Urine - bloody

Definition

Blood in your urine, or hematuria, can be classified as microscopic or gross. Microscopic hematuria is when there is very little blood in the urine and it can only be seen with a microscope. Gross hematuria is when there is enough blood in the urine that you can see it with the naked eye (usually it turns toilet water pale pink or bright red, or you may just see spots of blood in the water after urinating).

Considerations

In women, blood may appear to be in the urine when it is actually coming from the vagina. In men, what may be mistaken for urinary bleeding is sometimes a bloody ejaculation, usually due to a prostate problem.

Discoloration from certain drugs, beets, or other foods can mimic blood in the urine.

You may not see blood in your urine. In some cases, it is found microscopically when your doctor checks your urine during a routine exam. Your doctor will follow up on this problem to see if it persists and identify the cause.

When blood is visible to the naked eye, prompt and thorough evaluation is always needed. In children, hospitalization is often necessary to complete the work up.

Common Causes

There are many potential causes of blood in the urine. Often, bloody urine is from a problem in your kidneys or other parts of the urinary tract. If your kidneys, urinary tract, prostate, and genitals turn out to be fine, your doctor may check to see if you have a bleeding disorder.

Kidney and urinary tract causes include:

• Kidney or bladder stones
• Infection of the bladder (especially if chronic and recurrent), kidney, or urethra (tube that empties urine from the bladder to the outside)
• Inflammation of the bladder, urethra, or kidney (called glomerulonephritis)
• Cancer of the bladder or kidney
• Trauma to the kidney, fractured pelvis, or recent procedure somewhere in the urinary tract like catheterization, circumcision, surgery, or kidney biopsy.
• Polycystic kidney disease
• Kidney failure (acute or chronic)
• Kidney disease following strep throat, called post-stretococcal glomerulonephritis; this is a classic cause of blood in the urine in children

Causes from blood disorders include:

• Bleeding disorders (such as hemophilia)
• Sickle cell disease
• Blood clot in the kidneys
• Low numbers of platelets
• Medications including blood thinners (like warfarin)

Home Care

Call your health care provider if

Blood in the urine should never be ignored. Tell your doctor about this symptom and get an appropriate evaluation, especially if you have unexplained weight loss, burning with urination, frequent urination, or urgent urination.

Call your doctor right away if:

• You have fever, nausea, vomiting, shaking chills, or pain in your abdomen, side, or back.
• You are unable to urinate.
• You are passing blood clots.

Also call your doctor if:

• You have pain with sexual intercourse or heavy menstrual bleeding. The problem may be related to your reproductive organs.
• You have dribbling, nighttime urination, or difficulty starting your urinary flow. The problem may be related to your prostate.

What to expect at your health care provider's office

Your doctor will take a medical history and perform a physical examination. Medical history questions may include:

• When did you first notice blood in your urine?
• What is the underlying color of your urine?
• Do you have any pain with urination?
• Has the quantity of your urine increased or decreased?
• Does your urine have an odor?
• Are you urinating more frequently?
• Do you have an urgent need to urinate?
• What medications are you taking, including over the counter drugs?
• Have you recently eaten foods that may cause discoloration, like beets, berries, or rhubarb?
• Do you have any other symptoms like pain in your back, abdomen, or side? Fever, weight loss, nausea, vomiting, or diarrhea? Nighttime urination? Dribbling? Discharge from penis or vagina? Pain with intercourse?
• Have you had previous urinary problems or kidney problems?
• Do you have any allergies?
• Have you had a recent injury?
• Have you had any recent diagnostic or surgical procedures involving the urinary tract?

Diagnostic tests that may be performed include:

• Blood studies such as a CBC, blood differential, C3, and creatinine
• Urinalysis
• Urine culture
• 24-hr urine collection for creatinine, protein, calcium
• Tests for strep
• Tests for lupus
• Tests for sickle cell, bleeding problems, and other blood disorders
• Cystoscopy
• Kidney biopsy
• X-rays of the kidneys
• IVP
• Abdominal ultrasound
• CT scan of the abdomen

TREATMENT

The treatment will depend on the cause of the blood in the urine. If a urinary tract infection is confirmed, antibiotics may be prescribed. If appropriate, pain medications will be administered.

References

Campbell MF, Walsh PC, Retik AB, eds. Campbell’s Urology. 8^th ed. W.B. Saunders Company: Philadelphia, PA; 2002.

Yun EJ. Evaluation of the patient with hematuria. Med Clin North Am. 2004; 88(2): 329-343.

Illustrations

Female urinary tract

Male urinary tract

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