Hematuria is blood in the urine.
Finding blood in urine can be frightening, however, it is a common urologic condition that often times points to an underlying medical problem. There are two types of hematuria: gross and microscopic. When an individual can visibly see blood in their urine, this is known as gross hematuria. The color of urine may appear as light red, pink, brown, or bright red. If blood is only visible under a microscope, it is known as microscopic hematuria. Generally, this occurs as an incidental finding during urinalysis testing. In either case, it’s important for a doctor to determine the root cause of the blood. Sometimes, finding blood in a person’s urine constitutes an emergency situation that requires immediate attention. It can be important for medical providers to quickly determine the source of the blood, and to treat it immediately.
Symptoms of Hematuria
Blood may be present without any identifiable pain depending on its source. Likewise, individuals may be experiencing pain if a more serious condition, such as kidney stones or cancer, is the underlying cause. Hematuria can also be associated with other urinary symptoms such as urinary frequency, urgency and dysuria (or painful urination). Blood in the urine may be the only sign of significant underlying disease, especially when no other symptoms are noted.
Detecting microscopic hematuria when blood isn’t visible in the urine.
Microscopic hematuria, is diagnosed when blood is detected by the presence of red blood cells only found during laboratory testing or an in-office urinalysis. Microscopic hematuria may not have any symptoms, or it may be present along with various symptoms. In this case, the individual might be alerted to possible health problems by an unexplained fever, lower back pain, flank pain, pain while urinating (dysuria), high blood pressure, swelling, or stomach pain. While these symptoms may or may not be tied to microscopic hematuria, they could be signaling an underlying urologic condition, such as kidney stones, that should be evaluated.
What causes blood in the urine?
There are several reasons why blood may be appearing in the urine. Some of these reasons may be more concerning than others. Whenever blood is present, a diagnostic workup is warranted. Simple explanations, such as menstruation, can explain the presence of blood. Similar factors, such as sexual intercourse or strenuous exercise, may contribute to blood in the urine, but are clearly not medical emergencies. On the other hand, microscopic hematuria could be pointing to a hidden medical problem.
. Medical and non-medical causes of blood in the urine may include:
- Urinary tract infection
- Strenuous exercise
- Medications
- Trauma or injury
- Sexual intercourse
- Menstruation
- Kidney infection
- Kidney stones
- Bladder stones
- Prostatitis – inflammation of the prostate
- Benign Prostatic Hyperplasia (BPH) also known as an enlarged prostate
- Blood disorders such as Hemophilia or Sickle Cell Anemia
- Bladder cancer
- Kidney cancer
- Prostate cancer
When discovering blood in the urine, it will help your provider to have as much information as possible to assist them in narrowing down possible hematuria causes. By answering the following questions, the patient will be able to help guide the urologist in making a more accurate and timely diagnosis.
What color is the blood?
Hematuria can appear as a range of colors. It is common for patients to describe their urine as reddish pink in color, to a darker cola shade, or even a vivid red. It does not take a large quantity of blood to affect the shade of urine. Even a small amount of blood cells can cause a noticeable change. Although the doctor will perform an in-office urinalysis test, it is helpful if the patient is able to accurately describe the color of their urine when blood was first detected.
What symptoms are you experiencing?
Along with the color of their urine, it helps the urologist to know if the patient is experiencing any other unexplained symptoms. Some cases of hematuria do not appear to have any symptoms, aside from the urine change. However, if accompanying health changes are apparent, however small, it’s important to note them and discuss them with your provider. Health changes such as body pain, painful urination, a burning sensation while urinating, or even frequent urination should be discussed. Fever, along with pain located in the flank or back, can be signs that something may be affecting the kidneys.
Have your activities changed?
Hematuria is possible among athletes due to consistent or strenuous exercise. Health experts theorize that dehydration, bladder trauma, and a breakdown of red blood cells may be the a result of these strenuous activities. At times, exercising can have a traumatizing effect on the body, especially if it is a relatively new habit or is particularly intense. If you notice urinary bleeding near or during times of intense exercise, alert your doctor.
What medications are you currently taking?
Carefully consider the medications you are currently taking, including supplements. Anticoagulants, such as aspirin and blood thinners, have been known to cause urinary bleeding. In addition, some anti-cancer drugs have been connected to this condition. Talk to your doctor about any medications you take and discuss their possible side-effects.
Possible Health Causes
Ultimately, hematuria is the symptom of an internal issue involving the urinary tract. For men, prostate issues is an added concern. When problems such as infections, kidney stones, cysts, tumors, and enlarged prostate, the body responds with symptoms to raise awareness of the problem. Hematuria is not the primary issue that needs treatment, but rather the undiagnosed condition.
Evaluation and treatment of blood in the urine
When hematuria is unexplained or recurrent, it is important to have a comprehensive evaluation performed to rule out a significant underlying disease or condition. A typical evaluation for hematuria includes a CT urogram (also referred to as a CT-IVP), as well as a cystoscopy. A cystoscopy is a procedure in which a small camera is passed through the urethra into the bladder to visually inspect the bladder walls. Both of these tests are generally performed in the urologist’s office. Other radiographic tests such as ultrasound and MRI are used occasionally depending on the medical scenario of the individual patient.
Once a cause for the hematuria is identified, treatment options can be discussed. When no cause for the blood is identified referral to a nephrologist, or kidney specialist, may be recommended. If cancer is diagnosed, your provider will work with an oncologist to treat your condition.
If you can clearly see blood in your urine, either contact our office to determine if a visit is recommended, or if you should proceed to an emergency room.
