The effect of empty bladder and not emptying the bladder on hematuria rate in student speed and endurance runners
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1 Available online at Procedia - Social and Behavioral Sciences 46 ( 2012 ) WCES 2012 The effect of empty bladder and not emptying the bladder on hematuria rate in student speed and endurance runners Behroz Khodayari a *, Abdulamir Saiiari b a Department of physical education and sports science, Darehshahr branch, Islamic Azad University, Darehshar, Iran b Department of physical education and sports science, Abadan branch, Islamic Azad University, Abadan, Iran Abstract The purpose of this research was to study the effect of empty bladder and not emptying the bladder on hematuria in student speed and endurance runners in 6 region branches of Islamic Azad University. Twenty six students were assigned in two groups of 400m and 5000m. The subjects participate in two stages with empty bladder and not empty bladder. Pretest urine sample were collected before each stage. The process includes activity with empty bladder for the first stage and after 72 hours activity with not emptying the bladder for the second stage. In each stage after 60 minutes urine samples were collected. To analyze data t-test ance groups (p<0.05). There is no significant difference in hematuria rate between sprinters with empty bladder and not emptying the bladder (p>0.05).but there is a significant difference in hematuria rate between long distance runners with empty bladder and not emptying the bladder (p<0.05). However findings of this study showed that speed and endurance activities cause an increasement in hematuria but hematuria was more observed with empty bladder for endurance activities Published Published by by Elsevier Elsevier Ltd. Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Uzunboylu Open access under CC BY-NC-ND license. Keywords: Hematuria, Empty Bladder, Not Empty Bladder, Speed Running, Endurance Running; 1. Introduction The main difference between Pathologic Hematuria and Hematuria associated with practicing is that the second one will be resolved after 48 hours (Gambrell, R.C. 1996).While the pathologic Hematuria is an abnormal chronic condition. The suggested mechanism attributes Hematuria with the factors such as increased blood circulation, increased body temperature (Newhouse, I and et al presence of red blood cell parser factor (Jones, G.R.2004). suppressing red blood cells by muscular activity, repeated blows to metatarsus while running (Cianflocco, A. J.1992) and stress of bladder and kidney caused by a physical hit or shaking during a run (Blacklock, N. J.1997). Although, researchers believe that one of the causes of Hematuria is bladder damage, but no study has examine the occurrence of Hematuria in natural conditions. Considering the fact that bladder is located in the innermost layer and has transitional epithelial which has strain capability (Thompso, N.C.1989). And this fact that when bladder is empty, the width of hole is reduced and layers are put together so the bladder's wall becomes thicker, but when the amount of urine is increased, the layers open from each other and bladder forms a pears shape and walls contact each other less. Therefore, the chance of Hematuria caused by bladder will be reduced (Thompso, N.C. 1989). So, * Behroz Khodayari. Tel.: address: behrooz1620@yahoo.com Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Uzunboylu Open access under CC BY-NC-ND license. doi: /j.sbspro
2 5746 Behroz Khodayari and Abdulamir Saiiari / Procedia - Social and Behavioral Sciences 46 ( 2012 ) considering what was mentioned so far, this study attempts to clear the effects of speed and endurance activities and also empty and not emptying the bladder before sport activities on Hematuria level of runners. 2. Methods Participants Statistical community of this research includes 26 speed and endurance runners, educating in area 6 Azad universities. These people considering their sport major were divided to two groups with 13 members each, Group No.1: Speed Runner 400 meter (13 people) and group No.2: Endurance Runners 5000 meter (13 people) Measurements In this study following instruments were used, height gauge for height measurement, accurate scale for measuring runners weights, special containers for gathering urine samples, Centrifuge instrument and microscope Olympus CX31 for computing the number of red blood cells in urine Procedure 48 hours before starting their running activity, the urine and blood sample were taken from the entire applicant in order to make sure they are healthy and if they had any problem, they become excluded from the statistical sample list. Then subjects performed their activities in two stages: 1- activity with empty bladder 2- activity with not emptying the bladder. According to programming, subjects attended the running tracks and pre test urine samples were taken from them. After warming up and doing some special exercises, we asked group one(400 meter) to empty their bladder completely and start their running activity, speed runners in this group performed their task in highest speed as in contests and after recovery we gave them 400 millilitre water so bladder could gather enough urine for post test. The same routines were done for group no.2 (endurance 5000 meter). When each group (speed, endurance) finished their practice, the post test was taken from them after 60 minutes in order to estimate the hematuria level. Stage 2: based on pre programmed plan, subjects attended running tracks 72 hours later. 30 minutes before starting the their activity they were asked to empty their bladder and those samples were gathered as pre tests, then they drank enough water so they have reasonable amount of urine in their bladder, then the 400 meter runners after warming up and stretching, started their practice in high speed like in the contest and 60 minutes after their activity they were asked to give their urine sample as a post test. The same routines were done for group no.2 (endurance 5000 meter). After finishing mentioned above stages, tests were taken to the lab for hematuria level evaluation in runners. T-dependent and-independent was used to analyse. 3. Results As it mentions in Figs 1 to 2, results shows a significant difference between pre test and post tests of speed between amounts of hematuria in endurance endurance group with empty and not emptying the er hand, pre test and post test with empty and not emptying the bladder tests of
3 Behroz Khodayari and Abdulamir Saiiari / Procedia - Social and Behavioral Sciences 46 ( 2012 ) Hematuria rate in sprint runners Hpf Not Empty Bladder pre- test post-test Empty Bladder Fig1, Comparison of hematuria rate in sprint runners with empty and not emptying the bladder Hematuria rate in endurance runners Hpf Not Empty Bladder Empty Bladder pre- test post-test Fig2, Comparison of hematuria rate in endurance runners with empty and not emptying the bladder 4. Discussion & Conclusion The findings of this study show that performing a speed run with both not emptying the bladder and empty bladder increases hematuria in runners significantly. But hematuria level in not emptying the bladder case did have significant difference with empty bladder so, we can say that hematuria caused by speed running happens due to kidney disorders and has nothing to do with bladder. These findings are compatible with Oosterom (2006), Bllinghieri (2008) and Oto, M and et al (2004) researches. Researchers attributed the occurrence of such cases with following mechanism; injuries caused by positional anemia in renal vascular system, injuries caused by hypoxic renal system, impaired renal function due to acid accumulation in the blood. Portman (1984), Alya (1958), Cianflocco (1992), Jones and et al (2003) declared that during intense training (more than 65% VO2max) it is possible that 900 ml/min blood deviate from kidney to active muscles and also tension due to adrenalin and noradrenalin hormone discharge of afferent arterivels vessels and glomerular efferent and decrease the amount of glomerular filtration and increase kidney's leakage variability. Also Abarbanel and et al (1990), Castenfors (1997)
4 5748 Behroz Khodayari and Abdulamir Saiiari / Procedia - Social and Behavioral Sciences 46 ( 2012 ) and Newhouse (1993) suggested that extensive trainings make kidney's system acidic and hypoxic, which can harm nephrons and will increase the glomerular permeability and proteins and erithrocites excretion from urine. Based on evaluating the findings of this research, we can say that performing an endurance running with not emptying the bladder and empty bladder showed significant difference in hematuria level of runners and comparing pre test to post test results, post tests had more hematuria. In other hand, there was a meaningful difference in hematuria levels between endurance runners with empty bladder and not emptying the bladder. Therefore, we can conclude that Hematuria caused by endurance running not only is due to kidney failure but also bladder has some influence in it. These findings are compatible with Albersen and et al (2006), Gerth (2002), Telford and et al(2003) reaserches. The researchers consider mechanism such as hemolysis due to foot stress, dehydration, increase of body temperature and existence of free radicals in blood as the cause of this matter. Telford and et al (2003), Falsetti and et al (1983), Poortmans (1984), Miller and et al (1988) suggested that one of the reason of Hematuria caused by sport is hemolysis due to foot stress. There is possibility that because of repeated stress to metatarsus while running, the red blood cells passing metatarsus become damaged and this makes them ruptured. If hemolysis is low, hemoglobins are not extracted by urine, because free hemoglobins mix with haptoglobin and are absorbed by liver cells. But if hemolysis is considerable free hemogloubins become more than absorption capacity of haptoglobin, the free hemoglobins are excreted through urine. also during long exercises that a high amount of body water is consumed, Hematuria can be one of the related issues. Gerth (2002), Helzer and et al (1988) and Clement and et al (1984) emphasized that increase of blood viscosity and smolarity inside eritrosites and intense acid condition after practice may cause excretion of old eritrocites. besides Rhoades (1992) and Gardner (1956) declared that resistance of red blood cells velum is weaken due to increased body temperature. This condition increases the velum's exhaustion and rupture of weaken red blood cells that eventually can lead to hemolysis. Also, Zbigniew (1990) and Rhoades (1992) suggested that extensive, tiresome exercises can create free radicals in blood that this combination can effect kidney and increase hemolysis of red blood cells. Based on findings of this research we can observe a significant difference between Hematuria levels of endurance runners with not emptying the bladder and empty bladder. The result of this study is compatible with researches done by Eichner (1990), Alberson and et al (2006) suggesting that stress of back wall of bladder on trigon is the cause of Hematuria in runners. considering the researches before and present study, we can discuss that if bladder is empty, the repeated friction of bladder layers, also the increased rub of bladder's behind surface on bladder trigon can cause damage and therefore, free red blood cells in urine and increase Hematuria level. But when enough urine is in bladder can prevent the friction of layers and occurrence of such damages. Hence, we can conclude that for preventing the increase of Hematuria, we should leave the habit of emptying our bladder before activity. References Abarbanel, J., Benet, A. E., Lask, D., Kimche, D.(1990). Sports hematuria. J Urol, 143: PP: Albersen, M., Mortelmans, A., Luc, J. M., Baert, J.( 2006). Mountainbiker's hematuria: a case report.european Journal of Emergency Medicine. 13 (4) PP: Alya, E. P., Parish, H. H. (1958). Renal response to exercise urinary findings. JAMA, 167: pp: Bellinghieri, G., Savica, V., Santoro, D.( 2008). Renal alterations during exercise. J Ren Nutr, 18(1): pp: Blacklock, N. J. (1997). Bladder trauma in the long distance runner: 10,000 metres hematuria. Br J Urol, 49: pp: Castenfors, J. (1997). Renal function during prolonged exercise.ann N Y Acad Sci, 301: pp: Cianflocco, A. J.(1992).Renal complications of exercise. Clin Sports Med, 11: pp: Clement, D. B, Sawchuk, L. L. (1984). Iron status and sports performance.sports Med, 1: pp: Eichner, E. R. (1990). Hematuria a diagnostic challenge. Physican sport Med, 18: pp: Falsetti, E. R., Burke, E. R., Field, R. D., Frederick, E. C., Ratering, C. (1983). Hematological variations after endurance running with hard and soft-soled running shoes.physician Sports Med, 11: pp: Gambrell, R. C. (1996). Exercise-induced hematuria. Am Fam Physician, 53: PP: Gardner, K. D. (1956. Athletic pseudonephritis alteration of urine sediment by athletic competition. JAMA, 161: PP: Gerth, J., and et al. ( 2002 ). The effects of prolonged physical exercise on renal function, electrolyte balance and muscle cell breakdown. Clin Nephrol. 57(6): PP: Helzer, M., and et al (1988). The effect of exercise intensity and hydration on athletic pseudonephritis. J Med Phys Fitness, 28: pp: Jones, G. R., Newhouse, I. J., Jakobi, J. M., Lavoie, N. L.,Thayer, R.( 2003). The incidence of hematuria in middle distance track running. Can J Appl Physiol, 26(4): PP:
5 Behroz Khodayari and Abdulamir Saiiari / Procedia - Social and Behavioral Sciences 46 ( 2012 ) Miller, B. J., Pate, R. R., Burgess, W. (1988). Foot impact force and interavascular hemolysis during distance running. Int J Sport Med, 9:p p: Newhouse, I., McInnis, M. (1993). Mechanisms of exercise hematuria. Thunder Bay ON:Department of Kinesiology Lakehead University, 72(4): pp: Oosterom, D. L., Betjes, M. G.(2006). Exertion-related abnormalities in the urine. Ned Tijdschr Geneeskd, 27; 150 (21):1206 Ota, M., Ozono, S., Ikeda, T.(2004). Analysis of sports hematuria after running in summer.nippon Hinyokia Gakkai Zasshi, 95(5):pp: Rhoades, R., Saunders, R.(1992). Human physiology. 2ned ed. Fort Worth, TX: College Publishing (chapter 6). Poortmans, J. R. (1984). Exercise and renal function. Sports Med, 1: Telford R. D. and et al.(2003). Footstrike is the major cause of hemolysis during running. Appl Physiol, 94: Thompso, N. C. (1989). Evaluation of hematuria. Physician Assistant, 13: Zbigniew, S. (1990). Erythrocitic system under the influence of physical exercise and training. Sports Med, 10: pp:
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