Blood in Urine (Hematuria)

What is blood in urine (hematuria)?

The medical term for blood cells present in the urine is hematuria. Medical practitioners categorise blood in urine into three types:

• Gross hematuria: This occurs when there are enough blood cells in the urine to be visible to the naked eye, making the toilet water appear bright red or pale pink.
• Microscopic hematuria: This occurs when there is blood in the urine, but it is too small to be seen without a microscope.
• Dipstick hematuria: This occurs when a urine test strip changes colour due to oxidation. It doesn’t necessarily indicate the presence of blood cells in the urine. Dipstick tests are not entirely reliable and may give false-positive results.

How common is hematuria?

Blood in urine is relatively common, affecting approximately 2% to 30% of adults in the United Kingdom.

Symptoms

What are the signs and symptoms of blood in urine?

In most cases, there are no symptoms of hematuria besides the presence of blood in the urine. You may be considered ‘asymptomatic’ in such cases. However, when symptoms appear, they may include painful or frequent urination or an urgent need to urinate. These may also be accompanied by:

• Fever or chills
• Nausea or vomiting
• Pain in the lower abdomen or back

While blood in urine does not usually indicate a health problem, it could be a key warning sign of something serious. Therefore, you should never overlook blood in urine. Call your doctor right away if you notice bloody urine, as early diagnosis is crucial for any condition.

Causes

What are the causes of blood in urine?

There are various causes of bloody urine, ranging from minor to more severe conditions. Generally, they can result from infection or stones, such as:

• Urinary tract infection (UTI): This signifies the presence of an infection in any part of the urinary system.
• Pyelonephritis: This refers to an infection that has spread further into the kidneys.
• Cystitis: This is an inflammation of the bladder, which may be caused by infectious or other non-infectious factors.
• Urinary stone disease: This describes the presence of stones in the urinary system, such as kidney stones, ureteral stones, and bladder stones.

Other disorders contributing to hematuria may include:

• Inflamed prostate (benign prostatic hyperplasia): This is a non-cancerous condition in which the prostate enlarges.
• Urinary tract injury: Involves penetrating or blunt trauma to the urinary tract from assault or accidents.
• Endometriosis: This is a condition where tissue similar to the lining of the uterus develops outside the uterus.
• Menstruation: During the menstrual period, blood may be present in the urine.
• Kidney (renal) disease: This chronic disease affects the kidneys’ ability to function properly.
• Sickle cell disease: This is a genetic disorder affecting red blood cells.

Apart from these disorders, cancers that grow uncontrollably in certain parts of the body can lead to hematuria. These include:

• Bladder cancer
• Kidney cancer
• Prostate cancer
• Ureteral cancer
• Urethral cancer

Diagnosis and Tests

How is blood in urine diagnosed?

During the diagnosis of hematuria, the doctor will start by taking a detailed medical history and performing a physical examination. This may involve a pelvic examination or digital rectal exam to better understand your symptoms. Other diagnostic tests that may be ordered include:

• Urinalysis: Analysis of a urine sample.
• Urine culture: A test to look for infections in the urine.
• Urine cytology: A test to detect any abnormal-looking cells in the urine.
• Cystoscopy: Involves using a cystoscope to examine the inside of the urethra and bladder.
• Ultrasound: Examines the bladder, ureters, and kidneys using ultrasound waves.
• Computed tomography (CT) scan: Creates cross-sectional images of the abdomen and pelvis using X-rays and computer technology.
• Magnetic resonance imaging (MRI) scan: Produces detailed images of the body’s organs and structures using radio waves, powerful magnets, and a computer.

Management and Treatment

How is hematuria treated?

The treatment for hematuria is primarily determined by its underlying cause. Your practitioner will work with you to develop a suitable treatment plan based on the information obtained during the physical examination, medical history review, and test findings.

Medications to address causes of hematuria:

• Infections: Antibiotics are prescribed to eliminate the bacteria contributing to the infection, thus stopping the bleeding.
• Enlarged prostate: Urologists typically prescribe two categories of drugs, including alpha-blockers and 5-alpha-reductase inhibitors, to treat this condition.
• Cancer: The doctor will recommend treatment depending on the stage and extent of the cancer, while also considering your goals and needs. Options may include surgery, surveillance, radiation, chemotherapy, immunotherapy, hormone therapy, or sometimes a combination of these treatments.
• Sickle cell disease: Disease-modifying medications such as pain relievers, hydroxyurea, antibiotics, and medications that prevent red blood cells from dying or transforming into sickle shapes may be prescribed.
• Kidney disease: Treatment may involve various medications such as diuretics, cholesterol and blood pressure-reducing drugs, and erythropoietin to increase red blood cells for people who have anaemia.
• Endometriosis: Hormone-related medications may be recommended to treat this condition.

Other treatment options for hematuria include:

• Enlarged prostate: Surgery may be recommended if medication treatment is ineffective.
• Kidney disease: Dialysis may be required to filter waste from the blood, or a kidney transplant may be necessary.
• Cancers: A multidisciplinary team, including a urologist, will manage cancer cases.

What complications are associated with hematuria?

Both medications and procedures used to treat the causes of blood in urine can have different side effects, which vary depending on the treatment type.

However, a condition of hematuria that is left untreated can result in more severe complications, particularly if the underlying cause is serious rather than due to intense exercise. The doctor will aim to address any problems causing bloody urine. For causes such as kidney disease or cancer, early diagnosis leads to early treatment, resulting in better outcomes.

Prevention

Who is at risk of having hematuria?

Some individuals have an increased risk of hematuria, especially those with pre-existing conditions known to lead to bloody urine. These include urinary system infections, urological anatomical abnormalities, inherited diseases, and family histories of urological conditions. You are more likely to have blood in your urine if you have kidney stones, kidney disease, or a family history of kidney-related problems.

Taking certain medications can also increase the risk of hematuria. Examples include blood thinners and specific pain relievers. However, the presence of blood in your urine should not delay or prevent diagnosis.

Certain behaviours may also increase the likelihood of hematuria, including:

• Smoking
• Overuse of pain medications
• History of radiation exposure or contact with specific chemicals
• Occupational hazards like metals, dyes, fumes, or rubbers
• Exposure to radiation or certain chemicals
• Jogging or running long distances
• Intense sexual activity

To reduce the risk of hematuria, try to avoid these behaviours. Staying hydrated by drinking plenty of fluids, especially water, is also important for your urinary tract and overall health. Darker urine may indicate dehydration, and in extreme cases, dehydration could result in bloody urine.

Living With

When should I visit my healthcare provider?

Never overlook blood in your urine. If you have bloody urine or experience any hematuria-related symptoms, you should contact a healthcare provider right away.

A Note from MD.co.uk

Having hematuria, particularly after consuming foods like beets or during the menstrual period, shouldn’t be a reason to panic. Nonetheless, it’s advisable to contact your practitioner. Early detection is important, even if the cause is a minor urinary tract infection. You and your provider will work together to determine the cause of your bloody urine and develop the best treatment plan.