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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Occult Blood In Urine: What This Means

Occult blood is when you can’t see blood in your urine with your eye and it’s only visible under a microscope. You may need antibiotics or different treatments depending on the infection or other causes.

Being told you have blood in your urine can be concerning, especially if you cannot see the blood.

In medicine, the word “occult” means “hidden.” Occult blood in the urine means the blood in the urine is only visible under a microscope.

Here’s what you need to know about this test result, what conditions may cause it, and what additional testing you may encounter.

The medical term for blood in the urine is hematuria.

Blood in the urine may be tinged pink or red. When you can see it, this is considered gross hematuria.

When blood is in the urine but you cannot see any pink, red, or clotting, it’s considered occult blood. Another name for this condition is microscopic hematuria.

Doctors typically divide microscopic hematuria into categories depending on how much blood is found in the urine under the microscope (microscopy).

• Significant microscopic hematuria: 3 or more red blood cells (RBC)/hpf (≥ 3 RBC/hpf)
• Insignificant microscopic hematuria: 2 or fewer RBC/hpf (0-2 RBC/hpf)

Significant microscopic hematuria warrants further testing.

Readings in the insignificant category do not necessitate further testing unless symptoms or other issues develop.

There are numerous reasons you may have blood in your urine. Some involve health conditions, like infection or cancer, and others relate to certain activities or even trauma.

Causes include:

• bladder infection
• kidney infection
• other infections (urethra, prostate, etc. )
• stones in the urinary tract
• benign prostatic hyperplasia (BPH)
• endometriosis
• trauma

Blood in the urine may also be caused by more serious issues:

• bladder cancer
• kidney cancer
• prostate cancer
• hemophilia and other blood-clotting disorders
• sickle cell anemia
• kidney disease (with involvement of the glomeruli)

Dehydration may also lead to blood in the urine.

When this happens, it’s considered a false positive result because it does not relate to disease. Other causes of false positives in a urine dipstick test (a type of urinalysis) include:

• hard exercise
• the presence of menstrual blood in the sample
• recent sexual activity
• free hemoglobin or myoglobin

Doctors and labs use a few different tests to look for blood in the urine.

Urinalysis (microscopic exam) is usually the first test you’ll encounter after a dipstick test. In this test, you’ll be asked to urinate in a cup. You’ll need to do a “clean catch” and follow the instructions closely to ensure your sample isn’t contaminated. The lab will then look closely at the sample under a microscope.

Additional testing may include:

• blood tests to look for kidney issues, autoimmune diseases, or cancer
• cystoscopy, which uses a small camera to gather pictures inside the urinary tract
• kidney biopsy to evaluate tissue for disease or damage
• imaging tests to visualize issues with the bladder, kidneys, and other organs
  • computed tomography (CT)
  • magnetic resonance imaging (MRI)
  • ultrasound

What if you get a false positive or negative test result?

False positive test results for occult blood in the urine are relatively common (22%) with dipstick testing.

To be a true false positive, a microscopy test must also be negative. False negatives are less common (4%).

Diet, exercise, medications, and hydration may all affect test results. If you have concerns about your results, ask your doctor if a re-test may be warranted.

The treatment for blood in the urine depends on the underlying cause.

For example:

• infection may be treated with antibiotics
• dehydration may be treated by giving fluids
• enlarged prostate may be treated with medication
• bladder or kidney stones may be treated with sound waves (lithotripsy)

In cases where the blood is caused by benign things — like exercise or menstrual blood — no treatment may be necessary.

You may have blood in your urine even if you cannot see it. If your doctor tests your urine and the test comes back positive for hematuria, you may or may not need further testing.

The next steps hinge on how much blood was found in the urine and what other symptoms you’re experiencing.

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.