Bleeding from the penis is an alarming symptom, whether the blood is visible in the urine, semen, or appears as a discharge. This symptom, medically known as hematuria when related to the urinary tract, warrants a professional medical evaluation to determine the source and severity. While some causes may be minor, blood can also signal a serious underlying health issue that requires prompt diagnosis and treatment. This discussion provides general information about the possible origins of this symptom and is not a substitute for consulting a healthcare provider.
When Immediate Medical Attention is Required
Certain accompanying symptoms require an immediate visit to the emergency room or urgent care facility. The sudden inability to urinate, known as acute urinary retention, signals a complete blockage in the urinary tract that requires rapid intervention. The passage of large blood clots or heavy, continuous bleeding suggests a significant hemorrhage along the urinary system.
Severe pain in the abdomen, flank, or groin, especially when paired with bleeding, can indicate a major issue like an obstructing kidney stone or a spreading infection. If the bleeding is accompanied by systemic signs of illness, such as a high fever or chills, this suggests a severe infection like pyelonephritis or urosepsis. Feeling dizzy, lightheaded, or fainting alongside the bleeding are signs of significant blood loss or systemic shock. Any of these acute symptoms necessitate immediate medical triage, even if the bleeding stops on its own.
Localized Causes Originating from the Urethra or Foreskin
Bleeding that originates directly from the urethra or external genital structures is often localized and may not involve the upper urinary tract. Trauma is a common cause, ranging from minor scrapes to significant injuries of the urethra itself, such as those caused by vigorous sexual activity or instrumentation. A direct blow to the perineum, often called a straddle injury, can crush the urethra against the pubic bone, leading to blood visible at the urethral opening.
Inflammation of the urethra (urethritis) can also cause bleeding as the delicate lining becomes irritated and fragile. This condition is frequently caused by sexually transmitted infections (STIs), such as chlamydia or gonorrhea, and may be accompanied by pain during urination or a penile discharge. In uncircumcised individuals, infections of the foreskin and glans (balanitis) can cause fissures or tears that produce external bleeding, which may be mistaken for internal bleeding.
Structural abnormalities within the urethra, such as polyps or strictures, can also lead to bleeding. A urethral stricture is a narrowing of the tube caused by scar tissue, and the friction or pressure from urine passing through this tight spot can rupture small blood vessels. These localized causes generally require direct visualization or specialized testing for an accurate diagnosis.
Systemic Causes Originating from the Urinary Tract
When the blood originates from the bladder, prostate, or kidneys, it is termed hematuria. This systemic bleeding is often concerning because the potential causes include both common and serious diagnoses. The distinction between gross hematuria, where the blood visibly changes the urine color, and microscopic hematuria, where blood cells are only detectable under a microscope, is important for guiding investigation.
Urinary tract infections (UTIs) are a frequent cause of hematuria, where they typically involve the prostate gland, known as prostatitis. The inflammation caused by the bacterial infection irritates the lining of the bladder and urethra, leading to bleeding, often alongside symptoms like a burning sensation during urination and increased frequency. Acute bacterial prostatitis can present with additional symptoms like fever, chills, and pelvic pain.
Kidney stones or bladder stones cause bleeding as they move through the urinary tract and scrape against the lining. The presence of stones often results in the sudden onset of severe, cramping pain that radiates from the back or side down toward the groin, caused by the stone obstructing the flow of urine. Even small stones can cause microscopic hematuria, while larger stones may produce visible blood and clots.
In men over the age of 50, issues with the prostate gland are common causes of hematuria. Benign Prostatic Hyperplasia (BPH), or prostate enlargement, causes increased vascular fragility in the tissue around the bladder neck. The enlarged gland places pressure on the urethra and bladder, leading to urinary symptoms and intermittent bleeding. This bleeding is typically painless and results from the rupture of fragile blood vessels on the prostate surface.
Malignancy, particularly bladder cancer, is a serious cause of hematuria that requires timely investigation. Painless gross hematuria is the most common and often the first warning sign of bladder cancer. While many cases of hematuria are not cancer-related, the possibility of a tumor in the bladder, kidney, or prostate means that visible blood in the urine must be evaluated by a specialist, even if it occurs only once.
Other kidney conditions that affect the organ’s filtering units, the glomeruli, can result in hematuria. Conditions like glomerulonephritis cause inflammation and damage to the tiny blood vessels, allowing red blood cells to leak into the urine. This type of bleeding is often microscopic, but can sometimes be visible, and may be an isolated kidney disease or part of a broader systemic condition.