Blood in Urine (Hematuria)

Blood in the urine, or hematuria, means that blood is present in the urine. It appears in two main forms:

1. Gross hematuria: in this type, blood can be seen with the naked eye, and the urine becomes red, pink, or brown.

2. Microscopic hematuria: in this type, blood is visible only under a microscope, and the urine has a normal color.

Diagnosing Hematuria

Microscopic hematuria is usually diagnosed during checkup or periodic tests, when a microscopic urine test or urine dipstick is positive for blood. If the urine is red but laboratory tests are not positive, the color change may indicate other problems, such as myoglobin, bilirubin, or other substances in the urine.

Causes of Hematuria

There are many reasons for blood in the urine. Some are not concerning, but others may require medical care. Common causes of hematuria include:

1. Urinary tract infection: this is the most common cause of hematuria, especially in women.

2. Enlarged prostate: this condition is common in older men and can lead to bleeding in the urine.

3. Kidney or bladder stone: stones can injure the urinary tract and cause bleeding.

4. Menstruation: urine may mix with menstrual bleeding, causing people to mistakenly describe their urine as bloody.

5. Prostate infection: this condition can cause inflammation and bleeding in the prostate.

6. Kidney disease: some kidney diseases, such as glomerulonephritis, can cause bleeding in the urine.

7. Kidney trauma: kidney injury from an accident or trauma can lead to blood in the urine.

8. Bladder cancer: one sign of bladder cancer can be blood in the urine.

9. Cancer in other parts of the urinary tract: this includes cancer of the kidney, ureter, and other parts of the urinary tract.

10. Anti-inflammatory medicines: use of anti-inflammatory medicines, such as pain tablets and medicines for joint swelling.

11. Strenuous exercise: strenuous exercise can injure the urinary tract and lead to bleeding.

Diagnostic Methods and Patient Evaluation

When blood is found in the urine, doctors want to make sure there is no serious disease such as cancer of the urinary tract or bladder. Urinary tract cancers may only rarely cause obvious blood in the urine, and if they are diagnosed late, they can be life-threatening.

Risk Factors for Urinary System Cancers

Risk factors include the following:

• History of smoking

• Age over 50 years

• Male sex

• Certain types of chemotherapy

• Family history of bladder cancer

• Urinary tract cancer or Lynch syndrome

• Workplace exposure to chemicals such as benzene or aromatic amines

• Having a urinary catheter for a long time

Tests and Imaging

Tests are performed for two purposes:

• Identifying any bleeding disease in the bladder

• Evaluating the upper urinary tract, including the kidneys and ureters

A cystoscope is used to view the bladder. The upper urinary tract and kidneys are evaluated with imaging such as ultrasound or CT scan. A urine cytology test may also be requested to look for suspicious and cancerous cells in the urine.

If no explanation is found for blood in the urine, the doctor classifies the person into three cancer-risk groups: low risk, intermediate risk, and high risk.

Cancer Risk and Its Evaluation

Doctors follow specific guidelines to decide what type of testing each person needs. People at low risk of cancer are evaluated less extensively because their risk of cancer is low. A person at high risk needs deeper and more numerous tests.

Low Cancer Risk

Low-risk patients rarely have cancer. One common option is to repeat the urine test within 6 months. If that test shows blood in the urine, more testing is done. If the repeat test does not show blood, the patient is monitored for symptoms, or ultrasound and imaging are repeated after a while.

If visible blood in the urine occurs, further evaluation, including contrast-enhanced CT scan and cystoscopy, is necessary.

Intermediate Cancer Risk

Patients at intermediate risk are advised to have cystoscopy to view the bladder and kidney ultrasound to evaluate the kidneys. Additional tests may also be needed.

High Cancer Risk

People at high risk for cancer often undergo a complete evaluation, which includes:

1. Bladder cystoscopy

2. Contrast-enhanced CT scan of the abdomen and pelvis

3. Urine cytology test

4. Ultrasound

5. X-ray imaging with contrast injection

The main difference between CT scan and ultrasound is that CT scan can detect small abnormalities in the kidneys and ureters that may not be found on ultrasound.

Treatment

Most people who see blood in their urine do not have a serious problem or cancer. In many cases, the cause of bloody urine is not found, and tiny capillaries on the lining of the urinary system have bled. However, in patients with more serious bleeding or a high cancer risk, early diagnosis can be lifesaving. Treatment differs depending on the cause of bleeding.

Conclusion

Hematuria, or blood in the urine, is an important symptom that should not be ignored. With timely diagnosis and treatment, serious problems can be prevented. Regular medical care and attention to symptoms can help maintain urinary tract health.

Frequently Asked Questions