Causes, Risk Factors, Diagnosis, and Treatment

Written by Rick Ansorge

• Where Blood in Urine Might Come From
• Hematuria-Related Symptoms
• Hematuria Causes and Risk Factors
• Hematuria Diagnosis
• Hematuria Treatment

Blood in your urine — your doctor might call it hematuria — is not something you should ignore.

It can be a sign of a serious medical condition. Tell your doctor about it; they can order tests to look for the cause.

Hematuria is just a symptom, so treatment will focus on the condition causing it.

Blood in your urine can come from your kidneys, which make urine. It also can come from other parts of your urinary tract, such as your:

• Ureters (the tubes from your kidneys to your bladder)
• Bladder (which stores urine)
• Urethra (the tube from your bladder to the outside of your body)

Instead of its usual pale yellow color, your urine may be pink, red, brownish-red, or tea-colored. This is what doctors call gross hematuria.

Sometimes, you can’t see the blood in your urine. Only a lab test can find the red blood cells. Doctors call this microscopic hematuria.

You may not have any other symptoms. But some of the possible causes can have other signs. These include:

• Bladder infections (acute cystitis). In adults, bladder infections usually cause burning or pain when peeing. Infants with bladder infections may have a fever, be grumpy, and feed poorly. Older children may have a fever, pain and burning while urinating, a strong urge to pee, and lower belly pain.
• Kidney infections (pyelonephritis). Symptoms may include a fever, chills, and pain in your lower back (flank).
• Kidney stones. These cause severe belly or pelvic pain.
• Kidney cancer. You may experience weight loss, loss of appetite, fatigue, or pain in your side
• Kidney diseases. Symptoms include weakness, high blood pressure, and body swelling, including puffiness around your eyes.

You might have blood in your urine because of:

• Urinary tract or kidney infections
• Bladder or kidney stones
• Certain kidney diseases, such as inflammation in the filtering system (glomerulonephritis)
• An enlarged prostate (benign prostatic hyperplasia) or prostate cancer
• Inherited diseases such as sickle cell anemia and cystic kidney disease
• Certain medications such as aspirin, cyclophosphamide, heparin, and penicillin
• Cancer in your bladder or kidney
• A kidney injury from an accident or sports
• Vigorous exercise

Your urine could also be discolored because of red pigments from things like food dyes, medications or eating a lot of beets. Doctors sometimes call this “beeturia.” Your urine can also appear red because of muscle (rhabdomyolysis) or red blood cell (hemolysis) breakdown.

Your doctor will ask about your medical history and send a sample of your pee for lab tests. This is called urinalysis. The tests might include cytology, in which a technician uses a microscope to look for unusual cells.

Your doctor might order blood tests to look for wastes that your kidneys are supposed to remove. This could be a sign of kidney disease.

You may also need other tests including:

• CT scan. A special kind of X-ray scan can help find stones, tumors, and other problems in your bladder, kidneys, and ureters.
• Kidney ultrasound. This test uses sound waves to create a picture of your kidney.
• Cystoscopy. Your doctor threads a small tube with a camera into your bladder through your urethra. They might take tissue samples (biopsy) to check for unusual or cancerous cells.
• Kidney (renal) biopsy. A technician looks at a sample of kidney tissue under a microscope for signs of kidney disease.

Your doctor will treat the condition that’s causing blood in your urine. Then, they’ll test you again to see if the blood is gone. If you still have blood in your urine, you may need more tests, or you may see a specialist called a urologist or nephrologist.

If your doctor can’t find a cause during the first evaluation, they might tell you to have follow-up urine testing and blood pressure monitoring every 3 to 6 months, especially if you have risk factors for bladder cancer. These include being 50 or older, smoking cigarettes, and coming into contact with certain industrial chemicals.

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Causes, Symptoms, Treatment, and Prevention

Males can get urinary tract infections, and they are typically classified as complicated infections. Symptoms may include urgency, frequency, and burning when you urinate.

Urinary tract infections (UTIs) occur when bacteria, often from the rectum or skin, enter and overgrow in the bladder, kidneys, or the tubes that drain urine from the kidneys to the bladder.

Most UTIs can be cured easily with antibiotic drugs.

Language matters

In this article, we use “male and female” to refer to someone’s sex as determined by their chromosomes, and “men and women” when referring to their gender (unless quoting from sources using nonspecific language).

People often use the terms sex and gender interchangeably, but they have different meanings:

• “Sex” refers to the physical characteristics that differentiate male, female, and intersex bodies.
• “Gender” refers to a person’s identity and how they feel inside. Examples include man, woman, nonbinary, agender, bigender, genderfluid, pangender, and trans. A person’s gender identity may be different from the sex they were assigned at birth.

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Females are 30 times more likely to get UTIs than males, according to the Office of Women’s Health (OASH). This is due to anatomy. People with vaginas typically have shorter urethras. This means the bacteria need to travel less distance to reach the bladder.

UTIs in males are more common with older age. One reason is that older males are more likely to develop noncancerous enlargement of their prostate gland, called benign prostatic hyperplasia. The prostate wraps around the neck of the bladder, where the urethra connects to the bladder. Enlargement of the prostate gland can compress the bladder neck, making it harder for urine to flow freely. If the bladder does not empty completely, bacteria that are normally flushed out with the urine can gain a foothold.

The symptoms of a bladder infection include:

• painful urination and a burning sensation
• needing to urinate frequently
• sudden urge to empty your bladder, called urinary urgency
• pain in your central lower abdomen, just above the pubic bone
• blood in your urine

Certain symptoms in addition to those of a UTI could mean you have a prostate infection (prostatitis). These can include:

• fever
• chills
• fatigue
• difficulty urinating or “dribbling”
• pain in your pelvis

Most UTIs are caused by the bacterium Escherichia coli (E. coli), which is naturally present in your body. The bacteria gets into the urinary tract through the urethra. The urethra is the tube that drains urine from your bladder through your penis.

Factors that can put you at greater risk for UTIs may include the following:

• a previous UTI
• long-term use of a urinary catheter
• being immobile for long periods
• not drinking enough fluids
• recent urinary tract or kidney surgery
• urinary tract blockages like kidney stones or an enlarged prostate
• diabetes
• being uncircumcised
• fecal incontinence
• engaging in anal intercourse, which can expose the urethra to more bacteria

To diagnose a UTI, a doctor will examine you and ask about symptoms, including any past history of UTIs. You will likely be asked to provide a urine sample to check for bacteria and white blood cells, which indicate that your body is fighting an infection.

Sometimes the doctor will perform a urine culture to get more information about the bacteria causing the infection. If you have had a UTI before, a doctor might also perform an ultrasound to check for abnormalities in your urinary tract.

UTIs are categorized into two categories, uncomplicated and complicated. An uncomplicated UTI affects the lower urinary tract and is also known as cystitis or a bladder infection. An uncomplicated UTI is treated with antibiotics, and people typically recover within 3 days to 6 weeks.

Anytime a person with a penis has a UTI it is considered complicated.

UTIs are considered complicated if they affect certain groups. This can include:

• people who have a penis
• pregnant people
• people who are immunocompromised
• older adults
• people who use catheters
• people who experience recurring UTIs

If you think you have a UTI, it’s best to make an appointment with a doctor. They will typically make a diagnosis you based on your urine sample. You also may have to get an ultrasound to check for any abnormalities in your urinary system.

If you have a UTI, you will likely need to take antibiotic medications. Depending on the type of antibiotic a doctor prescribes, you may take the medication for 10 to 14 days.

It’s also important to drink adequate fluids. You may be tempted to reduce your fluid intake if urinating is uncomfortable. But urinating can help flush the bacteria from your system. It important to stay hydrated if you have a UTI, including while taking antibiotics.

Many people drink cranberry juice when they have a UTI in hopes of clearing the infection. Lab experiments with mice showed that several substances in cranberry juice lowered the bacteria count in the bladder. This suggests that there may be some benefits to drinking cranberry juice for humans with UTIs. However, there is no strong evidence that drinking cranberry juice while you have a UTI eliminates the infection or speeds recovery.

Recovery

After starting antibiotics, you should feel noticeably better within 24 to 48 hours. If your symptoms don’t clear up after taking antibiotics, talk with a doctor.

It’s important to finish all antibiotics prescribed, even if you’re feeling better. Stopping your antibiotics prematurely can encourage the growth of bacteria resistant to common antibiotics. In effect, less than the full course of treatment kills off the “weak” bacteria, leaving them stronger and more resistant strains.

People with prostates may need to take a longer course antibiotics in case the infection has reached the prostate, according to the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK).

If you think you have a UTI, you should seek medical attention right away. If left untreated, a UTI can spread from your lower to the upper urinary tract and cause a kidney infection like pyelonephritis.

Symptoms of a UTI that involves the kidneys can include:

• pain in your sides or back that doesn’t change when you change position
• fever and chills
• nausea and vomiting
• a burning sensation when you urinate

If you have a kidney infection and can take medication by mouth, a doctor will prescribe antibiotics. Some people, such as children or those with other health concerns or complications, may have to stay in the hospital for treatment.

If pyelonephritis or an upper urinary tract infection is left untreated, it can lead to sepsis. Sepsis is a life threatening condition.

Symptoms of sepsis can include:

• irregular or fast heart rate
• sudden changes in body temperature
• change in mental status
• fever and chills
• difficulty breathing

Sepsis can be caused by an infection in the urinary tract. Treatment for sepsis includes hospitalization, antibiotics, and fluids.

Emergency situation

Sepsis is a life threatening infection. If you believe you or someone else may have sepsis, seek immediate emergency medical attention or call your local emergency services.

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To prevent UTIs, the most important thing is to reduce the chance of bacteria invading your urinary tract. Steps you can take to prevent UTIs may include:

• Urinate when you feel the need. Don’t “hold it in.”
• Drink adequate fluids. For most people, that means drinking when thirsty and drinking during meals. When it’s hot and you’re active in hot weather, drink a little extra water.
• Keep your genital area clean and dry.

UTIs are less common in people with penises but have similar causes and treatment. Taking antibiotic medications usually clears the infection. If you have prolonged UTIs or UTIs that come back frequently, you may need to be evaluated by a doctor for conditions like a prostate gland infection.

The following are frequently asked questions about UTIs.

How can you tell the difference between a UTI and bladder infection?

Bladder infections are a type of UTI that involves the lower urinary tract, including the bladder. A bladder infection can spread to other parts of your urinary tract or kidneys if left untreated. The symptoms of bladder infections and UTIs can be similar. See a doctor if you are experiencing symptoms of a UTI, such as painful or frequent urination, pain in your central lower abdomen, or blood in your urine.

Is it possible to treat a UTI at home without the use of antibiotics?

Most UTIs require treatment with antibiotics. When certain groups of people, including people with a penis, have a UTI, the infection is usually considered to be complicated. Delaying treatment of complicated UTIs can lead to complications, such as a kidney infection or sepsis. If you are experiencing symptoms of a UTI, visit a doctor or healthcare professional and have a urine test performed.

UTIs occur when bacteria enter the urinary tract system. They are more common in females than in males. However, males who are older in age, have diabetes, are immunocompromised, or use a catheter may have a higher risk of developing a UTI.

If you are experiencing symptoms and think you have a UTI, visit a doctor for treatment.

Fecal incontinence – causes and treatments

Contents

1. Introduction 2. Why incontinence occurs 3. Diagnosis of encoporesis 4. Treatment methods for encoporesis

A condition in which a person cannot control the process of defecation is called encoporesis. Incontinence refers to the unintentional release of feces from the anus, as well as the inability to restrain the urge to defecate until the right moment. Fecal incontinence is not a life-threatening problem, but it can significantly reduce its quality. Against the background of incontinence, many patients who encounter this develop anxiety, embarrassment and a persistent desire to avoid appearance in society. If encoporesis is detected, it is necessary to consult a doctor, as this may be a symptom of another serious pathology, for example, bowel cancer. The widespread belief that fecal incontinence only affects patients in the elderly age group can be considered a misconception. According to statistics, half of the patients with such a complaint are people of active working age, both men and women.

Fecal incontinence develops against the background of problems with the coordinated work of the muscles of the pelvic floor and anal sphincter. When a sufficient amount of stool accumulates in the rectum, the body initiates the process of defecation. There is a contraction of the intestinal muscles, due to which the feces are evacuated to the outside. Normally, if a healthy person does not have the opportunity to visit the toilet, then, having felt the urge to defecate, he makes a deliberate effort to contract the muscles of the rectum and anal sphincter. Due to this, the urge to defecate becomes weaker, the sphincter remains closed. If the patient has problems with one of the links in the described chain of the defecation process, then the feces will come out spontaneously.

There are several forms of fecal incontinence. Permanent incontinence is typical for children or very elderly patients, whose condition is assessed as severe. Due to poor health, such people simply cannot prevent defecation, and any urge ends with the release of feces.

Partial incontinence occurs due to certain circumstances. For example, inadvertent fecal excretion can occur after lifting a heavy object, coughing or sneezing.

Why incontinence occurs

In adult patients, the causes of encoporesis lie mainly in the field of diseases of the intestine and pathologies of the rectum.

• Constipation. Normally, a person has a bowel movement once, and sometimes twice a day. If the need for a bowel movement occurs much less frequently, then we can talk about such a health problem as constipation. In this case, fecal masses will accumulate in the intestines, provoking its stretching and weakening of muscle structures. As a result of this, incontinence may begin, as the intestine will simply lose its tone.
• Injury to the external or internal anal sphincter. The retention of feces inside the rectum occurs due to the coordinated work of the anal sphincters. As a result of trauma or surgery performed on the perianal zone, the sphincters may lose their ability to contract normally.
• CNS problems. If a person cannot track the moment when the feces have accumulated, does not feel the fullness of the intestines and the tension of the sphincters, then we can talk about neurological disorders. They can occur against the background of head injuries, stroke, difficult childbirth.
• Decreased elasticity of the muscles of the rectum. A similar condition develops as a result of a surgical operation, chronic inflammation of the intestine, and also as a result of the treatment of an oncological process.
• Pelvic floor muscle problems. Usually observed in patients with overweight, as well as in women after childbirth, requiring serious surgical intervention, for example, dissection of the perineal tissue.
• Proctological problem. Often the cause of partial fecal incontinence is a manifestation of hemorrhoids. Enlarged hemorrhoids of internal localization will interfere with the normal closing of the anal sphincter. Incontinence is also observed in patients with prolapsed hemorrhoids.
• The habit of holding back defecation. As a result of regularly postponing going to the toilet, the anal sphincter and rectum will stretch unnecessarily, which will lead to irreversible changes.
• Mental and psychological pathologies. Sudden loss of bowel control occurs in patients suffering from mental disorders such as seizures and psychosis.

Diagnosis of encoporesis

A specialist with the qualification of a coloproctologist will help in solving this problem. Diagnosis includes questioning and examining the patient. During the conversation, the doctor will ask questions about the frequency of episodes of incontinence, the conditions under which it occurs, the duration of this symptomatology. To make a diagnosis and determine the causes of incontinence, the coloproctologist needs to know what the patient feels just before passing feces. You will need to tell the specialist and other important data: past illnesses, operations, stress, the presence of bad habits, the fact of taking medications.

Examination of the patient includes digital examination, anoscopy and sigmoidoscopy if necessary. The contractility and sensitivity of the sphincter is assessed by the results of the anorectal manometry procedure. To obtain data on the condition of the pelvic floor muscles and other adjacent structures, the doctor may prescribe an MRI, proctography, and ultrasound. In some cases, laboratory diagnostics is carried out: blood, feces, urine tests.

Based on the results of all the above diagnostic procedures, the doctor draws up an optimal treatment regimen.

Therapy for encoporesis

To obtain a stable result, the approach to the treatment of incontinence must be comprehensive, which means that it is necessary not only to deal with the consequences, but also to eliminate the root cause of the pathology. The involvement of the patient in the treatment process is extremely important. Since only his personal interest can become a guarantee that he will reconsider his lifestyle, nutrition principles, and begin to regularly train the muscles of the pelvic floor.

The purpose of drugs directly depends on the pathology associated with incontinence. The diet implies the normalization of digestion, the exclusion of constipation and diarrhea, and the removal of stress from the intestines. From the menu it is recommended to remove any products that can make feces too soft. Various sweeteners, dairy products, some spices, alcohol and coffee have this effect. Patients are encouraged to enter records of their meals and subsequent bowel response. So you can identify individual intolerance to specific categories of products.

Physiotherapy exercises, consisting of special exercises, will improve the function of sphincters and pelvic floor muscles. The basis of such gymnastics is the periodic tension and relaxation of the muscles. It should be understood that the result of exercise therapy will be noticeable only if it is regularly and responsibly performed.

If conservative methods of treating fecal incontinence do not show the expected result, then the doctor will decide on the need to resort to a surgical procedure.

If the patient has disorders in the work of the sphincter, then reconstructive plastic surgery of this zone is used. With hemorrhoids, the nodes are excised or reduced according to one of the minimally invasive techniques.

In severe cases, a sphincter replacement device can be used. Such an artificial substitute will allow the patient to defecate in a controlled manner. Also, with intestinal lesions, a colostomy operation is performed – it changes the process of defecation to the removal of feces out through a hole in the peritoneum.

If you are faced with encoporesis, you can get qualified medical care in our multidisciplinary medical center. Call +7 (4842) 20-70-20!

FAQ

If there are no complaints and the next of kin did not have oncological diseases of the rectum, it is recommended to visit a proctologist every 5 years.

If there are complaints and a genetic predisposition, consult a doctor immediately!

Proctological examination is performed with minimal discomfort for the patient. The diagnosis is made by the doctor, based on the testimony of sigmoidoscopy and anoscopy. These are absolutely painless procedures. Colonoscopy in some cases can be done with anesthesia. But it can not be carried out during pregnancy (with rare exceptions, with a direct threat to life and health).

Do not self-prescribe medications. The use of laxatives, activated charcoal and castor oil give a laxative effect. However, if taken uncontrolled, they can cause serious complications. It is possible to influence peristalsis by making adjustments to the diet and increasing physical activity.

You need to pay attention to the shade of blood in the stool. The darker it is, the higher the area of ​​​​the gastrointestinal tract is affected. Bright red blood indicates damage to the rectum or anus. Hidden blood in the stool may indicate the presence of cancer.

This is the same proctologist, but in a modern interpretation. According to medical doctrine, a coloproctologist deals with the diagnosis and treatment of the anus, rectum and large intestine.

causes, symptoms and treatment

The causes of delayed bowel movements can be varied, but most often in men the following provoking factors are detected ¹ :

Stress

relax can cause difficulty in bowel movements in men. Urgent tasks and the habit of postponing a bowel movement because of them can gradually negatively affect the sensitivity of the large intestine to distension ⁷ . As a result, the urge to defecate occurs only when a large amount of feces accumulate in the intestine ³ . In addition, with chronic stress, there may be a violation of the coordination of the muscles involved in the process of defecation ⁴ .

Smoking

Nicotine acts directly on the parasympathetic nervous system, stimulating intestinal motility. However, smoking can lead to both constipation and diarrhea ⁶ .

Age changes

Age-related changes also affect the functioning of the intestines. With age, the number of cells that regulate the motor activity of the intestine may decrease, and the structure of the internal anal sphincter of the rectum may also change, which helps to slow down the movement of intestinal contents. This can cause constipation in men after 60 years.

In addition, in old age, some men experience a decrease in physical activity, they switch to a sedentary lifestyle associated, among other things, with age-related changes in the musculoskeletal system and chronic diseases ² .

Abuse of laxatives

Sometimes, due to the excessive fixation of a person’s attention on the activity of his intestines, unreasonable demands begin to be made on the regularity of the stool. Normal stool frequency ranges from 3 times a day to 3 times a week. But sometimes people who have normal stool regularity can torture themselves with various manipulations with the aim of more complete, in their opinion, bowel emptying and abuse laxatives, thereby disrupting the natural process of emptying, which can contribute to the development of constipation ⁹ .

Postponing the act of defecation

Having once experienced a sharp pain, men can postpone the act of defecation and thereby provoke a delay in stool ¹¹ .

Improper nutrition

Sometimes men are less inclined than women to think about the usefulness of food and devote time to cooking homemade meals on their own. Often a full meal is replaced by snacks on the go with fast food, semi-finished products or processed foods (sausages, smoked meats, chips). Such food contains little vegetable fiber, which helps to improve the consistency of the stool, as well as increase its volume, which leads to mechanical irritation of the intestinal wall receptors. As a result, due to an unbalanced diet and the formation of small stools, constipation may develop ^1.5 .

Alcohol

Alcohol can also cause constipation ⁷ . It affects the motility of the gastrointestinal tract, absorption of food and the permeability of the intestinal mucosa ⁸ .

Certain medicines

Certain medicines may cause constipation. These drugs include antipsychotics, antihypertensives, anticonvulsants, some painkillers, and anti-inflammatory drugs ⁵ .