Hematuria (Blood in the Urine)

On this page:

• What is hematuria?
• How common is hematuria?
• Who is more likely to develop hematuria?
• What are the symptoms of hematuria?
• What causes hematuria?
• How do health care professionals diagnose hematuria?
• How do health care professionals treat hematuria?
• How do eating, diet, and nutrition affect hematuria?
• Clinical Trials for Hematuria

What is hematuria?

Hematuria means there is blood in your urine. The two types of hematuria are

• gross hematuria—when you can see the blood in your urine
• microscopic hematuria—when you cannot see the blood in your urine, but it can be seen under a microscope or is found using a urine test called a urinalysis

Urine is produced in the kidneys, then it flows from the kidneys through the ureters to the bladder. When the bladder empties, urine flows out of the body through the urethra.

How common is hematuria?

Hematuria is a common diagnosis in individuals who visit a urologist. Researchers estimate that at least 1 out of 5 people evaluated by a urologist is diagnosed with hematuria.¹ Gross hematuria is less common than microscopic hematuria.²

Who is more likely to develop hematuria?

You are more likely to develop hematuria if you

• have benign prostatic hyperplasia (BPH), or an enlarged prostate
• have cancer of the prostate or cancer in a part of the urinary tract
• have calculi, or urinary tract stones
• take certain medicines, including blood thinners, antibiotics, and aspirin or other pain relievers
• do strenuous exercises, such as long-distance running
• recently had a bacterial or viral infection, such as streptococcus or hepatitis
• have a form of kidney disease called glomerulonephritis

What are the symptoms of hematuria?

Gross hematuria makes your urine look pink, red, or brown. Though the color difference may be alarming, it only takes a small amount of blood in the urine to cause a color change. In most cases, gross hematuria does not cause pain or other symptoms. However, you may have bladder or back pain if there are blood clots in your urine. Blood clots can be painful to pass during urination or can cause pain if the clots block the flow of urine.

Microscopic hematuria does not change the color of urine and typically has no symptoms.

What causes hematuria?

Reasons people may have blood in the urine include

• infection in or inflammation of the bladder, kidney, urethra, or prostate
• trauma
• urinary tract stones or a recent urinary tract procedure
• BPH
• vigorous exercise
• sexual activity
• endometriosis

More serious reasons people may have hematuria include

• cancer of the bladder, kidney, or prostate
• blood-clotting disorders, such as hemophilia
• sickle cell disease
• kidney disease involving the glomeruli

How do health care professionals diagnose hematuria?

Health care professionals use your medical history, a physical exam, and urinalysis to diagnose hematuria and help find the cause. As part of the physical exam, your health care professional may perform a digital rectal exam if you’re a man, or a pelvic exam if you’re a woman.

Your health care professional may also order additional tests, such as urinary tract imaging tests, to help find the cause of your hematuria.

Urinalysis

Your health care professional will use urinalysis—or a urine test—to check a sample of your urine for blood. In some cases, your health care professional will test your urine again to confirm the diagnosis of hematuria.

Sometimes blood from a woman’s menstrual period can get into the urine sample, and the test can show that the woman has hematuria when she doesn’t. Women who test positive for hematuria and are menstruating at the time of the test may be asked to repeat the test after menstruation stops.

Health care professionals use urinalysis to check a sample of your urine for blood. The test may have to be repeated to confirm the diagnosis.

Additional testing

If urinalysis shows too many red blood cells in your urine, your health care professional may order one or more of the following tests

• Blood test is used to find out if you have problems with your kidneys or to detect signs of autoimmune diseases, such as lupus, or other diseases, such as prostate cancer.
• Computed tomography (CT) scan uses a combination of x-rays and computer technology to create images of the urinary tract.
• Cystoscopy is a procedure that uses a cystoscope—a long, thin instrument with a camera attached—to look inside the urethra and bladder.
• Kidney biopsy is a procedure in which a health care professional takes one or more tiny pieces of tissue from the kidney, and a pathologist examines the tissue samples under a microscope for signs of kidney damage or disease.
• Magnetic resonance imaging (MRI) uses magnets and radio waves, without using x-rays, to make pictures of internal organs, such as the bladder or kidney.
• Ultrasound uses sound waves, without using x-rays, to create an image of internal organs, such as the kidney.

How do health care professionals treat hematuria?

Health care professionals treat hematuria by treating the underlying cause of the hematuria. You may not need treatment if there is no serious condition causing your hematuria.

How do eating, diet, and nutrition affect hematuria?

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing hematuria.

Clinical Trials for Hematuria

The NIDDK conducts and supports clinical trials in many diseases and conditions, including urologic diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for hematuria?

Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of hematuria, such as

• the accuracy of different diagnostic methods to detect bladder cancer in people with hematuria
• how using blood thinners before surgical procedures involving the bladder or prostate can affect the presence and severity of hematuria after surgery
• less invasive treatments for managing conditions associated with hematuria
• new ways to diagnose and treat glomerular kidney disease

Find out if clinical studies are right for you.

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical studies for hematuria are looking for participants?

You can view a filtered list of clinical studies on hematuria that are open and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

References

What Causes Blood in Urine (Hematuria)?

Symptoms That Accompany Blood in Your Urine

If your urine is pink, red, or brown, you may be experiencing hematuria. A small amount of blood can change the color of your urine, but you may also notice that you’re passing larger blood clots. (2) 

Discolored urine, however, does not mean that you have blood in your urine. Certain foods such as blackberries, rhubarb, and beets, as well as some medications and vitamins, can change the color of your urine. (3) 

Regardless, it’s best to consult your doctor anytime that your urine is discolored to determine whether the change is harmless or more serious.

Additional symptoms that might accompany blood in urine can include: (4)

• Discomfort or pain while urinating
• Urgent need to urinate
• Frequent need to urinate
• Weight loss
• Inability to urinate
• Fever
• Nausea or vomiting
• Abdominal pain
• Chills

Causes of Blood in Your Urine (Hematuria)

When you experience hematuria, red blood cells leak from your kidneys or your urinary tract into your urine. Blood in your urine is not always a sign of a serious medical condition, but it should be taken as a warning sign that something could be wrong. Hematuria can be a sign of many different medical conditions, including: (2)

• Bladder or kidney stones
• Kidney disease
• Kidney injury
• Enlarged prostate
• Urinary tract infections
• Blood clots
• Kidney infections
• Cancer of kidneys, bladder, or urethra
• Sickle cell anemia

If you notice blood at the beginning of urination, the origin of the bleeding could be the urethra. If you notice blood throughout urination, it’s possible that the origin is your bladder, kidneys, or ureters. If you notice blood at the end of a urination stream, the cause may be the bladder or prostate. (5)

If you’re over age 35 and are a smoker, blood in your urine is often a sign of bladder cancer. (5)

Certain medications can also cause urinary bleeding, including: (2)

• cyclophosphamide (Cytoxan)
• penicillin
• aspirin
• heparin
• Anticoagulants such as warfarin (Coumadin), rivaroxaban (Xarelto), dabigatran (Pradaxa), or apixaban (Eliquis)

Extreme exercise can also cause hematuria, possibly because it can cause bladder trauma, dehydration, or the breaking down of red blood cells. If you’re a runner, or have exercised strenuously, and notice blood in your urine, contact your doctor. (2)

Blood may also come from other sources, such as the vagina during menstruation, ejaculation in men (often because of a prostate problem), or a bowel movement due to hemorrhoids or other issues. (4)

What Causes Small Blood Clots in Urine?

Urinary tract infections, kidney stones, and prostate problems are common causes of small blood clots, which can sometimes look like coffee grounds. If you notice blood clots in your urine — even small ones — you should contact your doctor. Larger blood clots can block the flow of urine and cause discomfort, and they’re often a sign of a medical emergency. (6)

If you notice different shapes of blood clots in your urine, such as a wormlike form, it may be a sign that you are experiencing bleeding from the urethra or prostate. If the clots are painful, they might be coming from the tubes that connect your kidneys to your bladder, known as ureters. (5)

Can Dehydration Cause Blood in Urine?  

While dehydration is less likely to be a direct cause of blood in the urine, it can lead to conditions that can cause hematuria. For example, low urine volume due to consistent dehydration can lead to kidney stones that can cause blood in the urine. Dehydration may also be a contributor when extreme exercise causes blood in the urine. (7)

Diagnosing the Cause of Blood in Urine

More on Diagnosing Causes of Urine in Blood

10 Things You Probably Don’t Know About Blood Tests

To determine the cause of blood in urine, your doctor will usually begin by discussing your medical history with you. They may ask if you’ve had any recent infections or have a family history of hematuria. (2) You can prepare for your appointment by making a few notes about the color and odor of your urine, as well as how frequently you’ve been urinating and whether you experience any pain while urinating. You may want to take a photo of your discolored urine on your mobile phone that you can show to your doctor during your appointment.

Your doctor may also perform a number of tests. A urinalysis can detect microscopic hematuria and also test for a urinary tract infection or kidney stones. If a urinalysis does not determine the cause, your doctor may also perform a CT scan, an MRI, or an ultrasound. They may also want to examine the bladder and urethra via cystoscopy, where a tube with a camera attached is inserted into your bladder. (2) Additional tests may include: (4)

• Antinuclear antibody test
• Blood creatinine level
• Kidney biopsy
• Complete blood count (CBC)
• Strep test
• Blood disorder tests
• Coagulation tests
• Blood chemistry tests
• 24-hour urine collection

“Many doctors and patients underestimate the importance of searching for a cause for blood in the urine,” says Anne Schuckman, MD, associate professor of urology and urologic oncology at the Keck School of Medicine of USC in Los Angeles. She recommends that patients with hematuria receive both a CT scan and a cystoscopy. “Unfortunately, many patients who have blood in the urine may also have some white cells in the urine and are treated for a presumed urinary tract infection. The antibiotics may help for a while. However, a serious underlying reason for the blood can be missed without a full investigation.”

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Blood in the urine

Blood in the urine can be an unpleasant surprise. Most likely, this condition indicates lesions of the genitourinary system. There can be several reasons for the appearance of impurities or whole blood clots in the process of urination, and all of them are a reason to visit a doctor.

Why can there be blood in the urine?

Hematuria or blood in the urine is a symptom of a kidney or urinary tract disease. By itself, a change in the color of urine is not a disease, but indicates possible pathologies, that is, the following diseases and conditions can be the cause of urination with blood:

• Urolithiasis. A disease that occurs due to metabolic disorders. It is characterized by the formation of various types of stones in the kidneys or bladder. Provoke the development of urolithiasis can be poor nutrition, poor quality of drinking water, a sedentary lifestyle, diseases of the genitourinary system and pelvic organs, and other factors.
• Infectious diseases of the genitourinary system. Various infectious diseases such as urethritis, adnexitis, vesiculitis, salpingitis, vaginitis, cystitis can cause blood in the urine. Most often, diseases develop due to infection of the internal organs by pathogenic bacteria.
• Oncological disorders of the kidneys, ureters and bladder. Cancerous tumors in the organs of the urinary system can provoke hematuria. Oncological diseases of the urinary system are difficult to diagnose, since in the initial stages they can be asymptomatic.
• Injuries. A bruised kidney or injury to the urethra also results in blood in the urine. If the color of the urine does not return after 48 hours or severe pain occurs, you should immediately consult a doctor. Serious injuries may require surgery.
• Runner’s hematuria. Strong physical activity, including intense sports, can lead to the appearance of blood in the urine. Most often, this form of hematuria does not require additional treatment and goes away on its own after 72 hours.
• Neoplasms. Papillomas, polyps, cysts are formations that can appear in the kidneys or bladder and provoke hematuria. Although these tumors are considered benign, treatment may be necessary to rule out cancer.
• Hereditary diseases. Such as coagulopathy, Alport syndrome or sickle cell anemia are one of the causes of blood in the urine.
• Taking medication. In rare cases, prolonged drug treatment, for example, after taking anticoagulants, can provoke hematuria.
• Special cases. Some diseases are manifested, including bloody impurities in the urine. For example, prostatitis can cause hematuria in men; in women, blood in the urine sometimes provokes endometriosis. In rare cases, urination with blood can occur with schistosomiasis, lupus, and also with anatomical defects.
• Harmless cases. Sometimes urine changes color due to the consumption of coloring foods, such as beets or drinks with red and brown dyes. Then the urine acquires an unusual shade from bright orange to dark brown, it is likely to take this phenomenon for hematuria. And yet, even in this case, it is better to visit a doctor to rule out more serious causes of blood in the urine.

Prevention by risk groups

Hematuria can occur at any age in any person. The causes in each case are different and prevention depends on the specifics of the disease provocateur.

Women

Causes of blood in the urine in women. Most often, doctors note hematuria in women with cystitis. Also, blood when urinating can cause bladder endometriosis and urethritis.

Prevention. Women in the first place should avoid infectious diseases of the genitourinary system, such as cystitis. Bypassing the disease will help: observing the rules of personal hygiene, proper nutrition, avoiding hypothermia and stressful situations, as well as supporting the body, including at the first sign of illness. Lactoflorene® CYST is a unique formulation designed to increase the body’s resistance to adverse risk factors for cystitis.

The product works in a complex way: against pathogenic bacteria, to maintain the genitourinary system and additionally strengthen the microflora of the body. First of all, the action of Lactoflorene® CIST is aimed at combating E. coli bacteria – the main causative agents of cystitis. D-mannose, which is part of the probiotic complex, has a slow digestibility, due to which it has time to reach the organs of the genitourinary system, block and remove E. coli pathogens. Additional protection against harmful bacteria is created by proanthocyanidins contained in cranberry extract. So CranPure® dry cranberry extract as part of LLactoflorene® CIST is involved in strengthening the walls of the urinary organs, thereby preventing pathogenic microflora from penetrating inside.

In addition, Lactoflorene® CYST, due to live lactic bacteria in the composition, maintains and restores the balance of the intestinal microflora, which in turn protects the immunity of the microbiota and enhances the barrier functions of the body.

Men

Causes of blood in the urine in men. The main cause of hematuria in men is prostate disease: prostatitis and neoplasms. Also, it is among men that “runner’s hematuria” is most common.

Prevention. Doctors recommend that men observe sexual hygiene, moderate, regular physical activity, give up bad habits, choose proper nutrition and a healthy lifestyle. In addition, it is very important to regularly undergo an examination of the prostate gland and organs of the genitourinary system in order to exclude the appearance of neoplasms.

Children

Causes of blood in the urine in children. Children are more likely than others to suffer due to trauma to the urethra, and bruises. However, the most common cause of hematuria in children is urinary tract infections and glomerulonephritis.

Prevention. From an early age, it is very important to teach children the rules of personal hygiene and its features in boys and girls. Avoid hypothermia of the child, which can provoke the development of diseases of the genitourinary system. Make sure that the baby regularly empties the bladder, does not tolerate the urge to urinate.

What should I do if I find blood in my urine?

If changes in the color of urine are visible during urination, this is a reason to consult a doctor. Most often, hematuria occurs with additional manifestations:

• pain or burning when urinating
• decreased efficiency, lethargy, weakness
• fever
• pain in the back and pubic area
• frequent urge to urinate
• feeling incomplete bladder emptying after going to the toilet
• pallor and dry skin

Which doctor to contact for hematuria

It is better to start treatment with a visit to a therapist or urologist, who, if necessary, will refer you to a nephrologist, gynecologist, and possibly a surgeon. Since most often the appearance of blood in the urine is associated with diseases of the genitourinary system, a urologist will observe a patient with blood in the urine. Therapy for hematuria is to treat the disease that caused the appearance of blood in the urine. Only a doctor can determine the specifics after collecting an anamnesis and necessary tests.

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CYST

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to fight cystitis

• Systemic action on the problem and prevention of cystitis
• Help in the removal of pathogens of cystitis (intestinal bacteria E. coli)
• Reducing pain and cramps when urinating
• Reducing the likelihood of relapses

MADE IN ITALY

Blood in the urine – identifying the causes

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Blood in the urine is an acute symptom that requires close attention of the patient and the doctor . This symptom is a sign of many diseases, including cancer.

As a rule, patients themselves diagnose blood in the urine visually during urination. This is the main reason for going to the doctor, in addition to third-party symptoms, pain and numerous urges to the toilet, which often accompany this pathology.

Blood in the urine – a number of manifestations of this symptom:

• gross hematuria – blood is determined visually in the urine with the naked eye;
• microhematuria – determination of blood cells in urine in laboratory parameters, in particular, in the general analysis of urine (erythrocytes).

The appearance of blood in the urine can also indicate the pathology of the urinary system on different “levels” of the body. However, already at the time of the onset of a symptom, it is possible to approximately establish its localization.

Thus, if blood appears at the beginning of urination, and then such facts are not noted, then the source of bleeding is probably the urethra (urethra). The appearance or discharge of blood droplets at the end of urination indicate the localization of the source of blood in the bladder (very often this occurs with cystitis). Complete staining of urine may indicate pathology of the kidneys or bladder. In addition, blood clots can be observed in the urine, which also makes it possible to characterize the location and cause of the symptom. For example, the presence of “worm-like” clots may indicate pathology of the kidneys or ureter. Round clots indicate the pathology of the bladder. In any case, the manifestations of this symptom require immediate consultation with a urologist and, if necessary, hospitalization in a hospital.

In summary, we can identify the causes of diseases in which blood appears in the urine:

• pyelonephritis;
• cystitis ;
• bladder cancer;
• kidney cancer;
• urolithiasis
• urethritis;
• kidney injury;
• injuries of the urethra and perineum.

Taking into account possible diseases, the urologist must accurately diagnose the cause of the disease, for which the following tests and procedures can be prescribed:

• complete blood count;
• urinalysis;
• bacteriological culture of urine;
• Renal ultrasound;
• Bladder ultrasound;
• cystoscopy;
• abdominal x-ray;
• computed tomography of the urinary system.

Remember that if you find yourself blood in your urine , you should immediately consult a doctor.