Hematuria is the presence of blood in the urine. Sometimes the blood turns the urine red or rust colored. When the blood is easily seen it is called gross hematuria. When the presence of blood can only be detected by a microscope or chemical test it is called microscopic hematuria. Because hematuria may be serious, it is important to search for the source of this problem and treat it if necessary.

The urinary tract consists of the kidneys, which produce urine; the ureters, which carry the urine to the bladder; the bladder, which stores the urine; and the urethra, which passes it out of the body. In the male, it also includes the prostate (the gland that produces fluid for semen) (Figures 1 and 2).

It is important to contact your doctor right away if you see blood in your urine even once. That is because urinary tract bleeding, even that caused by a serious disease, may be present one day and disappear the next. Whether blood is visible or not visible in the urine, you will need further testing to find the cause of your hematuria.

Sometimes, people with normal urinary tracts will have a few red blood cells (RBCs) in their urine. However, three RBCs on two separate urine tests indicate microscopic hematuria, and this will require further examination.

What Causes Hematuria?

There are many different causes of hematuria. In about 25% of all patients, the source of hematuria is a disease that may be serious. Some of the most common causes and symptoms are listed below.

• Kidney or ureteral stones: often associated with intense pain in the mid and lower back that may travel around the side, to the front, and into the groin.
• Cystitis: a bladder infection with pain or burning during urination and a strong urge to urinate immediately. Cystitis occurs more often in women than in men. In women, it may follow sexual intercourse.
• Cancer: cancer in any part of the urinary tract often causes hematuria. In the kidneys, it is often painless and microscopic. In the bladder, it may also cause pain and discomfort similar to that of cystitis. Bladder cancer is more common in men than in women and usually begins after 50 years of age. Tobacco smoking is thought to be a cause of bladder cancer.
• Enlarged prostate: in some older men, the enlarged prostate becomes inflamed and causes hematuria.
• Injury: falling and hitting your back or side can bruise a kidney and produce bleeding. High-impact sports or long-distance running can also jar the kidneys and produce hematuria.
• Underlying medical problem: sickle cell disease or trait (sickle cells are abnormal red blood cells) and glomerulonephritis (a serious inflammation of the kidneys).
• Medications: blood thinners, such as aspirin containing medications and drugs used for arthritis or for the relief of pain, may also cause hematuria.
• Foods: certain foods, such as beets or berries, can turn your urine red. If this is the case, further testing is not necessary.

Newborns (up to 6 weeks old):
Gross hematuria is not common among newborns. If it does occur it is most likely caused by bleeding disorders, urinary tract infections, birth defects, or kidney problems.

Children/adolescents (up to 20 years old):
Blood is rarely seen in the urine of children. When hematuria does occur, the most common cause is kidney infection or blockage in the urinary tract.

Adults 20-40 years of age:
Gross hematuria most often results from urinary tract infection. Symptoms that occur with the infection include pain with urination. A bladder tumor or stones are possible causes.

Adults 41-60 years of age:
Bladder tumors are the most common serious cause of gross hematuria, followed by stones and inflammation. The chance that hematuria is a sign of serious disease increases sharply after age 50. Men have urinary tract cancers more than twice as often as women. In addition, prostate problems may account for hematuria as well.

Adults 61 years of age or older:
Bladder tumors and urinary tract infections are the most common causes of hematuria.

DIAGNOSING HEMATURIA

If your doctor finds hematuria, he or she will ask you questions about your health history, give you a complete physical examination, and order certain tests. Your doctor may be able to tell what is causing your hematuria by finding out when and how it occurs.

Some of the most common tests that your doctor may order include:

1. Urinalysis: usually done when you have a complete physical examination. A fresh urine sample is sent to the laboratory where it is put through a series of studies and examined through a microscope. This is the most definite way to know if you have hematuria.
2. Urine culture and sensitivity: this test is done to see if there are bacteria in the urine. Bacteria are grown and identified in the laboratory so your physician will know which medication will provide the most effective treatment. A urine culture is usually ordered when your doctor thinks you may have a urinary tract infection.
3. Urine cytology: when your doctor thinks that you may have bladder or kidney cancer, he or she orders this cell study. Your urine is examined under a microscope for any abnormal types of cells.
4. Intravenous pyelogram (IVP) or computed tomography (CT) urogram: in these tests, a fluid is injected and x-rays taken of your kidneys, ureters, and bladder. Tumors; stones,, blockages, and other disorders are often seen on the 1VP or CT urogram.
5. Ultrasound: in this test, your kidneys, bladder, and prostate are viewed using sound waves to produce images of these organs.
6. Cystoscopy: examines the inside of your bladder and urethra with a cytoscope, a tube-like viewing device.
7. Dipstick: a chemically treated paper is dipped into a sample of your urine. The test will tell if there is blood in your urine and is often done along with urinalysis.

The treatment of hematuria depends on the cause of the bleeding and where the bleeding is located. Since hematuria is not a disease in itself, bleeding can only be stopped when the underlying condition is found and treated.

A few of the diseases that commonly cause hematuria and their usual treatments include:

• Cystitis: generally caused by bacteria that come from a woman's own intestinal tract. Cystitis is treated with antibiotics.
• Urinary stones: made of hard mineral deposits, stones can be found in any part of the urinary system. They may contain bacteria that trigger hard-to-cure infections. Depending on their size and position, stones can be passed out of the body with the urine, removed surgically, or broken into smaller pieces by shock waves.
• Bladder tumors: these growths are usually cancerous and need to be removed surgically. In addition, further treatment with chemicals or radiation may be needed.
• Idiopathic: refers to bleeding without an obvious cause that is not serious. Although idiopathic hematuria does not require treatment, the urologist will check on it periodically to be sure it is not a sign of a more serious problem.

Although hematuria can be prevented, in most cases it cannot. Athletes can prevent hematuria by avoiding high-contact sports. Runners should drink plenty of fluids and train on soft ground. Bicyclists can lower the nose of the seat, use a seat with a cushioned cover, and rise from the seat when riding over bumps.

Questions and Answers

If I see blood in my urine, does it mean I have cancer?
No. Blood in the urine can mean many things-some serious, some not so serious. Only your doctor can perform the tests that can tell you for sure.

What is more serious, gross or microscopic hematuria?
Both can be signs of a serious condition or disease. Just because there is less blood present in microscopic hematuria does not mean that the problem is less important.

If I see blood in my urine, what kind of doctor should I go to?
If you are a female younger than 40 and have symptoms of cystitis, first you should see your family doctor or gynecologist. In most other cases, it is probably best to see a urologist.

IMPORTANT TERMS

Antibiotics

infection-fighting drugs

Bladder

a balloon-like sac or container that stores urine

Cystitis

an infection or inflammation of the bladder

Hematuria

blood in the urine. May be gross (blood seen by the naked eye) or microscopic (blood seen only with a microscope).

Inflammation

swelling, redness, and pain resulting from irritation or infection.

Kidneys

a pair of organs located on each side of the spine in the lower back area. Kidneys filter the blood to eliminate wastes and excess water that combine to make urine.

Ureter

tube that carries urine from the kidneys to the bladder. Each kidney has one ureter.

Urethra

the channel that carries urine from the bladder and out of the body.

To continue reading about the following urological topics,
please click on the underlined words.

General Urology

• Hematuria
• Hematuria-2
• Testicular Self-Examination

Prostate

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• Prostatitis-2
• Needle Biopsy

Incontinence

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• Collagen Implants

Kidney Stones

• Lithotripsy