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A man who finds blood or blood clots in his urine or semen is usually very, very concerned. His doctor usually isn't. About 1 in 100 men at any given time have detectable blood in the urine, but only about 1 in 1000 men have a treatable disease that is causing it.

Sometimes blood in the urine and blood in the semen is a complication of overly vigorous exercise, especially running. They can also be a sign of an injury, such as a severe blow to the kidneys during a sporting event. They are also common in men who have sickle cell disease.

For hematospermia, which is just blood in the semen, usually doctors won't even look for a cause unless it has happened at least 10 times. In men who aren't yet 40, there is almost always never a dreadful disease causing the problem. It's a sign of an STD like chlamydia (which isn't hard to treat), or maybe some kind of unusual pressure on the prostate gland (which doctors aren't usually eager to learn more about). In men over 40, hematospermia may be a sign of prostate cancer, but it usually isn't. Even men who have prostate biopsies aren't likely to have blood or blood clots in the semen. Only about 1/3 have blood clots in the semen after 6 to 15 punches to the prostate. (If the prostate is removed, there is no semen.)

Occasionally men have a "prostate stone" that gets caught in the lining of the prostate can generates blood clots. It has to be removed surgically. If you have this procedure, you need to have a clear understanding with your doctor will remove the entire prostate or just the semen-producing vesicle in which the stone is caught. 

Prostate enlargement causes bleeding less often. If you have an enlarged prostate, you will also have problems urinating and probably with sex.

It's also possible to have variceal veins, which are something like varicose veins but around the prostate, that cause bleeding into semen. Usually your doctor won't treat them unless they are causing problems with urination or the patient is distraught. If you go to the doctor and say "You gotta' fix this, Doc," the doctor usually will. The treatment, which is also surgical, can be worse than the disease.

What about blood in the urine, hematuria? This is also something doctors don't get particularly excited about. The medical definition of hematuria in the United States involves taking three urine samples at least one week apart and finding a minimum number of red blood cells in each sample. The urine may be obviously bloody, smoky, or tea-colored. The darker the urine, the longer it has been since the blood entered the urinary tract. 

Most of the time it's not hard to track down the source of blood in the urine. The most common problem is a bladder infection or a UTI. Hematuria can also be caused by exposure to certain chemicals, such as arsenic in drinking water or agricultural poisons (no longer used in the US), carbon disulfide from solvents used in road mix for building highways and making rubber, or various heavy metals, especially antimony. Hematuria is also a symptom of renal calculi, kidney stones, but kidney stones aren't something you won't know you have.

Doctors become alarmed about blood in the urine when it is accompanied by:

  • Protein in the urine,
  • High blood pressure,
  • Irregularities in urination, either production of large amounts of clear urine, or small amounts of dark urine.

These are signs of serious kidney disease that needs to be treated aggressively. Glomerulonephritis can be deadly, but the chances are remote that you will develop it without any other signs of trouble.

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