Having blood in your urine can be a cause of alarm for everyone. Hematuria is the medical term used to describe the presence of blood in your urine.1 There are many different medical conditions and diseases that can cause blood in your urine. These may include infections, cancer, kidney disease, and some rare blood disorders. Blood in the urine may be clearly visible, or sometimes it may be present in such small quantities that it cannot be seen with the naked eye.2
The presence of any amount of blood in the urine should never be ignored as it could be a sign of a serious health condition, even if you notice it only once. Ignoring hematuria can cause underlying conditions like kidney disease and cancer to worsen. This is why you should consult your doctor at the earliest to let them know about the presence of blood in your urine.
Your doctor will send your urine sample for further analysis and also order some imaging tests to find out the exact cause of hematuria and then accordingly come up with a treatment plan.3
Let’s take a look at the various causes of blood in the urine and how it can be treated.
Types of Hematuria
In order to understand the causes of why there could be blood present in your urine, it is first necessary to understand the types of hematuria. There are two major types of hematuria – microscopic hematuria and gross hematuria.
- Microscopic hematuria: In this type of hematuria, you cannot see the blood in the urine with your naked eye. This is because the amount of blood is so small. This is why the condition is referred to as microscopic hematuria. Only a diagnostic urine test can detect the blood. Looking at a sample of urine under a microscope can confirm whether you have microscopic hematuria.4,5
- Gross hematuria: in this type of hematuria, you can see sufficient blood present in your urine. In fact, there is enough blood to have turned the color of your urine to red or pink. There could also be spots of visible blood in your urine when you have gross hematuria.6,7
Causes of Hematuria
There are many different causes behind why there is blood present in your urine. While in some cases, the blood could be coming from a different source. For example, blood that appears in the urine could actually be from the vagina in women, a bowel movement in either men or women or from the ejaculate in men. If the blood is truly present in the urine, there could be several potential causes behind the hematuria.8
The most common cause of hematuria is an infection. Usually, this is because of an infection in the bladder, urinary tract, or the kidneys. Infection happens when bacteria moves up into the urethra, which is the tube that transports urine from the bladder and out of the body. The infection can easily move up into the bladder, and from there, spread up to the kidneys as well. Such type of an infection is usually accompanied by pain and an urgent need to urinate. You may experience microscopic or gross hematuria.9
2. Enlarged Prostate
In older or middle-aged men, one of the common causes of blood in the urine is an enlarged prostate gland. The prostate gland is located just under the bladder and near the urethra.
When the prostate gland gets bigger, as is typically observed in men at middle age, it starts compressing on the urethra. This causes problems in urinating and sometimes also prevents the bladder from emptying completely. This can cause a urinary tract infection (UTI), which may lead to hematuria.10
Stones in the kidney or bladder are another common reason for observing blood in your urine. Stones are crystals that form from the minerals present in your urine. The kidneys or the bladder are the two most common places where they develop.
If the stones are big enough, they can cause a blockage that may cause hematuria along with a lot of pain.11
Cancer of the prostate, kidney, or bladder can also cause blood in the urine. However, this is usually a symptom that occurs in the advanced stages of cancer. Many people may not have experienced any earlier signs and symptoms of having cancer.
5. Kidney Disease
One of the less common reasons for hematuria is kidney disease. If you have an inflamed or diseased kidney, it can lead to hematuria. It is possible for kidney disease to occur independently or as part of another underlying medical condition or disease, such as diabetes.
In children aged 6 to 10 years, it has been observed that a kidney disorder known as post-streptococcal glomerulonephritis may cause blood in the urine.12,13 This kidney disorder can develop within a week or two after the child has had a strep infection that was left untreated. While it was a common disorder earlier, it is rare to find this condition in children today as antibiotics are used to quickly treat all infections caused by streptococcus.
6. Certain Medications
Certain medications are also known to cause blood in the urine. These include:
- Blood thinners like warfarin and heparin (brand name Coumadin)
- Cyclophosphamide – a drug used in the treatment of certain types of cancer
7. Other Causes
There are some other causes of hematuria that are less common than the ones discussed above. Some rare types of blood disorders like hemophilia, sickle cell anemia, and Alport syndrome can cause hematuria.14
Sometimes, an injury or blow to the kidneys or strenuous exercising can also cause some blood to show up in your urine.
How to Determine the Cause of Hematuria?
If you visit your doctor regarding blood in the urine, they will first ask you about how much blood was there in the urine, and when did you see it during the urination. They will also want to know how frequently you urinate, if you are experiencing any pain, if there are any blood clots in the urine, and what all medications you are currently taking.15
You will also need to undergo a thorough physical examination, and a sample of your urine will be collected and sent for testing. The urine analysis report will confirm whether there are any blood and bacteria present in the urine. The presence of bacteria will indicate that an infection is the likely cause of the hematuria.
If there is no bacteria present, your doctor may order imaging tests like a CT scan, which will use a small amount of radiation to display an image of the entire body. Another diagnostic test that your doctor may order is a cystoscopy.16 This test involves the use of a small tube to send a camera up into the urethra and into the bladder. With the help of the camera, your doctor will check the interior of the urethra and bladder to determine the exact cause of the hematuria.
What is the Treatment for Hematuria?
The underlying cause of the hematuria will determine what kind of treatment your doctor will prescribe.
If there is an infection due to which there is blood in your urine, such as a UTI, your doctor will prescribe a course of antibiotics to treat the infection and kill the bacteria.
If hematuria is being caused by large kidney or bladder stones, it needs to be treated at the earliest because the pain will continue to get worse if the condition is left untreated. Prescription medications and other treatments are used to pass the stones. In some cases, sound wave technology might be required to break up significantly larger stones. This procedure is known as extracorporeal shock wave lithotripsy (ESWL), and it helps break up the stones into smaller pieces.17
Your doctor may also use a scope to remove the kidney stones. For this procedure, a thin tube known as an ureteroscope is passed through the urethra and the bladder into the ureter. There is a camera attached to the end of the scope, and it helps in locating the stones. Once the stones have been found, your doctor will use specialized tools to capture the stones and remove them. In cases of large stones, they are broken down into pieces first and then removed.
If the cause of the hematuria is due to an enlarged prostate, your doctor will prescribe medications such as 5-alpha reductase inhibitors or alpha-blockers. In some serious cases, surgery may be required.18,19
Is It Possible To Prevent Hematuria?
Hematuria can be prevented if you are able to prevent the underlying medical causes. Here are some tips on how to avoid hematuria:
- To prevent stones from developing, drink plenty of water, and also avoid excessive consumption of salt and foods like rhubarb and spinach.
- To prevent urinary tract infections or other infections, drink plenty of water regularly, practice good hygiene, and urinate immediately after having intercourse.
- To prevent or reduce the risk of bladder cancer, avoid smoking, restrict the exposure to toxic chemicals, and drink plenty of water.
- Avoid overuse of pain medications
- Avoid being exposed to radiation
- Avoid jogging or running for long distances or strenuous exercises.
- If you have gotten injured in the kidney region, make sure to visit a doctor to rule out any internal bleeding or injury.
While seeing blood in your urine can alarm anyone, it is essential that you do not ignore hematuria and visit your doctor to find out the underlying cause. In most cases, hematuria can be treated by treating the underlying medical reason behind the bleeding.
- Sutton, J.M., 1990. Evaluation of hematuria in adults. Jama, 263(18), pp.2475-2480.
- Cohen, R.A. and Brown, R.S., 2003. Microscopic hematuria. New England Journal of Medicine, 348(23), pp.2330-2338.
- Benson, G.S. and Brewer, E.D., 1981. Hematuria: Algorithms for diagnosis: II. Hematuria in the adult and hematuria secondary to trauma. Jama, 246(9), pp.993-995.
- Golin, A.L. and Howard, R.S., 1980. Asymptomatic microscopic hematuria. The Journal of urology, 124(3), pp.389-391.
- Vehaskari, V.M., Rapola, J., Koskimies, O., Savilahti, E., Vilska, J. and Hallman, N., 1979. Microscopic hematuria in schoolchildren: epidemiology and clinicopathologic evaluation. The Journal of pediatrics, 95(5), pp.676-684.
- Pan, C.G., 2006. Evaluation of gross hematuria. Pediatric Clinics of North America, 53(3), pp.401-12.
- Greenfield, S.P., Williot, P. and Kaplan, D., 2007. Gross hematuria in children: a ten-year review. Urology, 69(1), pp.166-169.
- Matulewicz, R.S. and Meeks, J.J., 2016. Blood in the urine (hematuria). Jama, 316(14), pp.1508-1508.
- Nicolle, L.E., 1999. Urinary infections in the elderly: symptomatic or asymptomatic?. International journal of antimicrobial agents, 11(3-4), pp.265-268.
- Mobley, D., Feibus, A. and Baum, N., 2015. Benign prostatic hyperplasia and urinary symptoms: Evaluation and treatment. Postgraduate medicine, 127(3), pp.301-307.
- Feit, L., John, D., Torres, N.D. and Sinert, R., 2020. Flank pain and hematuria is not always a kidney stone. The American Journal of Emergency Medicine.
- Bergstein, J., Leiser, J. and Andreoli, S., 2005. The clinical significance of asymptomatic gross and microscopic hematuria in children. Archives of pediatrics & adolescent medicine, 159(4), pp.353-355.
- Becquet, O., Pasche, J., Gatti, H., Chenel, C., Abély, M., Morville, P. and Pietrement, C., 2010. Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study. Pediatric Nephrology, 25(2), p.275.
- Kashtan, C.E., 2004. Familial hematuria due to type IV collagen mutations: Alport syndrome and thin basement membrane nephropathy. Current opinion in pediatrics, 16(2), pp.177-181.
- Hyodo, T., Kumano, K. and Sakai, T., 1999. Differential diagnosis between glomerular and nonglomerular hematuria by automated urinary flow cytometer. Nephron, 82(4), pp.312-323.
- Kim, J.K., Ahn, J.H., Park, T., Ahn, H.J., Kim, C.S. and Cho, K.S., 2002. Virtual cystoscopy of the contrast material—filled bladder in patients with gross hematuria. American Journal of Roentgenology, 179(3), pp.763-768.
- Chaussy, C. and Schmiedt, E., 1984. Extracorporeal shock wave lithotripsy (ESWL) for kidney stones. An alternative to surgery?. Urologic radiology, 6(1), pp.80-87.
- Wilt, T.J., MacDonald, R., Hagerty, K., Schellhammer, P. and Kramer, B.S., 2008. 5‐alpha‐reductase inhibitors for prostate cancer prevention. Cochrane Database of Systematic Reviews, (2).
- Lepor, H., 2007. Alpha blockers for the treatment of benign prostatic hyperplasia. Reviews in urology, 9(4), p.181.
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