Is blood in your urine a cause for concern? Learn about the potential causes, risk factors, and diagnostic procedures for hematuria. Get the facts and take proactive steps to maintain your urinary health.

The Basics of Hematuria: Understanding Blood in Urine

Hematuria, the presence of blood in urine, can be a concerning condition for many individuals. However, it’s important to understand that not all instances of hematuria are a sign of a serious underlying problem. Blood in urine can have various causes, ranging from benign to potentially serious, and a thorough medical evaluation is essential to determine the underlying cause.

Distinguishing Microscopic and Gross Hematuria

Hematuria can be classified into two main types: microscopic hematuria and gross hematuria. Microscopic hematuria is the presence of blood in the urine that can only be detected under a microscope, while gross hematuria is when the blood is visible to the naked eye, causing the urine to appear pink, red, or brown.

Dr. Angela B. Smith, Assistant Professor of Urology at the University of North Carolina School of Medicine in Chapel Hill, emphasizes that even if the blood disappears after a single occurrence, it’s crucial to seek medical attention. “There’s a common misconception that if you see blood in your urine once and then it goes away that you’re in the clear,” she says. “But it’s important to seek care the very first time you see blood in the urine, so your doctor can confirm that it’s there and refer you to a urologist for an evaluation.”

Potential Causes of Hematuria

The causes of hematuria can be diverse, ranging from benign to more serious conditions. Some of the common causes include:

1. Urinary tract infection
2. Enlarged prostate
3. Kidney stones
4. Vigorous exercise, such as long-distance running
5. Certain medications, including blood thinners, aspirin, pain relievers, and antibiotics

More serious causes of hematuria include swelling of the kidney, urethra, bladder, or prostate, as well as cancer of the kidney or bladder. However, it’s important to note that only a small percentage of individuals with microscopic hematuria have cancer.

Risk Factors for Hematuria

Several risk factors can increase the likelihood of developing hematuria, including:

• Family history of kidney disease
• Chronic urinary tract infections
• Smoking
• Exposure to chemicals in the workplace
• Treatment with radiation for pelvic cancer

Dr. Michael J. Kennelly, Professor in the Department of Surgery, Division of Urology at the Carolinas Medical Center – Charlotte in North Carolina, emphasizes the importance of seeking medical attention for blood in the urine. “In many cases, kidney cancer and bladder cancer do not cause physical symptoms, so the tumor may continue to grow without a person being aware of it,” he says. “By the time the tumor does cause symptoms, it may not be curable. That’s why it is so important to seek medical attention if you see blood in your urine. It could be a warning sign for a potentially life-threatening illness.”

Diagnostic Procedures for Hematuria

If your doctor suspects you may have hematuria, they will typically perform a series of tests to determine the underlying cause. These may include:

1. Repeat urine test to confirm the presence of blood
2. Health history review, including questions about infections, kidney stones, smoking, menstruation, and recent injuries
3. Physical examination, including a digital rectal exam for men and a pelvic exam for women
4. Cystoscopy, a procedure that allows the doctor to examine the bladder and urethra using a thin, lighted tube
5. Imaging tests, such as CT scans or ultrasounds, to assess the kidneys and bladder

These diagnostic procedures are essential in identifying the underlying cause of hematuria and guiding appropriate treatment. Don’t hesitate to seek medical attention if you notice blood in your urine, as it could be an important indicator of your overall health.

Proactive Steps for Maintaining Urinary Health

While hematuria can be concerning, there are proactive steps you can take to maintain your urinary health and reduce the risk of developing this condition:

• Maintain a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking
• Stay hydrated by drinking plenty of water
• Practice good hygiene, particularly in the genital area, to prevent urinary tract infections
• Regularly schedule routine check-ups and follow-up appointments with your healthcare provider
• Communicate any changes in your urinary function or the presence of blood in your urine to your doctor

By understanding the potential causes, risk factors, and diagnostic procedures for hematuria, you can take proactive steps to maintain your urinary health and address any concerns promptly. Remember, seeking medical attention at the first sign of blood in your urine is crucial, as it could be an important indicator of your overall health.

Is Blood in your Urine a Reason to be Concerned?

Urology Health – Is Blood in your Urine a Reason to be Concerned?

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Is Blood in your Urine a Reason to be Concerned?

If you notice blood in your urine, don’t ignore it. There are many possible causes of this condition, known as hematuria. While some are simply treated and not dangerous, others may need immediate medical attention.

Not all hematuria can be seen with the human eye. In fact, the most common type of hematuria-called microscopic hematuria-can only been seen by a health care expert under a microscope. In many cases, microscopic hematuria is spotted when a person has a urine test during a health exam.

When a person can see the blood in his or her urine, the condition is called gross hematuria. People with gross hematuria have urine that is pink, red or brown.

“There’s a common misconception that if you see blood in your urine once and then it goes away that you’re in the clear,” says Angela B. Smith, MD, Assistant Professor of Urology at the University of North Carolina School of Medicine in Chapel Hill. “But it’s important to seek care the very first time you see blood in the urine, so your doctor can confirm that it’s there and refer you to a urologist for an evaluation. “

In most cases, people with either type of hematuria do not have pain or any other signs or symptoms.

What Causes Hematuria?

Common Causes of Hematuria: 

• Urinary tract infection
• Enlarged prostate
• Kidney stones
• Vigorous exercise such as long-distance running
• Certain drugs, such as blood thinners, aspirin and other pain relievers, and antibiotics

More serious causes are swelling of the kidney, urethra, bladder or prostate, or cancer of the kidney or bladder. Only a small percentage of people with microscopic hematuria have cancer. A history of smoking raises the risk of bladder or kidney cancer.

Risk Factors for Hematuria: 

• A family history of kidney disease
• Chronic urinary tract infection 
• Smoking
• Exposure to chemicals in the workplace
• Treatment with radiation for pelvic cancer

“In many cases, kidney cancer and bladder cancer do not cause physical symptoms, so the tumor may continue to grow without a person being aware of it,” says Michael J. Kennelly, MD, Professor in the Department of Surgery, Division of Urology at the Carolinas Medical Center – Charlotte in North Carolina. “By the time the tumor does cause symptoms, it may not be curable. That’s why it is so important to seek medical attention if you see blood in your urine. It could be a warning sign for a potentially life-threatening illness. Fortunately, the majority of the time, blood in the urine is not a sign of a serious illness.”

Diagnosing the Cause

If your doctor thinks you may have hematuria, you will have a repeat urine test to make sure the first test was right. Your doctor will ask you about your health history, including infections, kidney stones, smoking, menstruation and recent injuries. He or she will also ask about medications you are taking.

Your doctor will perform a physical exam to check for pain or tenderness in the bladder or kidney area. Men may be given a digital rectal exam to look for prostate problems. Women may have a pelvic exam to look for the source of red blood cells in the urine.

Other Tests May Include:

Cystoscopy. This is a procedure a urologist performs to see inside the bladder and urethra (the tube that allows urine to pass out of the body). The doctor uses a thin tube with a camera and light on the end–called a cystoscope–to look for cancer cells or other problems.
Kidney imaging tests. The doctor may order an imaging test such as ultrasound, CT scan or MRI to look for a tumor, a kidney or bladder stone, an enlarged prostate or other problem.

Your doctor may order one more urine test to look for signs of infection, kidney disease and cancer. You may have a blood test to check for high levels of the protein creatinine, a sign of kidney disease.

In many cases, the doctor is not able to find out why there is blood in the urine, Dr. Smith notes. He or she may decide to retest your urine in a year. If blood is found, you may undergo more tests. Or you may be retested several years later.

Treatment

Hematuria is managed by treating its underlying cause. For example, if the condition is caused by a urinary tract infection, it is treated with antibiotics. Treatment for kidney stones can include waiting for the stone to pass by itself, medication or surgery.

If you are found to have kidney or bladder cancer, your doctor may refer you to an oncologist or urologic surgeon. If the tumor is found early, the cancer often can be cured. There are a number of options for kidney and bladder cancer treatment, including surgery, chemotherapy and radiation.

If the doctor rules out any medical problem causing hematuria, you will not need treatment.

“If you find blood in your urine, or your doctor tells you that you have microscopic hematuria, don’t panic,” Dr. Kennelly says. “The good news is that with proper evaluation, your doctor can find out the cause and if needed, make sure you get the correct treatment right away.”

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What Is Trace Lysed Blood in Urine?

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Urine tests are routine–most everyone has peed in a cup for their doctor at one time or another. But what happens when the tests come back and you see “trace lysed blood in urine” on the report? That blood part may be alarming to you.

First things first: You probably have nothing to worry about from a report of trace lysed blood in urine. “Most of the time, it is not of any significance,” says Louis Kavoussi, M.D., chairman of urology for Northwell Health and professor of urology at the Zucker School of Medicine at Hofstra/Northwell in Uniondale, NY.

So what does it mean when you have trace lysed blood in your urine? Here’s what you need to know about what it is, what may be causing it, and what treatment you might need.

Blood in Urine, Explained

If blood is found in your urine, you have hematuria, which could have many causes ranging from an infection to trauma to bladder or kidney disease. Hematuria is labeled either “gross,” when you can see the blood in your urine, or “microscopic,” meaning it is visible only under a microscope. Either way, blood in urine is very common. A study in the journal Deutsches Arzteblatt International estimates that somewhere between 2% and 30% of the population has it.

What Is Trace Lysed Blood in Urine?

“Trace” means a very small amount of blood, while “lysed” means that the walls of the red blood cells in the urine have broken open and are no longer intact, explains Dr. Kavoussi.

“Under the microscope, it looks as if the red blood cells have ruptured,” explains R. Mark Ellerkmann, M.D., an assistant professor at Johns Hopkins School of Medicine in the department of gynecology and obstetrics and director of the Center for Urogynecology at the Weinberg Center for Women’s Health and Medicine at Mercy Medical Center in Baltimore, MD.

Trace lysed blood in the urine is a subcategory microscopic hematuria, Dr. Kavoussi says. “With microscopic hematuria, the red blood cells are still intact,” he explains. “But with traced lysed blood in the urine, the cells are broken. So the conditions are a little different,” he says, but adds that trace lysed blood in the urine starts off as microscopic hematuria before the cells break open.

What Causes Trace Lysed Blood in Urine?

While red blood cells are designed to break down naturally every 110 to 120 days on average, if they are breaking down in your urine, there’s usually another cause at work.

Red blood cells in the urine can break open if the urine sample is handled improperly, if the urine is very alkaline—meaning it has a high pH, usually caused by kidney disease or a urinary tract infection (UTI)—or if the urine sample is stored too long, Dr. Ellerkmann says. In some cases, it may occur if there is inflammation, an infection, or an injury, he says.

“The finding needs to be looked at, along with the results of other blood tests, symptoms, and any history of exposure to cigarette smoking, chemical exposure, and family history,” Dr. Kavoussi says. “A history of cigarette smoking puts you at risk for kidney disease,” which can cause blood in the urine, he adds.

Holding in urine or not urinating when you feel the need to are risk factors for trace lysed blood in the urine, says Vikas Desai, MD, a urologist at Northwestern Medicine Delnor Hospital in Geneva, IL, because it’s a risk factor of a urinary tract infection, which can cause microscopic hematuria. “Trauma or injuries to your muscle during a car crash also could be responsible, as could strenuous exercise and training for a marathon,” he says.

Diagnosing Trace Lysed Blood in Urine

There are no symptoms of trace lysed blood in urine, says Dr. Kavoussi. In fact, since you can’t even see it with the naked eye, you’ll need a urine test, or urinalysis, to know you have it.

If your doctor has reason to be concerned about blood in your urine or is trying to diagnose an infection, you’ll be asked to provide a urine sample for testing. The test uses a dipstick, which can quickly detect tiny amounts of blood in your urine. The dipstick is a chemical strip that changes color when certain substances are present or if their levels are high. Trace amounts of blood will cause the urine dip stick to become slightly discolored, says Dr. Kavoussi.

Other tests that may be helpful in diagnosing the cause of lysed blood in urine can include:

• Blood tests

• CT scan

• Cytoscopy (a small camera that is inserted through the urethra—using numbing gel—to check the bladder)

• Kidney biopsy

• Kidney ultrasound

• Urine cytology (analysis of cells lining the bladder and kidneys that are shed in urine)

Treatment for Trace Lysed Blood in the Urine

“Often there is no specific treatment for trace lysed blood in the urine,” Dr. Kavoussi says. “The vast majority of the time it is not a life-threatening finding. Usually, the doctor will follow you over time and other tests may be indicated if the amount of blood increases.”

While there is no specific treatment for trace lysed blood itself, Dr. Kavoussi says, whatever is causing the trace lysed blood may need to be addressed. The most common, according to the American Academy of Family Physicians (AAFP), include:

• Benign prostatic hyperplasia (enlarged prostate)

• Bladder stones

• Kidney disease

• Urinary tract infection

No cause can be found between 43 and 68% of the time, according to the AAFP.

Yes, blood in your urine can be worrisome. But if you can’t see it, and only know you have trace lysed blood in urine because a urinalysis told you so, you can breathe a little easier. The presence of trace lysed blood in urine is common and not especially worrisome, Dr. Kavoussi says. “It is an isolated finding and does not mean a whole lot,” he says. “In the vast majority of cases, it means absolutely nothing.”

Notes: This article was originally published January 30, 2012 and most recently updated May 22, 2023.

Definition of Hematuria: National Institute of Diabetes and Digestive and Kidney Disorders. (2022.) “Hematuria (Blood in the Urine).” https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine

Incidence of Blood in Urine: Deutsches Arzteblatt International. (2018.) “The Investigation of Hematuria.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365675/

Causes of Hematuria: Cleveland Clinic. (2022.) “Hematuria.” https://my.clevelandclinic.org/health/diseases/15234-hematuria

Red Blood Cell Lifespan: MedLinePlus. (2022.) “Hemolysis.” https://medlineplus.gov/ency/article/002372.htm

Hemolysis Definition: Journal of Medical Biochemistry. (2018.) “Effect of Blood Cell Subtypes Lysis on Routine Biochemical Tests. ” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294101

Urine pH: MedLinePlus. (2021.) “Urine pH test.” https://medlineplus.gov/ency/article/003583.htm

Diagnosis: UpToDate. (2022.) “Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics).” https://www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics

Dipstick: Urology Care Foundation.” (2020.) “How blood in the urine is tested and treated.” https://www.urologyhealth.org/healthy-living/care-blog/2020/how-blood-in-the-urine-is-tested-and-treated

Kidney Disease Symptoms: World Journal of Nephrology. (2015.) “Pathogenesis of glomerular haematuria.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419128/

Treatments for Blood in the Urine: American Academy of Family Physicians. (2022.) “Microscopic Hematuria.” https://familydoctor.org/condition/microscopic-hematuria/

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Blood in the urine (hematuria) | Symptoms, complications, diagnosis and treatment

Blood in the urine may be a warning sign. Although in many cases the cause is harmless, blood in the urine (hematuria) can indicate a serious disorder. Treatment depends on the cause.

Blood in the urine can be referred to by two terms. If the blood is visible to the eye, that is, the urine has a pink or burgundy color, then this condition is called gross hematuria. If the urine has a normal color, but an increased content of red blood cells, that is, blood elements, is detected in the urine test, then this condition is called microhematuria. This article will focus on the visible admixture of blood in the urine (gross hematuria).

Some medicines and foods, such as beets, rhubarb, and certain types of berries, can cause urine to turn red. To determine exactly whether the cause of this discoloration of urine is an admixture of blood or not, it is necessary to pass a urine test.

Symptoms

Hematuria produces pink, red, or cola-colored urine due to the presence of red blood cells. Urine has a pink color, or the color of the color of “meat slops”. In the urine, blood clots can also be determined in the form of black “worms”, “cakes”, long threads. At the same time, there may be pain when urinating, or pain in the lumbar region.

When to see a doctor

Make an appointment with your doctor any time you notice blood in your urine.

Some medications, such as laxatives and certain foods, including beets, rhubarb, and berries, can cause urine to turn red. Urine discoloration caused by drugs, food, or exercise may disappear within a few days.

Blood urine looks different, but you can’t tell the difference. Best consult a physician any time you see red-colored urine.

Causes of hematuria.

• Urinary tract infections (most commonly acute cystitis) – this happens when bacteria enter your body through the urethra and multiply in your bladder. Symptoms may include a constant urge to urinate, pain and burning when urinating, and extremely smelly urine.
• Kidney infection (acute pyelonephritis) – This can happen when bacteria enter the kidneys from your bloodstream or travel from the ureters to the kidneys. Signs and symptoms are often similar to bladder infections, although kidney infections are more likely to cause fever and side pain.
• Bladder, kidney or ureter stone – Minerals in concentrated urine sometimes form crystals on the walls of the kidney or bladder. Over time, the crystals can become small, hard stones.
  Stones are generally painless, so you probably won’t know you have them unless they cause blockages or are passed on. Then usually no symptoms occur – kidney stones, especially, can cause excruciating pain. Bladder or kidney stones can also cause both severe and microscopic bleeding.
• Enlarged prostate in older men – The prostate gland, which lies just below the bladder and surrounds the top of the urethra, often enlarges as men approach middle age. It then compresses the urethra, partially blocking the flow of urine. Signs and symptoms of an enlarged prostate (benign prostatic hyperplasia) include difficulty urinating, an urgent or persistent need to urinate, and visible or microscopic blood in the urine. An infection of the prostate gland (prostatitis) can cause the same symptoms. .
• Infection of the prostate gland (acute prostatitis) .
• Diseases of the kidneys (glomerulonephritis) – microscopic urinary bleeding is a common symptom of glomerulonephritis, an inflammation of the filtering system of the kidneys. Glomerulonephritis may be part of a systemic disease such as diabetes, or it may occur on its own. Viral or streptococcal infections, blood vessel disease (vasculitis), and immune problems such as IgA nephropathy that affect the small capillaries that filter blood in the kidneys (glomeruli) can cause glomerulonephritis.
• In women, urine contamination with menstrual blood during menses.
• Kidney Injury – Striking or other injury to the kidneys from accident or physical contact may cause visible blood in the urine. .
• Bladder cancer (most often smokers suffer).
• Cancer of the kidney, pelvis, ureter – Visible urinary bleeding may be a sign of kidney, bladder or prostate cancer. Unfortunately, there may be no signs or symptoms in the early stages, when these cancers are most treatable. .
• Medications (eg, non-steroidal anti-inflammatory drugs to relieve joint pain) – the anti-cancer drug cyclophosphamide and penicillin can cause urination. Visible urinary blood sometimes occurs if you are taking an anticoagulant such as aspirin and the thinner heparin and you also have a condition that causes bladder bleeding.
• Intense exercise Rarely, intense exercise can lead to gross hematuria, but the cause is unknown. This may be due to bladder injury, dehydration, or the breakdown of red blood cells that occurs with prolonged aerobic exercise.

When to see a doctor.

The admixture of blood in the urine can be a symptom of a serious illness, so it is necessary to consult a urologist . The urologist will prescribe examinations to find a clarification of the diagnosis. First of all, it is necessary to exclude malignant lesions of the urinary system, which, although not often detected, can pose a serious threat to health

Almost everyone, including children and teenagers, can have red blood cells in their urine.

Factors that make this more likely include:

• Age. Many men over 50 experience occasional hematuria due to an enlarged prostate.
• Recent infection. Inflammation of the kidneys after a viral or bacterial infection (post-infectious glomerulonephritis) is one of the leading causes of visible urinary blood in children.
• Heredity. You may be more likely to urinate if you have a family history of kidney disease or kidney stones. Sickle cell anemia, an inherited defect in hemoglobin in red blood cells, causes blood in the urine, both visible and microscopic hematuria. This can cause Alport’s syndrome, which affects the filtering membranes in the glomeruli of the kidneys.
• Some medicines. Aspirin, non-steroidal anti-inflammatory pain relievers and antibiotics such as penicillin are known to increase the risk of urinary bleeding.
• Physical activity. Long distance runners are particularly susceptible to exercise-induced physiological bleeding. In fact, this condition is sometimes referred to as runner’s hematuria. But anyone who works hard can have the symptoms described.

Diagnostics

Your urologist will determine the presence of risk factors for urinary tract cancer and possible other causes of blood in the urine. The most common risk factors for the development of cancer are smoking, previous radiation or chemotherapy, exposure to adverse production factors (dyes, solvents). Depending on age, the presence of risk factors, symptoms, the urologist will assess the amount of the necessary examination.

Examination

The purpose of the examination is to find the source of blood in the urine. To examine the bladder, ultrasound and cystoscopy are usually performed . To examine the upper urinary tract (kidneys and ureters), ultrasound or computed tomography with contrast injection (CT urography) is necessary. Laboratory tests usually include a urine culture to rule out infection, a blood test for creatinine, and a complete blood count.

Treatment

Treatment depends on the cause of the hematuria. In the presence of oncological diseases or stones, surgical treatment is necessary. In most other cases, medications can be dispensed with.

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Blood in urine

The presence of blood in the urine is called hematuria . However, it is worth noting that sometimes the red color of urine is not due to the admixture of blood, but to the use of certain foods (beets) or the intake of certain medications (nitrofurantoin, rifampicin). There are macroscopic (visible to the naked eye) and microscopic (determined only in the analysis of urine) hematuria. Thus, the normal color of urine does not always mean the absence of any pathology of the body.

Pay attention to the nature of the impurity (the appearance of individual drops of unchanged blood, the staining of all urine with blood, the appearance of worm-like clots in the urine), as well as the time of its appearance in the urine: at the beginning, at the end or during the entire act of urination. This will help your doctor reduce the time it takes to find the problem and locate it.

Causes

– Oncological diseases of the urinary system (kidneys, ureters, bladder, urethra) – the most formidable cause of blood in the urine. At the same time, kidney cancer is characterized by total staining of urine with blood, usually not accompanied by any painful sensations. Tumor of the ureter may be characterized by worm-like clots in the urine (representing casts of the ureters). In this case, blood clots can cause a block in the urinary tract, which is accompanied by pain on the side of the lesion (renal colic). With bladder cancer, in some cases, blood appears at the end of urination, but it can also stain the urine completely. With the localization of the pathological process in the urethra, blood will appear at the beginning of urination in the form of a few drops in unchanged urine.

– BPH (benign prostatic hyperplasia) or prostate adenoma – a disease in which an increase in the volume of the prostate gland can lead to rupture of the vessels of the bladder neck and the appearance of hematuria. It is important to distinguish this disease from prostate cancer, which can also be accompanied by an admixture of blood in the urine.

– Urinary tract infection. Cystitis is characterized by urination in small portions, the appearance of pain and burning during urination, as well as frequent urination. An admixture of blood often occurs at the end of urination (terminal hematuria), less often – throughout the entire act (total hematuria). When the infectious process is localized higher (pyelonephritis), the pain will also be localized higher, in the lumbar region of the corresponding side, accompanied by an increase in body temperature.