Blood in urine (hematuria)

Blood in urine (hematuria)

Definition  :

Seeing blood in your urine can cause more than a little anxiety. Yet blood in urine — known medically as hematuria — isn't always a matter for concern. Strenuous exercise can cause blood in urine, for instance. So can a number of common drugs, including aspirin. But urinary bleeding can also indicate a serious disorder.

There are two types of blood in urine. Blood that you can see is called gross hematuria. Urinary blood that's visible only under a microscope is known as microscopic hematuria and is found when your doctor tests your urine. Either way, it's important to determine the reason for the bleeding.
Treatment depends on the underlying cause. Blood in urine caused by exercise usually goes away on its own within one or two days, but other problems often require medical care.

Symptoms:


The visible sign of hematuria is pink, red or cola-colored urine — the result of the presence of red blood cells. It takes very little blood to produce red urine, and the bleeding usually isn't painful. If you're also passing blood clots in your urine, that can be painful. A lot of times, though, bloody urine occurs without other signs or symptoms.
In many cases, you can have blood in your urine that's visible only under a microscope (microscopic hematuria).

When to see a doctor
Although many cases of hematuria aren't serious, it's important to see your doctor anytime you notice blood in your urine. Keep in mind that some medications, such as the laxative Ex-lax, and certain foods, including beets, rhubarb and berries, can cause your urine to turn red. A change in urine color caused by drugs, food or exercise usually goes away within a few days. However, you can't automatically attribute red or bloody urine to medications or exercise, so it's best to see your doctor anytime you see blood in your urine.

Causes:

In hematuria, your kidneys — or other parts of your urinary tract — allow blood cells to leak into urine. A number of problems can cause this leakage, including:

• Urinary tract infections. Urinary tract infections may occur when bacteria enter your body through the urethra and begin to multiply in your bladder. Symptoms can include a persistent urge to urinate, pain and burning with urination, and extremely strong-smelling urine. For some people, especially older adults, the only sign of illness may be microscopic blood.
  
• Kidney infections. Kidney infections (pyelonephritis) can occur when bacteria enter your kidneys from your bloodstream or move up from your ureters to your kidney(s). Signs and symptoms are often similar to bladder infections, though kidney infections are more likely to cause fever and flank pain.
  
• A bladder or kidney stone. The minerals in concentrated urine sometimes precipitate out, forming crystals on the walls of your kidneys or bladder. Over time, the crystals can become small, hard stones. The stones are generally painless, and you probably won't know you have them unless they cause a blockage or are being passed. Then, there's usually no mistaking the symptoms — kidney stones, especially, can cause excruciating pain. Bladder or kidney stones can also cause both gross and microscopic bleeding.
  
• Enlarged prostate. The prostate gland — located just below the bladder and surrounding the top part of the urethra — often begins growing as men approach middle age. When the gland enlarges, it compresses the urethra, partially blocking urine flow. Signs and symptoms of an enlarged prostate (benign prostatic hyperplasia, or BPH) include difficulty urinating, an urgent or persistent need to urinate, and either visible or microscopic blood in the urine. Infection of the prostate (prostatitis) can cause the same signs and symptoms.
  
• Kidney disease. Microscopic urinary bleeding is a common symptom of glomerulonephritis, which causes inflammation of the kidneys' filtering system. Glomerulonephritis may be part of a systemic disease, such as diabetes, or it can occur on its own. It can be triggered by viral or strep infections, blood vessel diseases (vasculitis), and immune problems such as immunoglobulin A nephropathy, which affects the small capillaries that filter blood in the kidneys (glomeruli).
  
• Cancer. Visible urinary bleeding may be a sign of advanced kidney, bladder or prostate cancer. Unfortunately, you may not have signs or symptoms in the early stages, when these cancers are more treatable.
  
• Inherited disorders. Sickle cell anemia — a hereditary defect of hemoglobin in red blood cells — can be the cause of blood in urine, both visible and microscopic hematuria. So can Alport syndrome, which affects the filtering membranes in the glomeruli of the kidneys.
  
• Kidney injury. A blow or other injury to your kidneys from an accident or contact sports can cause blood in your urine that you can see.
  
• Medications. Common drugs that can cause visible urinary blood include aspirin, penicillin, the blood thinner heparin and the anti-cancer drug cyclophosphamide (Cytoxan).
  
• Strenuous exercise. It's not quite clear why exercise causes gross hematuria. It may be trauma to the bladder, dehydration or the breakdown of red blood cells that occurs with sustained aerobic exercise. Runners are most often affected, although almost any athlete can develop visible urinary bleeding after an intense workout. 

Treatments and drugs:

Hematuria has no specific treatment. Instead, your doctor will focus on treating the underlying condition. This might include, for instance, taking antibiotics to clear a urinary tract infection, trying a prescription medication to shrink an enlarged prostate, or shock wave therapy to break up bladder or kidney stones.
If the underlying condition isn't serious, no treatment is necessary.