What is Hematuria & How is it Treated?|Types, Causes, Symptoms, Risks of Hematuria

Hematuria is a medical condition that represents serious underlying disease, but it isn’t a specific disease in itself and is rather a symptom of some underlying problem. Although in many cases hematuria can be benign, causing no serious harm to the patient, it must not be ignored. Consulting a doctor will indicate the cause behind hematuria, which must be treated. Up to 10% of the general population is seen to be suffering from hematuria.

When there is an abnormal presence of red blood cells in urine, it is known as hematuria. The presence of RBCs in urine is a normal phenomenon. However, when it is to be considered as hematuria, needs to be understood. Hematuria is a sign that the kidneys, the ureters or tubes that carry urine from the kidneys to the bladder or even the prostate gland is having some problem resulting in introducing the blood into urine. For women, the bladder or the urethra can be facing problems leading to hematuria.

Depending on the amount or presence of RBCs in the urine, hematuria can be of two types:–

Gross Hematuria: When the urine becomes red, pink or dark brown in colour, it can be discerned that the urine is containing large or small blood clots that are causing this unique colour of the urine. However, since even 1 millilitre or 0.03 ounces of blood in the urine can change the colour of the urine, there is no reason for panicking that it indicates a serious underlying problem.

Microscopic Hematuria: When the amount of blood in urine is so little that it does not visibly change the colour of the urine and cannot be identified with bare eyes, and can only be discerned under a microscope, then it is known as microscopic hematuria. This is why this type of hematuria is called microscopic hematuria.

When it is more than 3 RBCs in every high-power field of urine, it is considered to be hematuria. Although the reddish tint of the urine is the most usual symptom of hematuria, this discoloration can also be the result of Myoglobin and Porphyria in urine, eating foods like beets, rhubarb that can make the urine to turn into red or pink and also because of a few drugs like phenindione, cascara, methyldopa, phenazopyridine, diphenylhydantoin, phenolphthalein, phenacetin, senna and phenothiazine etc. can cause hematuria. RBCs are not the sole reason behind this reddish brown discoloration. However, what is important is to consider the cause of this discoloration of the urine and thereby determine, whether it is hematuria or not, whether it is caused by the increase in the number of RBCs in the urine or not. The usual causes of hematuria are:

• Kidney or bladder infection.
• Glomerulonephritis.
• Tumor in the kidney or bladder.
• Prostate infection.
• Enlarged prostate.
• Prostate cancer.
• Benign prostatic hyperplasia.
• Bleeding disorders.
• Kidney stones.
• Trauma.

Those, who are suffering from these above mentioned diseases or conditions that are general causes of this condition, are at increased risk for having hematuria. Apart from this, people who are 50 years of age and above are also seen to be at higher risk of having hematuria. Although, it is also a fact that anyone can have hematuria, including children as well as teens. The general risk factors that contribute to hematuria are:

• Any kind of kidney and prostate disease.
• Men who are aged 50 years and above.
• Bacterial or viral infection.
• Exposure to certain industrial chemicals.
• Those, who are engaged in long-distance running and strenuous exercise.
• Those, who consume medicines like antibiotics, pain relievers and blood thinners.
• Renal stones.
• Smoking cigarettes.

Hematuria itself is a sign of another underlying disease in many cases. As there is presence of RBCs in the urine, the urine exhibits a change in colour by transforming from the pale yellow colour to red, pink or cola-coloured. However, there are many other associated symptoms of hematuria and they are:

• Decreased urinary force.
• Abdominal and side pain.
• Polyuria or frequent urination.
• Hesitancy in urinating.
• Dysuria or pain during urination.
• Urinary urgency.

Apart from these general symptoms, there are some associated symptoms of hematuria that can be seen which include the symptoms of the medical condition that cause hematuria. The symptoms that are associated with other diseases causing hematuria include:

• Skin rashes
• Arthritis
• Joint pains
• Swelling
• Nausea and vomiting
• Chills
• High fever
• Blood in semen
• Pain during ejaculation

When any of the general symptoms, along with reddish brown urination is found to be persisting, it needs to be consulted with the doctor, to find out whether it is a life-threatening problem or not. The doctor will ask for a sample of the urine. For women, the urine must be collected in between two menstruation cycle, as during menstruation, the blood may get mixed with the urine. Testing the presence of blood in urine is called urinalysis.

If hematuria is found by determining the increase of blood count in urine, the doctor generally asks for the medical history of the patient. Whether the patient has had any history of bladder problems or bleeding disorders or kidney disease, even in the family, is asked by the doctor. Any recent viral or bacterial infection, strenuous exercise or recent trauma is also noted by the doctor. Depending on the clinical analysis of the case history, the doctor refers for further diagnostic tests that will determine the diagnosis of cause of hematuria:

Urine Culture. Whether there is a kidney or bladder infection causing the hematuria is determined by this test.

Ultrasound. This test is done to check for kidney stones, whether the kidney has a benign or noncancerous mass, a fluid filled mass or a solid cancerous mass which is causing hematuria.

CT scan. This is done to identify tumours, bladder or kidney stones, or the presence of any other abnormalities. When the normal, non-intravenous computerized tomographic (CT) scan does not come up with required results, it is then recommended to use an intravenous dye that the radiologist injects into the vein and this brings the image through its travelling path on the CT scan.

Cystoscopy. To check the presence of any tumour in the lining of the bladder that is resulting in hematuria, a small telescope like tool is inserted into the bladder, when the patient is kept under mild sedation.

Treating hematuria is mostly aimed at treating the underlying cause behind this symptom. Generally the treatment for hematuria depending on the cause consists of:

Changing Exercise Regime. Hematuria caused by excessive exercise can be treated by changing the exercise regime.

Antibiotics. Using antibiotics, the infection causing hematuria can be treated.

Stopping Medications. Hematuria caused by certain medications, can be treated by stopping those medicines.

Surgery & Other Treatments. In other cases, like kidney stone, increased fluid intake and surgery or lithotripsy is recommended to remove the stone. For cancerous tumours, chemotherapy, surgery, radiation therapy as well as immunotherapy are used to treat cancer or resist the cancer from spreading. To treat Glomerulonephritis, certain medications are given by the doctor.

Hematuria caused by medication, excessive exercise or smoking can be prevented. But when hematuria is caused by cancerous tumours, kidney stones and other diseases, it cannot be prevented. However, the general preventions for hematuria include:

• Avoid smoking to prevent hematuria.
• Avoid unhealthy lifestyle that may cause urinary tract cancers and bleeding.
• Drinking a lot of fluid help in preventing hematuria.
• Switching to a less strenuous exercising program can also help prevent hematuria.

If hematuria occurs in children, who have had this as a consequence of some other disease like strep infection, it can be treated well and they can recover quickly. Adults, who are experiencing hematuria, as a result of glomerulonephritis, can recover on their own, depending on the type of the disease. For those, who are suffering from severe diseases like cancer or tumour, it depends on the stage of the disease, to determine whether hematuria can be treated or not.