Saturday, February 05, 2005

Causes of Scrotal Bleeding

As I mentioned to some of you yesterday, I have found it quite interesting that one of the greatest sources of hits to our site is from various search engines where people are looking for causes of Scrotal Bleeding. This is thanks to the Flash's piece on the shorn scrotum. I'm sure that it is also partly due to the fact that there is not a lot of material out there on scrotal bleeding. When I see these hits from the search engines, I just can't help but picture an intern getting a call in the middle of the night from the floor or ER to go see a patient with a bleeding scrotum that just won't stop. I thought we should do our best to give help on this subject on which there is obviously a deficiency of literature available. So I will get the ball rolling (pun intended), but will also count on input from the bossman who is the only member of the CC who can proudly boast that he has intentionally caused bleeding of the genitalia of any kind, through circumcision, on a another member of the CC.

Trauma- Since trauma is by far the most common cause of scrotal bleeding the discussion may need to focus on what to do about it.
Obviously any large trauma to the genitalia would require the consultation of a urologist or general surgeon, and therefore be out of the scope of this text.
For smaller infractions however, you have to address a key point. Is the degree of bleeding appropriate for the injury? If so then a thourough exam and wound closure may be all that is required. As noted by the Flash in his experience, chemical cauterization was attempted with apparent initial success. But when he began bleeding again, the area was sutured, with success.
If the scrotal bleeding appears to be greater than you would expect from the size of the injury you have to ask yourself what else is going on.
-Is there a clotting disorder? I believe brad told me that this guy was on coumadin which may have contributed, or what about haemophilia, von Willebrand's disease, and thrombocytopenia? Does he have Liver disease?
Or, as the bossman did mention, there could be vascular ectasia, and he therefore gets partial credit, but did not mention by name a specific disorder known as Angiokeratoma of Fordyce. This is a condition in which you may see typically asymptomatic, 2- to 5-mm, blue-to-red papules with a scaly surface located on the scrotum, shaft of penis, labia majora, inner thigh, or lower abdomen. It is benign and the main complication is bleeding. Spontaneous resolution has not been described and it has been treated with excision, cryotherapy, electrocautery, and laser treatment. Another related disorder is known as Angiokeratoma Circumscription, also here is an interesting case of case of angiokeratoma corporis diffusum.

That is about all I could find today. Luckily I have not encountered any bewildering cases of scrotal bleeding, but hopefully when I do, I will at least be able to sound smart if I can remember to say "He could have Angiokeratoma of Fordyce"

Whoa Nelly!! I almost forgot the Classic "There's Something About Mary" Trapped Zipper Syndrome! Obviously that won't be a mystery but, here are some Clinical Practice Guidelines Man, I'm glad I didn't let someone else have that one.

posted by Clay @ 2/05/2005 09:38:00 AM   22 comments

22 Comments:

At 3:11 PM, Blogger brad said...

You forgot to add as another etiology of scrotal bleeding- foreplay gone wrong, which could be the most likely etiology in our pt population.

 
At 5:54 PM, Blogger Shane said...

I asked the bossman about the said circumcision of one our members. He said, to the best of his memory, that the person in question was "Hung like a groundhog." I guess that's a compliment.

 
At 6:07 PM, Blogger joe said...

Well, angiokeratoma of Fordyce is a great dx to remember, but if you note vascular ectasis is the mechanism of action and in my opinion best describes the pathology.

Please don't undertake removal of these lesions with conventional treatment--argon lasers are reported to produce exceptional results.


Another cause of scrotal bleeding must include varicocele, usually on the left due to anatomy (lt. testicular vein drainage into lt. renal vein).

In general varicose veins and coumadin can lead to MASSIVE bleeding. My only clinical experience was in the lobby to the Royal Sonesta in N.O. years ago, overwt white female on the ground and blood EVERYWHERE. Of course, the only thing was compression and elevation of the leg until the ambulance came.

 
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At 5:45 AM, Blogger Cryotherapy said...

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At 8:31 AM, Anonymous Anonymous said...

is spouting blood in several spots. When I dry up the spot there is no mark where it bled. Then another spots starts to bleed. I discovered about 4 different spots where blood spouted and there was a lot of blood on the towels and floor mat etc. But due to his numerous medical problems I want a doctor to see him rather than depend on the internet, but thank you for the information that seems to alleviate my worry until we get there. You see among other things he has Diastolic CHF, CRF Stage 4 and anemia.

 
At 7:37 AM, Anonymous Anonymous said...

I woke and felt moisture on my leg. I'd just been up to uninate and thought I might be leaking urine but discovered blood on my thighs and discovered it was dripping from my scrotum onto the floor. I applied light pressure with a wad of paper towels and eventrually sat down with some under my scrotum, which stopped the bleeding. I had previously found blood on my thighs and drops on the floor but wasn't able to determine where it came from. In both cases, there was no pain and no trauma.

 
At 6:05 AM, Anonymous Anonymous said...

After a trip to the bathroom I noticed a lot of blood on my scrotum and left inner thigh. It literally seemed to becoming out of a pore in my skin. The blood was very dark and the bleeding continued for 15-20 mins. There was no pain and I hadn't cut myself with a nail or anything, I'd actually just been watching tv. The mark left is so small its very hard to see.

Should I be worried at all?

 
At 6:55 PM, Anonymous Darr said...

Anonymous, Your discription of your bleedind is the exact experiance that had this morning after drying off after a shower. I too would like to know if I should be worried and what action is needed.

 
At 10:44 AM, Anonymous Anonymous said...

I've had the exploding capillary on my scrotum once a year now for five years. The 1st time was on a sailboat many miles from assitance and stopped the bleeding with gauze and a large paper clip. Since then I have noticed that I will accumulate many of these bulging capillaries until there is a rupture and all of the little sacks drain. I always carry another pair of pants in my hand carry on plane rides! Guess I should see about getting it fixed.

 
At 7:55 PM, Blogger Talltoddler said...

I often have itching sensation in the
inner thighs and in the scrotum area.
Inadvertently I scratch these places during sleep in the night.
I had the impression that my nails probably caused the bleeding. I was wrong. During the last 2 years on 3 occasions, I had scrotum bleeding which lasted for 2 to 3 mts. but it left no trace of its location. I was able to stop the bleeding by applying cold water and ice cubes.
I am anxious that it might catch me
with pants down at public parties.
I am sixty and I am diabetic. Is there anything seriously wrong with me? I am anxious about this.

 
At 10:59 PM, Anonymous Anonymous said...

Just another sign your not as young as you once were

 
At 10:47 PM, Blogger The Lost Dutchman said...

01/12/12 2127

Like any other time nature calls, got up from the couch, scratched my nuts, walked into the bathroom, relieved myself and zipped up. I felt a wet spot in my britches, ok, just a little dribble. Thought I'd check the spot for drying and noticed the blood on my fingers, WTF! Back to the bathroom, no blood in the can. Unzipped my britches and it looked like a hog had been slaughtered. Bloody boxers, pants, sock and shoe. Started cleaning up but could not find the origin. Finally I realized its source , placed a small bandage on the sack and began my search here and any other related site. Nothing to worry about accept, how the hell will I wash my nuts going forward!

 
At 1:36 PM, Anonymous Anonymous said...

Hello everyone, I came to this site to learn about my similar scrotem bleeding. It shows up in my underware mostly when I am surprised to sit down on the toilet and find it. I have taken a magnifying mirror in search of where it is coming from and unable to locate it. Now this moring I drying myself down there and to my surprise for the first time it was on my towel. So will have to visit the doctor and learn more. Do hope there is no other types of problems with this.

 
At 8:26 AM, Blogger Paul Alters said...

I'm a 60 year old male and I was sitting at my desk and felt wetness on my leg, took a look and found blood on my hand, leg and my scrotum. After investigation I realized I was bleeding from a vein on my scrotum at a healthy drip, drip drip.

It's been bleeding for over 2 hours now and pressure stops it but as soon as I release pressure it starts up again. I have gauze and a clothes pin on it to keep it under control and am hoping it will stop soon. I've had no recent injury to the area. Neve had this issue before.

 
At 1:04 AM, Anonymous Anonymous said...

Happen to me just now. 2hours and going....its due to those red small sacks on your sac. Tissue or toilet paper with a paper clip (get used to the pain) leave it for an hour. Het in a cold room, air on full blast. Lie naked with your call sack higher than your chest. Bleeding then stops.

 
At 7:35 PM, Anonymous Anonymous said...

I found that putting on a jock strap with tissue inside seems to apply enough pressure to stop mine fairly quickly (10-15 minutes) shorter if I put a cold pack on it and raise the area above my chest.

 
At 4:49 PM, Anonymous Anonymous said...

BEST REMEDY I FOUND WAS WATER AS COLD AS YOU CAN GET IT IF JUST AFTER A SHOWER. ANY OTHER TIME IF CAUGHT WITH YOUR PANTS DOWN ICE AND VERY COLD COMPRESSES.

 
At 7:07 PM, Anonymous Larry N. said...

I am 75 and had a bleeding scrotum for 5--6 years.I am on cumadin (blood thinner), and baby aspirin. Made several trips to the E.R.--All they did was put some kind of ointment on it to stop the bleeding. It last for 4 days (hard seal) The Doc. said the skin is very thin on the sac. I carry a potato chip bag clip with me at all times, although it never bled on me only in the shower. I am ready to have the sac cut off if that is possible. My Doctor said that there is no vitamin or magic potion that can toughen the skin on the sac.

 
At 11:24 AM, Blogger jermaine white said...

I have gotten hit under my balls at work and it's hard for me to take a piss but I'm spotting blood a little bit and I'm uncircumcised

 
At 11:33 AM, Anonymous Anonymous said...

Several people have said that it is very difficult to stop the bleeding. I had this happen once and was able to put a small round bandage on it and press it until it stuck. I first trimmed the hair and then shaved that area of the scrotum. Even with this technique it took several tries -- but it did eventually work. It was the classic case - after a shower and towel dry, almost invisible pin prick and "non-stop" bleeding. To make things worse I am on blood thinners. I also found that lying down to elevate the scrotum was once of the best things you can do to stop the bleeding.

 
At 11:39 AM, Anonymous Anonymous said...

My wife gave me one of those stick-on pads used for menstrual bleeding as a safety move. I haven't used it yet, but it seems like a good idea.

 

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