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Urine problem turns out to be a gyn problem

I am a 53 yr old that has had issues with pain during intercourse for quite sometime but didn’t really think too much about it. Then a few months ag I have noticed blood in my urine that would come and go. It would even show up on urinalysis even if I didn’t see it. But yet I did not test positive for UTI. Then recently I noticed I have been urinating through my vagina. I had read on a message board where you can test your suspicions by taking a azo pill for UTI that changes your pee to orange and then use a tampon and if it turns the tampon orange then that is a good indicator that you are urinating through there. Well mine did. So I went to a urologist where he did a cystoscope. Yes I am urinating through there and probably always have. I do not have a fistula which was thought to be the problem. Apparently where the urine come from the bladder to urethra is to close to my vagina so it come out there. But also while doing the scope he also looked in my vagina with the camera and noticed a great deal of blood in my uterus so that is why it was thought that i was bleeding in my urine. I have not had a period in a good 8 or 9 months. My last pap was in 2017. Does anyone know why it was only seen in my urine and not seen on my underwear like spotting or irregular bleeding? I do have an appt with my gyn this Tuesday. My urologist also ordered a ct scan with contrast for this wed. This is all so confusing to me that I thought it was a bladder issue and come to find out it could be a gynecology issue. Could this be uterine cancer?
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134578 tn?1614729226
COMMUNITY LEADER
My ob/gyn was head of Obstetrics for our local hospital for a long time, and then he went into his favorite specialty, gynecologic urology. It's interesting to hear of someone whose situation would benefit from just that kind of specialist. Does your doctor think the peeing-through-the-vagina thing even needs to be addressed (like, by surgery) or, because you have always been that way, does it seem fine to leave it alone? (Urine is sterile, after all. If it comes out this way and always has, it would almost seem like there is more risk than it is worth in trying to mess with anything via surgery. Those are pretty little tubes to be stitching; you might risk getting scar tissue that would be detrimental, and who knows the condition of your urethra after 53 years of no use.)

Anyway, it sounds like the only reason this was discovered is that you had some random bleeding from your uterus. I would not think it is bleeding because of the connection of the bladder to the vagina, or anything. Given that you're perimenopausal, if you haven't had a period for a few months, it isn't surprising that you would have a pretty full uterus, and no, that is not necessarily suggestive of cancer. It sounds like you are producing more estrogen than progesterone, if you have blood in the uterus but haven't been having periods. (Look up endometrial hyperplasia -- a pretty good article is https://familydoctor.org/condition/endometrial-hyperplasia -- and you'll see how that can happen during pre-menopause.) If this is what is going on, the doc might prescribe progesterone, to be taken 12 days a month and then stopped, to bring on a bleed and clear out your uterus. I wouldn't hesitate to take it. (This would be especially true if you are taking anything with estrogen in it to make the painful sex less painful.)

As for the painful sex, that could also be a perimenopausal thing. The skin of the vagina gets thinner with time. Are you using a lube or any other method to try to make it better?
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The CT Scan is to look further into the urinating through vagina issue. But he did say it must have always been that way but he did not understand why it was just now coming to light now after all I did have 3 children but they were all c-section. As for the bleeding I should also mention that 2 yrs ago I had a dvt which because I am protein c deficient I have to be xarelto for lifetime. And that caused me to need a endometrial ablation in 2017. So harmone therapy was suggested risky to me before and now with the heart issue, I’m not sur I would want to risk that. I suppose if it’s ok and not cancer I would just as well leave it alone.  I do use KY only as lubricant but have not been active since this latest issues have come up.
Oh also constantly feel the need to urinate but no infection
Check with your doctor as to whether progesterone is risky for DVT. "Hormone therapy" is a broad term that covers both the use of estrogen and progesterone. But I believe it is estrogen that is considered problematic for the risk of deep-vein thrombosis, not progesterone, and lack of progesterone is what keeps women from getting a period when they are still getting a uterine lining (which is caused by estrogen). In other words, it might be possible (again check with your doctor) to take progesterone to clear out your uterus and it might not have any effect on the risk of another DVT. If your doctor does not know the difference between estrogen's effect and progesterone's effect on your body,  find a different doctor. At the least, get your estrogen levels tested, because the things you are talking about (DVT and endometrial hyperplasia and even heart issues) seem to be related to estrogen production.
Thanks !!!! I go Tuesday to Gyn so hopefully this issue gets resolved soon
Avatar universal
According to this site https://www.webmd.com/digestive-disorders/blood-in-urine-causes some causes besides bladder or UTI infections are blood thinners (which you take), kidney problems including inflammation and even medication or food "coloring" (natural or dyes). There are other causes listed.

Another possibility is atrophy of the urethra.

As far as your thick uterine lining, that is not surprising since you have gone 8 or 9 months without a period. Our bodies usually do a pretty good job of shedding it all before anything sinister happens (e.g. hyperplasia or cancer). Also, the scar tissue from your ablation may make the lining appear thicker than it is.

Keep us posted on what you find out.
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