Blood in urine (hematuria)
Overview
It can be scary to see blood in urine, also
called hematuria. In many cases, the cause is harmless. But blood in urine also
can be a sign of a serious illness.
If you can see the blood, it's called gross
hematuria. Blood that can't be seen with the naked eye is called microscopic
hematuria. It's such a small amount that it can be seen only under a microscope
when a lab tests the urine. Either way, it's important to figure out the reason
for the bleeding.
Treatment depends on the cause.
Symptoms
Blood in the urine can look pink, red or
cola-colored. Red blood cells cause the urine to change color. It takes only a
small amount of blood to turn urine red.
The bleeding often isn't painful. But if blood
clots get passed in the urine, that can hurt.
When to see a doctor
See a health care provider whenever urine
looks like it might have blood in it.
Red urine isn't always caused by red blood
cells. Some medicines can cause urine to turn red, such as a medicine called
phenazopyridine that eases urinary tract symptoms. Certain foods also can turn
urine red, including beets and rhubarb.
It can be hard to tell whether a change of
urine color is caused by blood. That's why it's always best to get a checkup.
Causes
This condition happens when the kidneys or
other parts of the urinary tract let blood cells leak into urine. Different
problems can cause this leaking to happen, including:
·
Urinary
tract infections (UTIs). These
happen when bacteria get into the tube through which urine leaves the body,
called the urethra. Then the bacteria multiply in the
bladder. UTIs can cause bleeding that makes urine look red, pink or
brown. With a UTI, you also may have a strong urge to pee that lasts a
long time. You may have pain and burning while peeing. Your urine may have a
very strong smell too.
·
Kidney
infection. This type
of UTI also is called pyelonephritis. Kidney infections
can happen when bacteria enter the kidneys from the bloodstream. Infections
also can happen when bacteria move to the kidneys from a pair of tubes that
connect the kidneys with the bladder, called the ureters. Kidney infections can
cause the same urine-related symptoms that other UTIs can. But
they're more likely to cause a fever and pain in the back, side or groin.
·
A
bladder or kidney stone. The
minerals in urine can form crystals on the walls of the kidneys or bladder.
Over time, the crystals can become small, hard stones.
The
stones are often painless. But they can hurt a lot if they cause a blockage or
leave the body through urine. Bladder or kidney stones can cause blood in urine
that can be seen with the naked eye as well as bleeding that can be seen only
in the lab.
·
Enlarged
prostate. The prostate
gland is just below the bladder, and it surrounds the top part of the urethra.
It often gets bigger toward middle age. It then puts pressure on the urethra,
partly blocking the flow of urine. With an enlarged prostate, you might have
trouble peeing, an urgent or lasting need to pee, or blood in the urine.
Infection of the prostate, called prostatitis, can cause the same symptoms.
·
Kidney
disease. Blood in urine
that can be seen only in the lab is a common symptom of a kidney disease called
glomerulonephritis. With this disease, the tiny filters in the kidneys that
remove waste from blood become inflamed.
Glomerulonephritis
may be part of a condition that affects the whole body, such as diabetes. Or it
can happen on its own.
·
Cancer. Blood in urine that can be seen with the
naked eye may be a sign of advanced kidney, bladder or prostate cancer. These
cancers might not cause symptoms sooner, when treatments could work better.
·
Inherited
illnesses. A genetic
condition that affects red blood cells, called sickle cell anemia, can cause
blood in urine. The blood cells could be visible or too tiny to see. A
condition that damages tiny blood vessels in the kidneys, called Alport
syndrome, also can cause blood in the urine.
·
Kidney
injury. A blow or other
injury to the kidneys from an accident or contact sports can cause blood to
show up in urine.
·
Medicines. The anti-cancer drug cyclophosphamide
(Cytoxan) and the antibiotic penicillin are linked to blood in urine. Medicines
that prevent blood clots also are tied to blood in urine. These include
medicines that keep blood cells called platelets from sticking together, such
as the pain reliever aspirin. Medicines that thin the blood, such as heparin,
also may be a cause.
·
Hard
exercise. Blood in the
urine can happen after playing contact sports, such as football. It may be
linked to bladder damage caused by getting hit. Blood in urine also can happen
with long-distance sports, such as marathon running, but it's less clear why.
It may be linked to bladder damage or other reasons that don't involve an
injury. When hard exercise causes blood in urine, it may go away on its own
within a week.
If
you see blood in your urine after exercise, don't assume it's from exercising.
See your health care provider.
Often the cause of hematuria is unknown.
Risk factors
Almost anyone can have red blood cells in the
urine. This includes children and teens. Some things that can raise the risk of
blood in the urine include:
·
Age. Middle-aged and older men may be more
likely to have hematuria due to an enlarged prostate gland. The risk of some
cancers that can cause blood in urine also may rise after the age of 50.
·
Urinary
tract infection. This is one of
the top causes of blood that can be seen in children's urine.
·
Family
history. The chances of
having blood in the urine may go up if one or more family members have had
kidney disease.
·
Certain
medicines. Some pain
relievers, blood thinners and antibiotics can raise the risk of blood in urine.
·
Hard
exercise. Marathon
runner's hematuria is one nickname for hematuria. Contact sports can raise the
risk too.
Diagnosis
These tests and exams play a key role in
finding a cause for blood in the urine:
·
Physical
exam. This includes a
talk with a health care provider about your health history.
·
Urine
tests. These can be
used to diagnose blood in the urine. They also can be used weeks or months
later to see if the urine still has blood in it. Urine tests also can check for
a urinary tract infection or for minerals that cause kidney stones.
·
Imaging
tests. An imaging test
is often needed to find the cause of blood in the urine. You might need
a CT or MRI scan, or an ultrasound exam.
·
Cystoscopy. A health care provider threads a narrow
tube fitted with a tiny camera into your bladder to check for signs of disease.
Sometimes the cause of blood in the urine
can't be found. In that case, you might need regular follow-up tests, mainly if
you have risk factors for bladder cancer. These risk factors include smoking, radiation
therapy to the pelvis or exposure to certain chemicals.
Treatment
The treatment for blood in the urine depends
on the cause. Treatment might involve:
·
Taking antibiotic
medicines to clear a urinary tract infection.
·
Trying a prescription
medicine to shrink an enlarged prostate.
·
Having a treatment
that uses sound waves to break up bladder or kidney stones.
In some cases, no treatment is needed.
If you get treatment, see your provider
afterward to make sure there's no more blood in your urine.
Preparing for your
appointment
You can start by making an appointment with
your regular health care provider. Or you might be referred to a doctor who
specializes in urinary tract disorders, called a urologist.
Here's some information to help you prepare
for your appointment.
What you can do
Make a list of:
·
Your
symptoms. Include any
symptoms, even ones that may not seem to be related to the reason for your
checkup. Note when your symptoms began too.
·
Key
medical information. This includes
other conditions for which you're being treated. Note whether bladder or kidney
diseases run in your family too.
·
All
medicines, vitamins or other supplements you take. Include the doses for each. The dose is how much
you take.
·
Questions
to ask your health care
provider.
Some questions to ask about blood in the urine
include:
·
What might be causing
my symptoms?
·
What tests do I need?
·
How long might this
condition last?
·
What are my treatment
choices?
·
I have other health
issues. How can I best manage them together?
·
Are there brochures or
other printed material that I can have? What websites do you suggest?
Ask any other questions too.
What to expect from
your doctor
Your provider is likely to ask you questions,
such as:
·
Do you have pain when
you pee?
·
Do you see blood in
your urine only sometimes or all the time?
·
When do you see blood
in your urine — when you start peeing, toward the end of your urine stream or
the entire time you're peeing?
·
Are you also passing
blood clots when you pee? What size and shape are they?
·
Do you smoke?
·
Are you exposed to
chemicals on the job? What kinds?
·
Have you had radiation
therapy?
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