Hematuria is the presence of blood in the urine.
Hematuria is a condition that can be visible to the naked eye (gross hematuria) or detectable only under a microscope (microscopic hematuria).
It can be a sign of various underlying conditions, ranging from benign to serious. Proper diagnosis and management are essential for addressing the root cause.
Learn more about hematuria, including its definition, causes, symptoms, diagnosis, treatment options for hematuria in St. Louis, and potential risks and complications.
Urologists at WashU Medicine
Urologists at WashU Medicine see patients at Barnes-Jewish Hospital, one of the top hospitals in the nation, as well as convenient locations across the St. Louis region.
What is hematuria?
Hematuria refers to the presence of red blood cells in the urine. It can be classified into two types:
- Gross hematuria: Blood in the urine that is visible to the naked eye, causing the urine to appear pink, red, or cola-colored.
- Microscopic hematuria: Blood in the urine that is not visible and can only be detected through a laboratory test.
Causes of hematuria
Urinary tract infections (UTIs)
Bacterial infection of any part of the urinary system, including the bladder (cystitis) or kidneys (pyelonephritis), can cause hematuria.
Symptoms of UTIs include frequent urination, burning sensation during urination, and lower abdominal pain.
Kidney and bladder stones
Stones in the kidneys or bladder can cause irritation and bleeding, leading to hematuria.
Symptoms of kidney stones include severe pain in the back, side, or lower abdomen, and pain during urination.
Learn more about kidney health problems>>
Enlarged prostate (BPH)
Enlargement of the prostate gland in men (also called benign prostatic hyperplasia or BPH) can cause the prostate to press against the urinary tract and cause hematuria.
Symptoms of enlarged prostate include difficulty starting urination, weak urine stream, and frequent urination, especially at night.
Learn more about enlarged prostate>>
Glomerulonephritis
Inflammation of the glomeruli, the small filtering units in the kidneys, can lead to blood in the urine.
Symptoms include protein in the urine, swelling in the face, hands, feet, or belly, and high blood pressure.
Traumatic injury
Injury to the urinary system, including the kidneys, bladder, or urethra, such as from a fall or accident, can cause hematuria.
Symptoms include pain and visible blood in the urine following the injury.
Cancer
- Bladder cancer
- Kidney cancer
- Prostate cancer
Medications
- Blood thinners: Medications like aspirin, warfarin, or other anticoagulants can cause hematuria.
- Other drugs: Certain drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and some antibiotics, can cause hematuria.
Inherited conditions
- Polycystic kidney disease (PKD): A genetic disorder marked by the growth of cysts in the kidneys, which can cause hematuria.
- Alport syndrome: An inherited condition affecting the glomeruli, leading to hematuria and kidney dysfunction.
Symptoms of hematuria
- Discolored urine: Pink, red, or cola-colored urine indicating the presence of blood.
- Painful urination: Burning sensation during urination associated with infections or stones.
- Frequent urination: Increased frequency of urination, often with urgency.
- Pain in the abdomen or back: Discomfort in the lower abdomen, back, or sides, often associated with stones or infections.
Diagnosis of hematuria
Medical history and physical examination
- Symptom assessment: Detailed inquiry about the onset, duration, and severity of symptoms.
- Medical history: Evaluation of past and current medical conditions, medications, and family history.
Urinalysis
- Microscopic examination: Detection of red blood cells in the urine.
- Dipstick test: Quick screening test to detect hematuria and other abnormalities in the urine.
- Urine culture: Testing for bacterial infections in the urine.
Imaging studies
- Ultrasound: Non-invasive imaging to visualize the kidneys and bladder for abnormalities.
- CT scan: Detailed imaging of the urinary system to detect stones, tumors, or other issues.
- MRI: Magnetic resonance imaging for detailed views of the urinary system.
Additional investigations
- Cystoscopy: Examination of the bladder and urethra using a cystoscope to identify abnormalities such as tumors or stones.
- Kidney biopsy: Removing a small sample of kidney tissue for laboratory analysis to diagnose glomerulonephritis or other kidney diseases.
Treatment of hematuria
Addressing underlying causes
Blood in the urine is usually a sign of another urologic problem. Urologists will typically diagnose and treat the underlying cause of blood in the urine.
- Urinary tract infections: Antibiotics to treat bacterial infections.
- Kidney and bladder stones: Medications, hydration, or surgical intervention (such as lithotripsy) to remove or break up stones.
- Enlarged prostate: Medications (alpha-blockers or 5-alpha-reductase inhibitors) or surgical procedures to manage BPH.
- Glomerulonephritis: Treatment with medications such as corticosteroids or immunosuppressants, and managing underlying conditions like high blood pressure.
- Cancer: Surgical removal, chemotherapy, or radiation therapy depending on the type and stage of cancer.
- Traumatic injury: Observation, surgical repair, or other interventions to address injuries to the urinary system.
- Medications: Adjusting dosages or switching medications under the supervision of a healthcare provider.
Symptomatic treatment
- Pain management: Pain relievers to alleviate discomfort associated with stones, infections, or other conditions causing hematuria.
- Hydration: Increasing fluid intake to help flush out the urinary system and reduce irritation.
Read more: Hydration and kidney function>>
Prevention of hematuria
Lifestyle modifications
- Hydration: Drinking plenty of fluids to keep the urinary system flushed and reduce the risk of stones and infections.
- Diet: Eating a balanced diet and avoiding excessive amounts of salt, protein, and oxalate-rich foods to prevent kidney stones.
- Healthy lifestyle: Maintaining a healthy weight, exercising regularly, and avoiding smoking to reduce the risk of cancer and other conditions.
Monitoring and health management
- Regular check-ups: Periodic visits to healthcare providers to monitor kidney function and overall urinary health.
- Managing chronic conditions: Effective control of diabetes, hypertension, and other chronic conditions to prevent kidney damage.
Potential risks and complications
Complications from underlying causes
- Infections: Risk of spreading infections from the urinary tract to the kidneys, leading to more severe conditions like pyelonephritis.
- Kidney failure: Severe or untreated glomerulonephritis and other kidney conditions can lead to kidney failure.
- Cancer progression: Undiagnosed or untreated cancer can progress, causing more severe health issues and lowering survival rates.
Treatment-related risks
- Medication side effects: Potential side effects from antibiotics, pain medications, or other drugs used to treat underlying conditions.
- Surgical risks: Complications like infection, bleeding, or anesthesia reactions from surgical interventions.
Impact on quality of life
- Chronic pain and discomfort: Persistent hematuria can lead to ongoing pain and anxiety.
- Emotional impact: Stress, anxiety, and fear associated with visible blood in the urine and uncertainty about its cause.
Hematuria can be a sign of various underlying conditions, requiring thorough evaluation and appropriate management.
Understanding the causes, symptoms, diagnosis, and treatment options is essential for effective care.
If you experience blood in your urine, consulting with a health care professional is crucial for identifying the underlying cause and developing a personalized treatment plan tailored to your specific needs.
Frequently asked questions about blood in urine
Hematuria is blood in the urine. Heme means blood, and uria is blood. There should not be any blood, proteins, glucose (sugar) or ketones in the urine normally.
Hematuria can be caused by many different benign and severe medical conditions.
Hematuria can be caused by kidney stones, urinary tract infections, prostatic enlargement, urinary tract strictures and other benign conditions.
Painless gross hematuria is concerning for urinary tumors. It is important to study the urinary tract for kidney and bladder tumors.
Gross hematuria means that the blood is visible to the naked eye. Most people with gross hematuria have a definable cause of the blood in the urine.
Microscopic hematuria means that the blood is not visible to the naked eye. Only a small percentage of men with microhematuria have a major urologic problem. The likelihood of having a problem that requires treatment is dependent on the amount of blood in the urine under a microscope.
About 1 in every 5 people with micro hematuria could have an urologic condition that requires intervention or regular monitoring.
Cystitis is a diagnosis of an inflammatory process involving the bladder. Acute cystitis is a short-term condition, and it is most often secondary to a urinary tract infection.
Blood in your urine is never normal. However, some people with medical renal disease (primary kidney insufficiency) have chronic, low-grade microscopic hematuria.
