Hematuria (Blood in the Urine): Symptoms, Causes, Treatment

What are the symptoms of hematuria?

Hematuria refers to the presence of blood in the urine, which can be visible to the naked eye (gross hematuria) or only detectable under a microscope (microscopic hematuria). Common symptoms associated with hematuria include:

1. Pink, red, or cola-colored urine: This is the most obvious symptom, where the urine appears discolored due to the presence of blood.
2. Blood clots in urine: Sometimes, blood clots may be present in the urine, especially in cases of gross hematuria.
3. Pain or burning sensation: Some individuals may experience pain or a burning sensation during urination, similar to symptoms of a urinary tract infection (UTI).
4. Abdominal or pelvic pain: Pain in the abdomen or pelvis can occur, which may indicate underlying causes like kidney stones or infections.
5. Frequent urination or urgency: There may be an increased need to urinate or a sudden urgency to urinate.
6. Fever: In cases where hematuria is caused by an infection, fever may accompany the symptoms.
7. Nausea or vomiting: These symptoms can occur if hematuria is related to severe kidney stones or infections affecting the urinary tract.

It’s important to note that hematuria itself is a symptom and not a disease. It can be caused by various conditions affecting the urinary tract, kidneys, or other parts of the body, ranging from minor issues to serious medical conditions. If you or someone you know experiences hematuria, it’s advisable to seek medical evaluation to determine the underlying cause and appropriate treatment.

What are the causes of hematuria?

Hematuria can be caused by a variety of conditions affecting the urinary tract, kidneys, or other parts of the body. Some common causes include:

1. Urinary Tract Infections (UTIs): Infections in the bladder or urethra can cause inflammation and lead to hematuria.
2. Kidney Infections (Pyelonephritis): Bacterial infections that start in the bladder and spread to the kidneys can cause hematuria.
3. Kidney Stones: Small, hard deposits of minerals and salts can form in the kidneys and cause bleeding as they pass through the urinary tract.
4. Bladder or Kidney Stones: Stones in the bladder or kidney can irritate the lining and cause bleeding.
5. Enlarged Prostate (Benign Prostatic Hyperplasia – BPH): In men, an enlarged prostate can compress the urethra and lead to hematuria.
6. Cancer: Tumors in the bladder, kidneys, or prostate can cause hematuria.
7. Inherited Disorders: Conditions like polycystic kidney disease, Alport syndrome, and sickle cell anemia can cause blood in the urine.
8. Kidney Disease: Glomerulonephritis, an inflammation of the kidney’s filtering units (glomeruli), can lead to hematuria.
9. Medications: Certain medications, such as anticoagulants (blood thinners), aspirin, and some antibiotics, can cause hematuria.
10. Strenuous Exercise: Intense exercise, especially long-distance running, can cause hematuria, sometimes referred to as “runner’s hematuria.”
11. Trauma: Injury to the kidneys or bladder from an accident or physical activity can cause blood in the urine.
12. Menstruation: In women, blood from menstruation can sometimes be mistaken for hematuria.
13. Urinary Catheterization: Insertion of a catheter can cause irritation and bleeding in the urinary tract.
14. Radiation Therapy: Radiation treatment for cancer can cause inflammation and bleeding in the urinary tract.
15. Certain Foods and Dyes: In some cases, foods like beets, berries, or rhubarb, and certain food dyes can cause urine to appear red or pink, which might be mistaken for hematuria.

It’s essential to consult a healthcare provider if you experience hematuria to determine the underlying cause and receive appropriate treatment.

How is the diagnosis of hematuria made?

The diagnosis of hematuria (blood in the urine) is typically made through a combination of medical history, physical examination, and laboratory tests. Here are the common steps involved in making a diagnosis:

1. Medical History: The healthcare provider will ask questions about the patient’s symptoms, such as:
   • How long have you been experiencing hematuria?
   • Is the blood present in the urine all the time or only occasionally?
   • Is the blood in the urine accompanied by pain, burning sensation while urinating, or other symptoms?
   • Are there any associated medical conditions, such as kidney stones, urinary tract infections, or kidney disease?
2. Physical Examination: A physical examination is performed to check for any signs of underlying medical conditions that may be causing hematuria, such as:
   • Abdominal tenderness or masses
   • Enlarged kidneys or spleen
   • Abnormal bowel sounds
3. Urinalysis: A urinalysis is performed to examine the urine sample for:
   • Red blood cells (RBCs)
   • White blood cells (WBCs)
   • Protein
   • Glucose
   • Other substances that may indicate an underlying condition
4. Dipstick Test: A dipstick test is a simple, quick test that can detect the presence of blood in the urine. The test involves dipping a special strip into the urine sample and waiting for a few minutes to see if it changes color.
5. Microscopic Examination: If the urinalysis or dipstick test suggests hematuria, a microscopic examination of the urine sample is performed to identify the type and number of RBCs present.
6. Imaging Studies: Depending on the results of the above tests and medical history, imaging studies such as:
   • Computed Tomography (CT) scans
   • Magnetic Resonance Imaging (MRI) scans
   • Ultrasound
   • Cystoscopy (direct visualization of the urinary tract)
7. Endoscopy or Biopsy: In some cases, endoscopy or biopsy may be performed to visualize the bladder and ureter or to obtain tissue samples for further examination.
8. Specialized Tests: Depending on the suspected cause of hematuria, specialized tests may be ordered to diagnose conditions such as:
   • Cystoscopy: to visualize the bladder and ureter
   • Urodynamic testing: to evaluate bladder function
   • Renal function tests: to assess kidney function

By combining these diagnostic steps, healthcare providers can identify the underlying cause of hematuria and develop an appropriate treatment plan.

What is the treatment for hematuria?

The treatment for hematuria (blood in the urine) depends on the underlying cause of the condition. Here are some common treatment approaches:

Mild Hematuria:

1. Observation: Mild hematuria without any underlying medical conditions may not require treatment, and the condition may resolve on its own.
2. Hydration: Drinking plenty of fluids to help flush out the kidneys and reduce the risk of kidney stones or infections.

Hematuria due to Kidney Stones:

1. Pain management: Medications such as ibuprofen or acetaminophen can help manage pain and discomfort.
2. Hydration: Drinking plenty of fluids to help pass the stone and reduce the risk of infection.
3. Alpha-blockers: Medications such as tamsulosin or terazosin can help relax the muscles in the ureter and help pass the stone.
4. Stents: In some cases, a stent may be inserted to keep the ureter open and allow the stone to pass.

Hematuria due to Urinary Tract Infections (UTIs):

1. Antibiotics: Antibiotics are typically prescribed to treat UTIs.
2. Pain management: Medications such as ibuprofen or acetaminophen can help manage pain and discomfort.
3. Hydration: Drinking plenty of fluids to help flush out the kidneys and reduce the risk of complications.

Hematuria due to Kidney Disease:

1. Treatment for underlying condition: The treatment will depend on the underlying kidney disease, such as chronic kidney disease, acute kidney injury, or glomerulonephritis.
2. Medications: Medications such as ACE inhibitors or angiotensin receptor blockers may be prescribed to slow the progression of kidney disease.
3. Dialysis: In severe cases of kidney disease, dialysis may be necessary.

Surgical Treatment:

1. Ureteroscopy: A procedure in which a scope is inserted through the urethra to remove small stones or debris from the ureter.
2. Cystoscopy: A procedure in which a scope is inserted through the urethra to visualize the bladder and remove any debris or stones.
3. Surgery for tumors or cancer: Surgery may be necessary to remove tumors or cancerous growths in the urinary tract.

Other Treatments:

1. Blood thinners: Medications such as warfarin or aspirin may be prescribed to prevent blood clots from forming.
2. Vitamin supplements: Vitamin C supplements may be recommended to help reduce inflammation and promote healing.

It’s essential to note that treatment for hematuria should only be initiated after a proper diagnosis has been made, and it’s always best to consult with a healthcare provider for personalized guidance on managing hematuria.