Hematuria Causes, Signs, Symptoms, Diagnosis, Treatment And Prevention

Hematuria Causes, Signs, Symptoms, Diagnosis, Treatment And Prevention


Hematuria (Blood in the Urine)


Blood in the urine is a common problem. The medical term for red blood cells in the urine is hematuria. If there are only a small number of red blood cells in the urine, the urine color might not change and the blood cells are only apparent under a microscope. This is usually referred to a microscopic hematuria. Larger amounts of blood in the urine can cause a discoloration of the urine from a light pinkish hue to a dark red or even brown appearance. This is known as gross hematuria or macroscopic hematuria. Sometimes blood in the urine is a sign of a serious problem in the urinary tract, while other times it is not serious and requires no treatment. Only after a thorough evaluation by a health care professional should blood in the urine be attributed to a nonserious cause.

Hematuria Causes, Signs, Symptoms, Diagnosis, Treatment And Prevention
Hematuria (Blood in the Urine)

Kidneys: You have two kidneys, located closer to your back than your front at about waist level. The kidneys filter the blood in your body and produce urine.

Ureters: These narrow, hollow tubes carry urine from the kidneys to the bladder.

Bladder: The bladder is a balloon-like organ that holds urine until it is convenient for you to empty your bladder (urinate).

Urethra: This narrow, hollow tube carries urine from the bladder to the outside of your body. The flow of urine is controlled by internal and external sphincter muscles, which tighten or relax around the urethra, holding or releasing urine.

In men, the genitals and prostate are considered part of the urinary system. The prostate surrounds the urethra in men. It is made up of glands that secrete a fluid that is part of semen. The prostate often becomes enlarged in older men.

Blood in the urine is not always visible. If the amount of blood is small, the urine can look normal. This is called microscopic hematuria because the blood cells are visible only under a microscope. Typically, this is discovered when the patient has a urine test for some other reason or as part of a screening examination.

When there is enough blood to be visible, the urine may look pinkish, red, or smoky brown (like tea or cola). This is called gross or frank hematuria. It takes very little blood in urine to be visible -- about 1/5 of a teaspoon in a half quart of urine.

A trace amount of blood in your urine can be normal but needs to be observed and followed by a health care professional.

An abnormal amount of blood in the urine can be acute (new, occurring suddenly) or chronic (ongoing, long term). Acute hematuria can occur just once, or it can occur many times.

Sometimes the urine can appear with a color, indicating hematuria, though the urine actually does not contain red blood cells but rather is discolored by medications or foods. This can be distinguished by a urinalysis (UA) test.

Up to 10% of people have at least one episode of hematuria. About 3% of people develop gross hematuria.

  • Women develop hematuria more than men because women are more likely to have urinary tract infections, and these infections may lead to hematuria.
  • Older adults, especially men, have hematuria more often than younger people because they are more likely to take medications that can irritate the urinary tract, or have enlargement of the prostate, or cancer.

Causes of Hematuria (Blood in the Urine)


Hematuria has many different causes.

  • Blood in the urine can come from any condition that results in infection, inflammation, or injury to the urinary system.
  • Typically, microscopic hematuria indicates damage to the upper urinary tract (kidneys), while visible blood indicates damage to the lower tract (ureters, bladder, or urethra). But this is not always the case.
  • The most common causes in people younger than 40 years of age are kidney stones or urinary tract infections.
  • These may also cause hematuria in older people, but cancers of the kidney, bladder, and prostate become a more common concern in people older than 40 years of age.
  • Several conditions causing hematuria may exist at the same time.
  • Some causes of hematuria are serious and others are not. Your health care professional will perform tests to help tell the difference.

The well-known causes of blood in the urine include the following:

  • Kidney stones
  • Infections of the urinary tract (UTIs) or genitals
  • Blockage of the urinary tract, usually the urethra, by a stone, a tumor, a narrowing of the opening (stricture), or a compression from surrounding structures
  • Cancer of the kidney, bladder, or prostate
  • Blood-clotting disorders
  • Injury to the upper or lower urinary tract, as in a car accident or a bad fall (especially falls onto your back)
  • Medications: antibiotics (for example, rifampin [Rifadin]), analgesics such as aspirin, anticoagulants (blood thinners such as warfarin, [Coumadin]), phenytoin (Dilantin), quinine (Quinerva, Quinite, QM-260)
  • Benign (noncancerous) enlargement of the prostate known as benign prostatic hypertrophy (BPH), a common condition in older men
  • Chronic diseases such as diabetes, hypertension, and sickle cell anemia
  • Viral infections
  • Inflammation of the kidney, usually of unknown cause
  • Strenuous exercise, especially running, results from repeated jarring of the bladder. In one study, 24% of runners who competed in an ultramarathon had hematuria after the race. The hematuria disappeared within 7 days. A 20% incidence has been found in marathon runners.

Sometimes no cause is found for blood in the urine.

  • If serious conditions such as cancer, kidney disease, and other chronic diseases that cause kidney damage or bleeding are ruled out, the cause is usually not serious.
  • The hematuria will probably go away by itself or continue as a chronic condition without doing harm. Any changes should immediately trigger a return visit and evaluation by your health care professional.

Urine can be colored pink, red, or brown for reasons that have nothing to do with bleeding in the urinary tract, such as:

  • Foods such as beets, berries, and rhubarb in large amounts
  • Food colorings
  • Medications: Different medications can change your urine color (Phenazopyridine [Pyridium], a pain reliever affecting the lower urinary tract, can change body fluids including urine color to orange.).
  • Menstrual blood or vaginal bleeding that is mistaken for hematuria
  • Liver diseases: These may also be very serious causes of discolored urine.

Hematuria (Blood in the Urine) Symptoms and Signs


Blood in the urine is itself a symptom rather than a disease. The appearance of the urine is usually not a clue as to the cause.

  • In gross hematuria, the urine appears pinkish, red, or smoky brown (like cola or tea). There may be small blood clots. The amount of blood in the urine is not correlated with the seriousness of the condition.
  • In microscopic hematuria, the urine appears normal.

Many people with hematuria have no other symptoms. Other symptoms that may be present are related to the underlying cause of the bleeding.

  • Pain in the flank (side of the body between the ribs and the hips), back, lower belly (abdomen), or groin
  • Burning sensation or pain when urinating (dysuria)
  • Fever
  • Nausea or vomiting
  • Decreased appetite
Kidney stones: Not all people with kidney stones have all of these symptoms.

  • Pain, often severe, in the flank, back, or lower abdominal pain that may radiate to the groin area. In men, the pain will often radiate into the scrotum.
  • Nausea and vomiting
  • Usually a normal temperature
  • Frequent urination
  • Burning sensation with urination
  • Restlessness: constant moving around (writhing) to find relief from pain

Urinary tract infection: Symptoms may be similar to those of kidney stones.

  • Pain in lower back, flank, lower abdomen, or groin may be severe but not enough to cause writhing.
  • Fever with or without chills
  • More frequent urination
  • Sensation of having to urinate but little urine produced (urinary urgency)
  • Burning sensation or pain with urination
  • Cloudy urine due to pus in the urine

How is blood in urine diagnosed?


The evaluation for blood in urine consists of taking a history, performing a physical examination, evaluating the urine under a microscope, and obtaining a culture of the urine. Lower urinary tract symptoms, such as urgency (feeling a strong need to urinate) and frequency (needing to urinate frequently), as well as the presence of fever and/or chills are suggestive of infection. Recent trauma, even if believed by the patient to have been inconsequential, should be considered as a potential cause. Abdominal and/or flank pain, especially if radiating to the inguinal or the genital area, may suggest kidney stones. All recent medications, including vitamins or herbal supplements, should be reviewed with the health-care provider. However, it is important to note that even if the patient has been taking a medication that is associated with bleeding, a full workup (as listed below) should still be undertaken.

The physical exam will focus on possible sources of hematuria. Bruising over the back or abdomen may indicate trauma. A digital rectal exam should be performed, as findings consistent with prostatitis (for example, tenderness on palpation of the prostate) or an enlarged prostate (suggestive of BPH or benign enlargement of the prostate gland) may be useful in making a diagnosis. A repeat urinalysis, as well as a urine culture, should be obtained. The presence of white blood cells on urinalysis is more consistent with a urinary tract infection. Protein, glucose, or sediment in the urine may indicate the presence of a disease of the kidneys. Blood tests are also important, as they will aid in assessing renal function and identifying any clotting abnormalities.

In addition to the basic history and physical exam, there are three additional components for any workup of hematuria: CT scan, urine cytology, and cystoscopy.

The CT scan is an imaging evaluation of the urinary tract. Prior to the procedure, the patient drinks an oral contrast agent and a dye is injected intravenously. The patient then goes through the CT scan machine and images are taken of the abdomen and pelvis. Another test that can be performed, the intravenous pyelogram (IVP), is also a type of X-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of X-rays are then taken over a 30-minute period to look for abnormalities. The CT scan is more commonly performed than the IVP to evaluate the urinary tract and should be considered the test of choice. Both of these studies are especially useful for evaluating the kidneys and ureters but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. This is a simple 10-minute procedure wherein a thin, flexible cystoscope (or fiberoptic camera) is inserted via the urethra into the bladder in order to directly visualize any lesions or sources of bleeding. This is usually done with local anesthetic jelly injected into the urethra. Finally, urine cytology involves giving a urine sample to be analyzed by a pathologist for the presence of cancerous or abnormal-appearing cells.

How is blood in urine treated?


Treatments for hematuria vary widely and depend wholly upon the reason for the bleeding. It is important to note that there is often no source found for the hematuria. This should not be a source of major concern, however, since an appropriate workup effectively rules out the most serious causes of hematuria (for example, cancer). In cases where a workup is negative and the cause of the hematuria remains unknown, observation with repeat urinalyses is a reasonable option. A blood test to check kidney function and a blood-pressure check should be done as well. Men over 50 should discuss with their doctor the yearly prostate-specific antigen (PSA) blood test to screen for prostate cancer.

Further discussion of the treatment for hematuria would depend upon the results of the previously mentioned workup and the exact cause for the hematuria. The urologist who performs this examination would direct any further treatment or workup that would be necessary.

Blood in the Urine Medical Treatment


Many conditions can cause blood in the urine. Some of these have no medical significance and do not require treatment. They usually go away by themselves. Others can be serious and require immediate treatment. Treatment depends on the underlying cause of the bleeding. Anytime you notice blood in the urine you need to consult a health care professional for an evaluation.

Kidney stones:


 For most cases of kidney stones, you will be told to drink plenty of water and other fluids and to take pain-control medications.

Most stones will pass through urinary system by themselves. In certain instances, more extensive treatment measures may be required.

One form of therapy, called extracorporeal shock wave lithotripsy, uses sound waves to break up the stones. The smaller pieces can then pass through the urinary tract more easily, though some pain will remain.

Another form of therapy uses cystoscopy to find the stone in the ureter and then to grab and remove it with a small scoop.

Urinary tract infection: 


Treatment seeks to get rid of the bacteria responsible for the infection. If you have no other significant illness, you will take a course of antibiotics for 3 to 14 days, depending on the source of the infection.

Benign prostate enlargement: Sometimes eliminating certain foods and medications that irritate the prostate can help shrink the prostate. Sometimes medication is necessary.

Medications: 


If a medication is causing hematuria, you and your health care professional should weigh the benefits and risks of the medication. Some medications only discolor the urine without actually causing hematuria. Your health care professional should determine if these can be continued. Do not stop a medication without talking it over with your health care professional.

Urinary tract blockage: 


A blockage usually requires surgery or other procedure to correct or remove the block.

Injury: 


These may heal over time, or you may need surgery or another procedure to repair the injury or remove the damaged tissue.

Prevention for Blood in urine (hematuria)


It's generally not possible to prevent hematuria, though there are steps you can take to reduce your risk of some of the diseases that cause it. Prevention strategies include:

Urinary tract infections


Drinking plenty of water, urinating when you feel the urge and as soon as possible after intercourse, wiping from front to back after urination, and avoiding irritating feminine hygiene products may reduce your risk of urinary tract infections.

Kidney stones


To help lower the likelihood of kidney stones, drink lots of water and limit salt, protein and oxalate-containing foods, such as spinach and rhubarb.

Bladder cancer


Stopping smoking, avoiding exposure to chemicals and drinking plenty of water can cut your risk of bladder cancer.

Kidney cancer


To help prevent kidney cancer, stop smoking, maintain a healthy weight, eat a healthy diet, stay active and avoid exposure to toxic chemicals.