Blood In Urine (Hematuria)

1 What is Blood in Urine (Hematuria)?

The appearance of blood in your urine is called hematuria.

In most instances, blood in the urine may be due to benign causes, while other times, it can indicate a serious underlying disorder.

Blood that can be seen in the urine with naked eye is called gross hematuria, whereas urinary blood that can be detected only during microscopic examination is called microscopic hematuria.

Regardless of the type of hematuria, it is important to find out the reason for blood appearing in the urine.

The treatment is planned based on the underlying cause.

2 Symptoms

There will be no symptoms in most of the patients with microscopic hematuria, whereas with people who have gross hematuria, the urine turns pink, red, or cola-colored.

This change in color is due to the presence of red blood cells in the urine. A slight amount of blood in the urine can change its color.

There may not be any other signs, but if blood clots appear in your urine, it can cause pain.

Other notable factors

Sometimes, taking medications such as the laxative Ex-lax and the intake of certain vegetables such as beetroot, rhubarb and berries can turn your urine red.

It is important to see your doctor whenever you notice abnormally colored urine as bloody urine cannot always be due to medications or exercise.

3 Causes

Blood in Urine (Hematuria) is caused when your kidneys or other parts of the urinary system release blood cells into urine.

There are several reasons for blood to leak into your urine, which may include:

  • Urinary tract infections: Urinary tract infections happen when bacteria gains entry into your body through the urethra and starts multiplying in your bladder. Symptoms include a persistent, frequent urge to pass urine, pain and burning sensations during urination and extremely foul smelling urine. In older adults, the only sign may be microscopic hematuria.
  • Kidney infections: Kidney infections (pyelonephritis) occur if bacteria enters your kidneys from circulating blood or by moving upwards from your ureters. Signs and symptoms are similar to bladder infections, but are more likely to cause fever and pain in the flank area.
  • A kidney or bladder stone: The minerals of concentrated urine precipitate out leading to crystal deposition on the walls of your kidneys or bladder. Gradually, these crystals develop into small, hard stones. These stones are usually painless, and you will not be aware of these until there is a blockage. Bladder or kidney stones can cause both gross and microscopic bleeding.   
  • Enlarged prostate: The prostate gland often gets enlarged as men reach middle age. The enlarged gland compresses on the urethra causing partial blockage in the urinary flow. Signs and symptoms of an enlarged prostate include either visible or microscopic blood in the urine, difficulty urinating and the persistent need to urinate.
  • Kidney disease: Microscopic blood in the urine is a common symptom of glomerulonephritis. Glomerulonephritis may occur along with diabetes or on its own. It can also be due to viral or bacterial infections, blood vessel diseases (vasculitis), and immune problems such as IgA nephropathy, which affects the tiny capillaries (glomeruli) that filter blood in the kidneys.
  • Cancer: Visible blood in the urine may be a sign of advanced stages of kidney, bladder or prostate cancer.
  • Inherited disorders: Sickle cell anemia, a disorder affecting the hemoglobin in red blood cells can cause both visible and microscopic hematuria. Alport syndrome that affects the filtering membranes in the glomeruli of the kidneys may also cause hematuria.
  • Kidney injury: A direct blow or other type of trauma to your kidneys, either from an accident or contact sports can cause visible blood in your urine.
  • Medications: A drug used to treat cancer such as cyclophosphamide (Cytoxan) and antibiotics such as penicillin can cause blood in the urine. Visible urinary blood sometimes occurs if you are on anticoagulant therapy such as aspirin, and the blood thinning agent heparin.
  • Strenuous exercise: Strenous and sustained aerobic exercising may cause dehydration, bladder trauma and the breakdown of red blood cells. Long-distance runners are the most affected, although any athlete can experience visible urinary bleeding after an intense workout.

4 Making a Diagnosis

At the time you make an appointment, be sure to ask about any restrictions in advance so that you can prepare for common diagnostic tests for Blood in Urine (Hematuria). 

Make a list of the following:

  • All the symptoms you are experiencing, including those that may seem unrelated to the current condition.
  • Key medical information, including other conditions for which you are receiving treatment, and any medications, vitamins or supplements you are taking regularly.
  • Questions to ask your doctor

For hematuria, some of the basic questions you may ask your doctor include:

  • What may be the causes of my symptoms?
  • What type of tests do I need?
  • Do these tests need any special preparation?
  • What is the best treatment available?
  • I have other health problems. How can I best manage them together?
  • Do you have any brochures or recommended websites for further research?

Your doctor may ask you a number of questions, such as:

  • Do you have pain when you pass urine?
  • Do you see blood in your urine every time?
  • Do you see blood in your urine when you start urinating, or does it become apparent towards the end of your urine stream? Or is blood seen in your urine stream the entire time you are urinating?
  • Do you see blood clots in your urine?
  • What is the size and shape of the blood clots?
  • Do you smoke?
  • Are you exposed to chemicals at your workplace? What kind of chemicals?
  • Have you undergone radiation therapy at any time?

Apart from the physical examination and discussion of your symptoms, your doctor may order following tests to determine the cause for bloody urine:

  • Urine tests: Even if the hematuria was discovered during urine testing (urinalysis), you may have another test to check whether your urine still contains red blood cells. Urinalysis may also detect a urinary tract infection or the presence of minerals that cause kidney stones.
  • Imaging tests: Often, an imaging test may be required to find out what is causing blood to appear in your urine. Your doctor might recommend a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan or an ultrasonography.
  • Cystoscopy: With this procedure, your doctor passes a thin tube attached with a tiny camera into your bladder for closer examination of both the bladder and urethra for signs of disease. Sometimes, when the cause for urinary bleeding remains occult, your doctor may advise follow-up tests regularly, specially if you are at a greater risk for bladder cancer.

5 Treatment

The treatment of blood in urine (Hematuria) focuses on management of the underlying cause.

This might include treatment of a urinary tract infection with antibiotics, a prescription medication to shrink an enlarged prostate gland or shock wave therapy to break up the bladder or kidney stones.

If there is no serious underlying condition, no specific treatment will be required.

6 Prevention

You can follow certain preventive measures that reduce your risk of developing the diseases that result in blood in your urine or hematuria.

Prevention strategies    

Urinary tract infections- in order to avoid urinary tract infections:

  • Drink plenty of fluids
  • Do not hold back your urine for long periods of time, urinate when you feel the urge and after intercourse.
  • Adopt proper wiping method –wipe from front to back after urination (for women).
  • Avoid feminine hygiene products that may cause irritation in your genital area.

 Kidney stones- to avoid kidney stones:

  • Drink lots of fluids and reduce the intake of salt, protein, and oxalate-containing foods such as spinach and rhubarb.

 Bladder cancer- these measures may help decrease the risk of bladder cancer:

  • Quit smoking
  • Avoid exposure to chemicals
  • Drinking plenty of water and other fluids

Kidney cancer- to help prevent kidney cancer:

  • Quit Smoking
  • Watch your weight
  • Maintain a healthy diet
  • Exercise often
  • Avoid exposure to harmful chemicals

7 Risks and Complications

The major factors that increase your risk of having blood in your urine include:

  • Age: A majority of men above the age of 50 may have hematuria because of an enlarged prostate gland.
  • Gender: Women are more susceptible to urinary tract infections, and they may have it at least once in their lives, possibly with some urinary bleeding. Young men are more likely to develop kidney stones or suffer from Alport syndrome, a type of hereditary nephritis that causes appearance of blood in the urine.
  • A recent infection: Kidney inflammation resulting from a viral or bacterial infection (post-infectious glomerulonephritis) is one of the cause for urinary blood in children.
  • Family history: A family history of kidney disease or kidney stones may increase your risk of developing hematuria.
  • Certain medications: Aspirin, nonsteroidal anti-inflammatory drugs, blood thinning medications and antibiotics such as penicillin may increase your risk of urinary bleeding.
  • Strenuous exercise: Athletes such as long-distance runners are prone to exercise-induced urinary bleeding. In fact, this condition is sometimes called jogger's hematuria. Sometimes, any person involved in strenuous work out can develop hematuria.

People of all age-groups including children and teenagers may develop hematuria.