Pissing blood

[taikonoatama]

In the Armando Peraza interview that congalero had posted, Armando mentioned that he used to piss blood after a particular hard set. I'd heard this said by a teacher of mine as well. Thought I'd write in to "The Straight Dope" to see what the explanation might be:

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Cecil,

I've heard and read stories about musicians, specifically hand drummers, pissing blood after playing a particularly tough or long set. Santana's longtime bongo player, from 1972-1990, the great Armando Peraza, says this:

"Playing percussion for Carlos you had to be able to play hard, non-stop for sometimes up to three straight hours, and play loud enough to be heard over the electric instruments. A lot of times I played so hard that I would piss blood after the shows. Santana gigs were an endurance test of the highest order."

from this interview:
http://www.salsaweb.com/music/articles/peraza_cm.htm

What would the connection be here? Can blood really get into urine through this kind of physical exertion? Does it have anything to do specifically with the pounding the hands and the blood inside them get?

Thanks,

James
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Who knows if he'll find the question answer-worthy. Has this ever happened to any of you?

[umannyt]

In my 2 years of seriously playing Latin percussion instruments, mainly congas and bongos, I've actually pissed blood once.

In my case, it didn't happen at the urinal. Strangely, for me, it must have happened while I was sleeping 'cause, when I woke up in the morning to go to the bathroom, I noticed that there were a couple of blood stains on the front of my underwear.

I clearly remember that the night before I had played my congas unusually hard and long. That's why I suspected that the blood in the piss was the direct result of such activity.

I've read somewhere (possibly in one of the earlier threads in this Forum) that the cause of this bleeding is the bursting of tiny blood vessels (capillaries) inside the palms of one's hands when one plays really hard and long. In other words, some form of internal hemorrhaging actually occurs. But, it's only a minor one and not really health-threatening.

The hemorrhaged blood is then eventually expelled by the body through the urinary system.

I'm not a medical doctor. So, obviously, I'm presenting this merely as a theory and not hard fact. Perhaps, someone can either confirm or negate this.

[Light Seeker]

This happened to me on three Tuesdays in a row about a month ago or so. In my town, there's a reggae night at a club, where I am usually allowed to sit in with every band that plays (two to three), and often I'm unmiked and playing over very loud bands with electric guitars and a full horn section, so I would play VERY hard for pretty much 2 and 1/2 to 3 hours straight. When I got home each of these three weeks in a row, my pre-bedtime piss was rust-colored. I didn't freak out because there was no pain associated with it. For some reason, though, I never bothered to research if there was any connection between this and drumming. Only now did I look it up after it was mentioned here, and I came up with two potentially interesting articles on the matter.

http://cjasn.asnjournals.org/cgi/conten ... t/3/4/1022

http://www.drums.org/djembefaq/v13f.htm

[JConga]

IT happened to me twice after long rumbas(9 hours)....it comes from straining your kidneys and straining yourself while playing...it hasn't happened to me since for over 25 years. It never happened to me while i was ever touring around the world either, only when into those long rumbas in Central Park-NYC...Johnny Conga

[jorge]

This is a well known medical phenomenon that used to be called march hemoglobinuria because soldiers get it from marching too long. It is also well known among conga and bata players, and may actually be hazardous to our health.

What happens is the repeated impact of each step, or in the case of hand drumming, each hit of the drum, causes a few red blood cells to break within the capillaries. The tiny red cells get crushed by the physical pressure and impact and break open, spilling their contents into the blood plasma that surrounds all the red cells. Blood may look like a liquid but is actually billions of microscopic red and white blood cells suspended in a liquid called plasma. The hemoglobin molecules escape from the broken cell into the blood plasma. Small amounts of hemoglobin in the blood can be eliminated by normal mechanisms, and do not cause a problem. This happens all the time, every day, and does not cause hemoglobin to get into the urine. When there are too many red cells breaking and too many hemoglobin molecules floating around in the blood, free hemoglobin (not inside red cells or bound by other proteins in the blood) gets filtered through the kidneys and gets into the urine. This appears as dark or rust colored urine, not as bright red blood in the urine. Red blood in the urine is due to some other cause, generally bleeding in the lower or upper urinary tract, and should be evaluated by an internist, urologist, or kidney specialist. Free hemoglobin that is outside the red cells and not bound up by the natural proteins in the blood plasma can actually be toxic to the kidneys and can do damage. There are case reports of renal failure in patients with this kind of hemoglobinuria, making me wonder whether conga players with kidney problems have gotten kidney damage from a lifetime of playing congas. Two AfroCuban master conga players have died of or with renal failure in the past 6 months. There were other factors contributing as well, so the link is not completely clear, but that anecdotal evidence is consistent with several published medical studies, two of which were referenced by LightSeeker above.

This is not due to direct force to the kidneys or straining the kidneys, bursting of capillaries, or hemorrhaging, but rather the physical crushing of red blood cells inside the capillaries in the fingers. Given the little bit of published medical evidence that links march hemoglobinuria with renal failure (shutting down of the kidneys, often permanently, that may require dialysis or kidney transplant), I think it would be wise to try to avoid having this happen. I know lots of conga players have had this happen and not developed frank renal failure, but that does not prove it is safe, just that there is variability in people's susceptibility to this. As much as we like to hit hard and play over amplified bands etc, we should remember that John Henry died after beating the mechanical drill. I strongly recommend using microphones when playing with loud instruments.

By the way, this post is based on several studies in the medical literature, and is presented here as medical and public health advice. This is a potentially serious medical problem that can be prevented. I am a practicing physician, board certified in internal medicine and preventive medicine (occupational) and have been playing congas for 37 years, since before I studied medicine. Feel free to ask more questions, I think it is important that everyone here understands this phenomenon well enough to take steps to prevent it. I was actually thinking about this when we were playing rumba at the funeral of one of the great AfroCuban master conga players who passed on a couple of months ago after several years on dialysis. It is coincidental and important that this question came up here on the website.

George Friedman-Jimenez, MD
Director, Occupational & Environmental Medicine Clinic
Bellevue Hospital Center
NYU School of Medicine
New York, NY
george.friedman.jimenez@nyu.edu
212 562-4572

[ABAKUA]

Never happened in my 15 years of playing professionally, and I am a heavy handed mofo.

[Garvin]

I used to get this when I played in a Guinean Drum and Dance troupe... The first time it happened, I freaked out, but then everyone was just like "oh, yeah that happens from time to time".

Great explanation from a doctor who walks among us as well. Thank you!

[Thomas Altmann]

Jorge,

thank you very much for your post. Finally an exhaustive and easy-to-understand explanation.

This thing happened to me once in my life after hard playing. It was so long ago, I can't even remember the occasion.

Thomas

[umannyt]

As some of you may already know, this topic is really nothing new and has been covered before under the following forums and their respective topic:

1. Forum: CongaSet and accessories
Topic: Congas for a Piano Player

2. Forum: Bongo
Topic: Switching from bongos to cowbell - When, where and why?

FYI,

[Djembe]

I'm a djembe player and it's great to see we are not alone in this horriblness...

We've also been recently discussing this pissing blood and I was directed here by one of the other members.

It happens pretty regularly to me and my djembe playing friends.

I don't dig it at all and the dull ache in the kidney area is pretty worrying....

Do you have any advice of minimising the damage this causes Jorge?

Some people on the djembe forum have suggested things like:
1) Don't drink acidic drinks before playing
2) Don't take ibuprofen or aspirin before playing.
3) DO chew a Tums (baking soda) before playing.
4) Drink plenty before during and after a performance.
5) Don't think things like milk.

Anyway I think there's other usefull information there that people would benefit from checking out....

[Light Seeker]

I may be wrong, but I think the incidences of rusty urine that we've talked about here have not been accompanied by any pain, at least mine weren't. If your kidney is aching, I would not hesitate to see a doctor if I were you.

[jorge]

Hi Djembe,
My advice is to play softer so you never piss blood. None of the 5 things you mention is likely to have any effect greater than the placebo effect in reducing hemoglobinuria. The actual hemoglobinuria is not associated with lower back and flank pain in the kidney area, so I agree with the last poster that this is likely to be due to some other cause, either low back muscle strain, or some other kidney problem like a infection that needs to be urgently evaluated by a qualified physician. Kidney stones cause pain in that area, but the pain is usually so excruciating that you will wind up in the emergency room and have it medically evaluated, so the cause does not remain in question for long.

I frequently have had this discussion with djembe players. I tell them they play too hard. There is no need in an indoors venue (which usually has too much echo anyway) to play hard enough to cause hemoglobinuria. Just because you are competing with a dundun player slamming huge drums with sticks doesn't mean you have to match his (or her) volume. Tell the dundun player to play softer too. The dancers will still love you. The teacher will still love you, and may even have some voice left at the end of the class. If there are no dancers, even more reason to play softer. You can still enjoy playing just as much or more if you play a little softer.

[Djembe]

Just back from playing our weekly spot on Wednesday nights and again I am rusty...

No pain this time though.

Discomfort is a better description than pain.

I got it after I peeed, which was about 3 hours after I finished playing last time. It didn't last very long and I had it before when I peed blood a few months ago.

There was no prolonged ill effects after recovering quicly....

The discomfort is more in my stomach area than back or other places.

I have definitely been more aware of how hard I'm playing this week and to be honest I was surprised to have this again.

I will have to take steps to talk to the other people to get them to play softer me thinks....

[jorge]

Djembe,
A feeling of "discomfort" in the area of the kidneys or in the stomach area is not typical of this kind of hemoglobinuria. Flank discomfort has been reported in one case report that I have seen, but is not usually reported by patients with known traumatic hemoglobinuria. Also, even the djembe, bata, and conga players I know who play the hardest and longest don't get obviously rusty or dark colored urine often at all, only on occasion. Other than gastritis or pancreatitis due to overconsumption of alcohol commonly associated with drumming, I have not heard of drumming-related stomach discomfort in drummers. Next time you play pay attention to what you eat and drink before, during, and after playing. If the discomfort is not obviously related to food or drink, what you are experiencing sounds unusual. If it continues, you should get it evaluated by a physician.

SInce the discolored urine occurred again even after playing less hard, I recommend that you get a medical evaluation by an internist, urologist, or kidney specialist to make sure there is nothing else going on with your kidneys, bladder, or other parts of your urinary tract. This sounds unusual for drumming-related hemoglobinuria. Tell him or her all about your history of discolored urine, and your history of playing djembe with your hands. It would not be surprising if most internists in Ireland are not familiar with this cause of hemoglobinuria as it has only been rarely reported in the medical literature. The medical term is "march hemoglobinuria" or "traumatic hemoglobinuria". There have been several medical publications on this topic in the 1970s and one that I know of in 1994. Your doc can do a literature search and if he or she would like, I can email references for hard copy articles (the articles are too old to be available in pdf files).

[taikonoatama]

In the Armando Peraza interview that congalero had posted, Armando mentioned that he used to piss blood after a particular hard set. I'd heard this said by a teacher of mine as well. Thought I'd write in to "The Straight Dope" to see what the explanation might be.

Who knows if he'll find the question answer-worthy. Has this ever happened to any of you?

I just got an email from the staff there saying they posted the question on 2/27 (not my title, btw) and their answer is on the site:

http://www.straightdope.com/columns/rea ... piss-blood

http://boards.straightdope.com/sdmb/sho ... p?t=508495

James

PS. Our Dr. Jorge's prognosis of "march hemoglobinuria" (mashed blood cells) makes more sense to me than The Straight Dope's "rhabdomyolysis" (mashed muscle tissue), but I'm no expert.