.

But, the best medical advice is that, if you discover blood in your urine during exercise, you should stop the activity you're doing as soon as possible, and make sure you're hydrated. The reason being that it could be a sign of developing kidney injury that could be exacerbated by more exercise and dehydration, and it can be potentially life-threatening or do permanent damage to vital organs if not addressed.

This article by the American Medical Society for Sports Medicine is a good primer on garden variety peeing blood.

Usually just stopping, drinking plenty of water, and allowing your body to rest for a day or two is sufficient, but:

If you experience other symptoms, including lethargy or sluggishness, feeling generally ill, or feeling pain around your kidneys (on one or both sides of your lower back), these are additional serious warning signs and you should seek medical attention immediately.
If the blood appeared after a trauma, fall, or injury, you should seek medical attention.
If discoloration or blood in your urine doesn't resolve within 72 hours, or happens repeatedly, you should have yourself checked out by your medical provider.

Ultrarunning Magazine gives some good advice on how to avoid the most dangerous types of kidney damage that occur among endurance athletes, and their further recommendations include:

Avoid taking NSAIDs - painkillers like Advil, Motrin, Aleve, Celebrex, etc. - during intense exercise.
Do not engage in intense, extended exercise if you've been recently ill.
Don't over- or under-hydrate
And make sure you're trained properly for what you're doing. This includes avoiding returning too quickly from an injury before rebuilding a base of fitness.

And Angel's advice on the podcast is this:

It is always wise to go in and get checked by a health care provider whenever you see blood in your urine if you don’t already know what the cause is. If you’re doing a highly physically intense or strenuous activity, like running a long way, climbing a really difficult mountain, skiing really hard, or anything else that leads to dehydration and physical exhaustion, then you should stop whatever that activity is that you’re doing, make your way back to your transport in the least strenuous manner as possible and and make a plan to get checked by a health care provider.
Timing of getting checked can depend on how you feel. If you feel sick or lethargic you should go to urgent care or the emergency room to be checked right away. If you feel completely fine and you’re seeing blood in your urine, try and call your primary care provider and get an appointment within the next 1-2 days and if that is not possible, ask to speak to the nurse to review your symptoms and get advice while your waiting if that’s available to you or go to an urgent care.
It is important to note that it makes zero difference if it is a little or a lot blood in your urine. If you see even a small amount, you should abort your mission and start making plans to get checked.

Adam Kochanek's Adventure Story: The wrong time to give up.

Adam Kochanek and friends at the summit.

Adam Kochanek shared with us at a Calgary Boldly Went about this challenges of going out with a new, unknown partner into the challenging Alaska wilderness.

Since telling us this story, Adam and his partner Melba Seto have become proud parents, and we're looking forward to sharing a story she told in a future episode.

Adam and Melba are experienced adventure athletes who were also previous Woods Canada ambassadors, which allowed them to spend a year exploring the Canadian back country in a variety of ways.

And unfortunately, we don't have any easy advice for you about what to do if you get a ruptured testicle. Get yourself to the ER however you can.

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