Myoglobinuria

No experience here. However, I occasionally have the blood-in-urine problem when I empty my bladder before a run while being slightly dehydrated. That's normal for runners. I'm suspicious of medical analysis that's focused on non-atheletes. Be sure you compare your results with other runners, not the average couch-potato. For instance, highly-trained atheletes commonly have "abnormal" EKG's.

Maybe a second opinion from a sports doc would be appropriate for you. Good Luck.

purple wrote:

No experience here. However, I occasionally have the blood-in-urine problem when I empty my bladder before a run while being slightly dehydrated. That's normal for runners. I'm suspicious of medical analysis that's focused on non-atheletes. Be sure you compare your results with other runners, not the average couch-potato. For instance, highly-trained atheletes commonly have "abnormal" EKG's.

Maybe a second opinion from a sports doc would be appropriate for you. Good Luck.

umm sorry this seems slightly more serious than the normal "runners blood in pee" syndrome

purple wrote:

No experience here. However, I occasionally have the blood-in-urine problem when I empty my bladder before a run while being slightly dehydrated. That's normal for runners. I'm suspicious of medical analysis that's focused on non-atheletes. Be sure you compare your results with other runners, not the average couch-potato. For instance, highly-trained atheletes commonly have "abnormal" EKG's.

Maybe a second opinion from a sports doc would be appropriate for you. Good Luck.

first of all, blood in your urine is NEVER normal - runner or not. it means there is something wrong. whether or not that problem is serious or not is a different story, but it's never normal.

second, highly trained athletes rarely have "abnormal" EKGs. and i mean rarely. some may have hearts that are bigger proportially, but that doesn't effect EKG status which is simple a measure of the electrical properties of the heart.

third, myoglobinuria is a pretty specific disorder, and one that can be tested in a variety of ways. the docs are right in suspecting something like this because it can be serious in some people - or a sign of something else more serious.

finally, from what i know about the disorder (and granted i'm still in school) is that there are a number of causes of myoglobinuria. some of them are genetic, some can be caused by diet. most of the treatments deal with the diet or eliminating a lot of the contributory factors like alcohol or certain types of drugs.

good luck.

blood in your urine is NEVER normal

Strictly speaking, you're right. I was thinking more along the lines that it's normal that you'll get a blister if your shoes don't fit right. That's a normal reaction that corrects itself - it doesn't necessarily mean there's disease or anything.

I agree this seems like a more serious situation, and that's why I suggested a second opinion. That should avoid the possibility that the first doc is not aware of situations specific to athletes.

Thanks for the quick responses. Any insight as to whether or not I should run tomorrow? I hate to take a day off, especially without doctor's orders...but the results will still be pending.

A few thoughts from a layman, based on literature that may be totally out of date by now:

As you probably know, red urine is pretty common among runners. It can be caused by any of a number of substances in the urine -- blood, hemoglobin, myoglobin, or various foods, dyes, or pigments. It's usually not a big deal, but even trained nephrologists, if they don't treat serious distance runners in the usual course of their practice, may overreact.

Large amounts of myoglobin in the urine (myoglobinuria) can be serious because the myoglobin molecule is relatively large (as compared with, for example, the hemoglobin molecule) and can cause blockage of, and eventual shutdown in, the kidneys. In a runner, myoglobinuria can be caused by severe, prolonged muscle stress (as in a marathon) combined with heat and dehydration. Also, a low carbohydrate diet (as in a carbo-depletion phase prior to a marathon) or fasting can set you up for subsequent myoglobinuria.

For runners, the "treatment" is to prevent dehydration, avoid overheating, and don't fast, carbo-deplete, or play around with the Atkins diet.

I have no idea how long the condition takes to resolve itself. Also, although I understand that some elevated level of myoglobin in the urine following a run may not be a big deal, I have no idea what level of myoglobin would indicate a serious problem. I do, however, suggest that you get a second opinion if your doc tells you that your competitive running career is over.

Actually, I've just read several sources that state that the myoglobin molecule is smaller than the hemoglobin molecule, which contradicts what I've previously read.

I'm one of those runners that has experienced runners hematuria over the past 20+ years. I've had just about everytest there is. Just like some have posted here said, I sometimes tend to to bruise my bladder and I'll pass a bit of bloody urine.

However, after going to a "sports doc" who told me just rehydrate and all will be ok, I would just ignore it.

A few years ago, I experienced some bloody urine after a 1000m workout which was 2 days after a 2 hour run. I figure I was just a bit dehydrated and ignored it. 2 days later I was still passing real dark urine. I go to the ER and they tell me dehyration caused this, gave me an IV and sent me on my way. 2 days later, I'm still passing dark urine and go back to the ER, see a doctor who actually runs the proper tests and this time it's not runners hematuria, it's myoglobinuria. I take her advice, get follow up tests, back off the training and a couple weeks later I was ok. I don't know what would have happened if I decided to find a doc that would see the fact that I was an athlete and couldn't miss a couple of weeks of running and thus tell me what I wanted to hear. (go running you'll be ok)

Sometimes as runners we are too quick to think that all docs are pains in the ass and have no idea, I know sometimes they are, but when it comes to things like this you need to listen to the docs. You've had the tests and have a diagnosis, not a guess.

I do know that a guy that was a returning winner at either the Cowtown or White Rock marathon had a major system meltdown after suffering from this. DNF'd at early in the race, finally listened to some friends to go to the hospital and winds up in either the ICU or the CCU.

My 2 pennies

If you were experiencing isolated myoglobinuria and your urine was deeply pigmented as you are indicating then there would be something more serious than a little dehydration going on. Myoglobin blood levels required to impart even a slight pinkish hue in the urine (100mg/dL approximately) would require either a significantly reduced GFR (indicating very poor renal function: you would not feel like running and be swollen all over) or very significant muscle necrosis. Well trained athletes have a higher muscle myoglobin content, but I would still say that to achieve a myoglobin blood level of close to 100 you would need a high voltage shock, a severe cruch injury, tetanus, a cocaine overdose or some other highly myotoxic event. You mentioned that your your urine level was 1.5mg/L, this is actually the lowest detectable level of myoglobinuria and indicates the dissolution of about 100g of normal muscle or perhaps 20-50g of trained athletes muscle.

My point, you surely do not have pure myoglobinuria and I reckon your doc might be being thrown off by your higher than usual urine myoglobin levels (there is normally a small, detectable amount and this may be several times higher in an athlete), and the main issue is likely to be haematuria. And count yourself lucky as heavy myoglobinuria has a dismal prognosis and is strongly associated with Acute renal failure.

Haematuria on the other hand is far less likely to be serious in an athlete, especially if it resolves on 2-3 days of abstaining from exercise. It is most commonly from the bladder in runner, which gets thrust around the pelvis while running causing bruising and bleeding. Up to 90% of athletes will have a detectable (not necessarily visible) amount of blood in their urine at the end of a marathon. The other site of blood loss is from the kidneys, which are kept in a relatively hypoxic state during heavy exercise (blood supply is shunted away and the kidneys need to survive with less than their usual oxygen supply). For obscure reasons this causes a temporary leak of blood. Both of these phenomena are likely to be threshold related in the athlete, i.e. your kidneys just might like shedding a bit of blood when you exercise. However, all red urine must be taken seriously and these benign causes are a diagnosis of exclusion, meaning that all other causes of haematuria and haemoglobinuria (stones, infections, and worse) need to be excluded before you can rest easy. The other issue of course is anaemia - get your iron levels checked.

NZ Intern wrote:

You mentioned that your your urine level was 1.5mg/L, this is actually the lowest detectable level of myoglobinuria and indicates the dissolution of about 100g of normal muscle or perhaps 20-50g of trained athletes muscle.

Actually, he said, "[M]y 2nd round of urine (taken during a 10 day running layoff) came up with 15 mg/L of myoglobin."