Hematuria Following Colonoscopy with Polypectomy

Primary Consideration: Post-Polypectomy Bleeding

Delayed bleeding occurs in 2-8% of colonoscopy cases with polypectomy and can present up to 15-30 days after the procedure, resulting from sloughing of the eschar at the polypectomy site 1, 2, 3
The bleeding is usually self-limited and resolves with supportive care in more than 70% of cases 1, 2
Patients may mistake rectal bleeding or blood in the toilet bowl for hematuria, especially if they are not carefully observing the source of bleeding 1
This is a common clinical pitfall that should be clarified through careful history-taking about whether blood is seen during urination, mixed with stool, or in the toilet water 1

Colonoscopy can rarely cause direct trauma to adjacent structures including the bladder or ureters, particularly during difficult procedures or in patients with anatomical variations 1
Although rare, colonic perforation can involve adjacent urinary structures, leading to true hematuria 1

Observational data shows that aspirin continuation does not significantly increase post-polypectomy bleeding risk compared to patients not taking aspirin 4, 5
Some studies report aspirin as an independent risk factor for delayed bleeding with large colonic EMR, while others show no increased risk 4, 5

True hematuria may be unrelated to the colonoscopy, arising from bladder malignancy or prostatic disease 5

Obtain urinalysis with microscopy to confirm presence of red blood cells in urine versus contamination from rectal bleeding 6
Check hemoglobin level to quantify blood loss 6
Monitor vital signs for hemodynamic instability 1
If true hematuria is confirmed, perform cystoscopy to identify urological source 6
If rectal bleeding is suspected, consider repeat colonoscopy for hemostasis using injection of 1:10,000 epinephrine followed by thermal therapy or clipping 1, 2