It was, like yesterday, a warm and for California an exceptionally humid day. I pushed 2 bottles on the way up, drank a bottle at the spigot at the summit, and refilled all the bottles; I was taking electrolyte capsules at the rate of 1 per bottle. I was drenched despite the fact that it wasn't too hot, due to the humidity. I took an anemic dribble of a piss just after the summit and didn't think much of it; then charged on down the hill (10 miles in 1:17). At my car I drank two bottles of water and headed home.
(WARNING: Reading on is not for the squeamish).
Off to the shower, I weighed myself at 145lbs (huh?! 9 pounds down from normal weight?!) then used the bathroom and ...yipes...I was peeing what looked like cranberry juice...the dreaded blood in the urine. I kept pushing the fluids and kept peeing and the urine cleared up quickly (thankfully!) so this seems to be "just" a case of a bruised bladder. If you are unfamiliar with the urinary viscisitudes of ultramarathoning: One thing that can happen in a long run is that, after getting dehydrated (first problem) and emptying the bladder completely (second problem), the bladder walls can get bruised due to the jostling of a hard run which can bang the bladder walls together. This happened to me a few times in the nineties, but not due to heat. Rather, I was running in Oregon in cool weather with too strong a drink mix (in order to get calories without overloading on fluids, or so I thought). I learned from that experience to be careful to watch the concentration of my running drinks, and to be mindful of my piss habits while running; specifically I learned to not empty the bladder completely when running...but today I forgot that old lesson.
One problem with all this is that there are other much more serious conditions that can cause blood in the urine and other much more serious conditions that look like blood in the urine... "rhabdo", or rhabdomyolysis, being one very serious possibility. This is, as I understand it, when muscle tissue breakdown due to the trauma of exercise, recent illness, electrolyte imbalances, and /or possibly use of NSAIDs, releases the red muscle pigment myoglobin into the blood, from which it is filtered by the kidneys. The problem is that myoglobin can clog the kidneys' filtration system...especially if NSAIDs like ibuprofen are being used, as NSAIDs reportedly interfere with kidney function. This can lead to kidney failure. There have been a few high-profile ultrarunners hospitalized with this condition in the last few years...its a very serious, life-threatening condition. So when the pee is red or rust colored, it merits ones full attention, full stop and deal with the issue, its not a joke.
Back in the day (eighties and nineties) advice commonly given to newbies (like then me) by the experienced guys, was to take 800 mg of ibuprofen every 25-30 miles as a prophylactic against inflammation injuries; another one I heard was, take an ibuprofen every hour to ward off inflammation injuries. The experience with blood in my urine back in the nineties scared the hell out of me sufficiently that I woke up and realized the complete folly of such an approach. I stopped using ibuprofen altogether during runs, ever, for fear of rhabdo (despite the fact that what I had experienced was not rhabdo) as well as a concern about reports that NSAID use can predispose one to develop hyponatremia. I look back on this practice that many followed, including me, and see it as utterly insane. Today I realize: If one needs meds to ward off "inflammation" injuries, then one is not running correctly. Better stop and figure THAT out before ramping the mileage.
Back to my case of a bruised bladder. So what happened?
- I got dehydrated yesterday in my 31 mile, 14,200ft grinder. Despite the fact that consumed 14 bottles yesterday, it was not enough given the humid conditions and the fact that I sweat excessively. I need to focus on better hydration.
- After the 30 miler yesterday, I didn't fully rehydrate afterwords. After the run I ate and rehydrated my way back up to 150 pounds but this still left me down from my normal weight of 154lbs. I just wasn't that hungry after a long hot run in the humid heat. This set me up for the run this morning probably already dehydrated.
- I didn't take today's 20 miler seriously. It was relatively short (!) and the first 10 miles was a power walk. I felt fine. So when I had signs of inadequate fluid intake (inadequate urine production), I ignored it. I should have stopped and corrected the problem.
- I emptied my bladder completely before embarking on the fast downhill charge down the mountain- and my bladder got bruised as a result. I should have done what I know to do..always leave some urine in the bladder to prevent this type of injury. The reason was...there just wasn't enough urine to leave in the bladder, but hey, see #3.
- I was likely low on electrolytes. It was not excessively hot so I didn't think I needed to watch this too carefully; but it WAS very humid and I was drenched with sweat. I underestimated the conditions.
Looks like I got off easy, no harm done, just a scare. I did go to an urgent care facility to get a few things checked out (make sure my self-diagnosis was right). I am a bit embarrassed by this set of mistakes but I put it out there for the possible benefit of anyone reading this that may be into high mileage running particularly in summer weather: Hopefully you may learn from my mistakes and not repeat them! And if you find yourself with blood in your urine associated with running, remember that we are all different, so while the episode above applies to me, it may not apply to you- my suggestion is to get it checked out and take it very seriously- and especially if your urination does not resume quickly to normalcy, seek medical attention to be safe.