What if your pee turns pink?

Bladder problems HaematuriaHave you ever come back from a great training session or even a race, went to the bathroom and noticed the colour of your urine was distinctly pink or red? You know you didn’t eat beetroot either!

If so, did your heart skip a few beats? I know my heart did. Good news is you are not alone. This condition is known as Haematuria. I’ve experienced it very seldom in all my years of duathlon and triathlon. Three times I think, yet each time I got a fright.

Here’s the low down on the condition. The good news is its probably nothing too serious, so sleep easy. That’s the opinion of numerous doctors I’ve spoken to, such Dr Raoul van der Merwe, himself a veteran of 21 Comrades, eight Cycle challenges and a number of Midmar miles.

Vials depicting different dilutions of blood in the urine of a patient with Haematuria.

Vials depicting different dilutions of blood in the urine of a patient with Haematuria.

Essentially the colour and texture means there is blood in the urine. Yes, it sounds scary, however, its either red blood cells or haemoglobin(which is the oxygen colouring pigment found in the red blood cells.

One thing to be aware of is: “The darker the colour the greater the severity of the potential problem”. That’s the view of UK sports doctor Jim Bledsoe.

In most cases the red cells are being filtered into the blood via the kidneys, but the bladder could also be allowing blood into the urine. The first time it happened to me I had been racing in a triathlon. During the bike section I stood out the saddle to climb a short sharp hill and in the climbing my chain slipped off the chain ring. We believe that incident was the trigger as it caused micro vascular lesions.

That’s the first thing to ask yourself: “What sudden or abrupt increases in intensity or duration happened in your session or race?”

It may not be like my example. It could be a sudden change in pace. It also doesn’t need to be long bursts of speed either. Tests done on runners even found 60 second intervals could cause haematuria to occur in some athletes.

The intensity of the effort seems to be the underlying cause. According to Dr Bledsoe’s research, statistics suggest men are more likely to suffer haematuria than women. Another interesting observation is at this stage, runners seem to notice this occurrence more than other sports. However, in my case, and in Dr van der Merwe’s experience, many cyclists he has treated have also suffered haematuria.

haematuria 400There is some uncertainty though what causes this disorder. Dr Bledsoe offers some possible influences:

  • Lack of adequate blood flow to the kidneys or if you fancy the medical term “renal ischaemia””
  • Bladder or kidney trauma associated with exercise exertion. (Running on a tarmac could affect the kidneys and bladder).
  • The use of anti inflammatory and/or non steroidal medication.
  • Dehydration.

The most recent time I suffered this condition was definitely related to dehydration. It came during a heat wave. Quite frankly I had not consumed anywhere near enough water. How did I know it was haematuria and not simply dehydration without being a doctor? Most definitely the colour of the urine is distinctly different! Sorry to be graphic but the colour of urine in a very dehydrated athlete is likely to be dark yellow whereas in haematuria the colour is usually red or pink.

Okay, so you have it, what do yo do about it?

First thing, as mentioned, it’s usually not serious. That said, my advice is visit a doctor. Have a urine sample done so they can rule out other more worrying possibilities.

Second bit of advice I can offer is don’t train for 24-72 hours. I did and guess what? it came back again and again. I would rehydrate and by the next morning my urine presented a normal colour so I figured I was “good to go”. I wasn’t. The deceptive thing is you don’t feel anything is wrong with you. Your energy levels are normal. You definitely feel you can train, however, if there have been vascular lesions the area need a few days to recuperate.

If its dehydration, the body may still need more time as I discovered. Both Dr Van der Merwe and Bledsoe concur that 24-72 hours is sufficient time to recover. Having experienced it firsthand I’d err on the side of 72 hours to be safe. During that time I rehydrated on water and products like Citro Soda to try eliminate possible formation of “grit” in the kidneys.

I hope this information is useful and helps guide you on a ” What to do If…” Scenario occurs to you.

Happy training!



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About Glenn Macnamara

Glenn is an elite triathlete who also loves running trails. He competes internationally and he has numerous top five finishes to his name. He coaches kids and adults. His love of writing is inspired by the sports he competes in.

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