Occasional Hematuria

There are many reasons why a person can have blood in their urine. This condition, known as hematuria, can be an indication of a serious problem or conversely, have no negative connotation. What should you do if you find out that there's blood in your urine?

1. The causes of hematuria vary depending on the age of a woman and the underlying risk factors. Common Causes of Hematuria or Bloody Urine in Women are: Cystitis, Urinary tract infection (UTI), kidney infection, and pyelonephritis; Kidney stones and Ureteral stones can usually cause microscopic hematuria, but occasionally gross hematuria.
2. Hematuria – the presence of red blood cells in the urine – can be caused by a number of different conditions. Most of them are not serious and will quickly resolve themselves.

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What is hematuria?

Hematuria is defined as the presence of red blood cells in the urine. It can be characterized as either 'gross' (visible to the naked eye) or 'microscopic' (visible only under the microscope). Microscopic hematuria is an incidental finding often discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria could prompt you to visit the doctor. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra. It is estimated that hematuria occurs in 2.5 to 21 percent of the population. In many patients no specific cause is found; however, hematuria may be a marker for infection, stone disease or urinary tract cancer. Risk factors for significant underlying disease include: smoking, radiation, overuse of some pain medicines and exposure to certain chemicals.

What are the common causes of hematuria?

Blood in the urine is often not a sign of significant disease. Studies have shown that between nine to 18 percent of normal individuals can have some degree of hematuria. However, hematuria can be a sign of an important medical condition requiring treatment. Below is a list of common causes of hematuria:

• Cancer (Bladder/Kidney/Urethra/Ureter)
• Urinary Stone Disease
• Urinary Tract Infection (UTI)
• Renal (Kidney) Disease
• Radiation or Chemical Induced Cystitis (Bladder Irritation)
• Injury to the Urinary Tract
• Exercise-Induced

How is hematuria diagnosed?

Visible hematuria is often worrisome to the patient and prompts them to seek medical attention; however, microscopic hematuria can be just as severe. It often has no symptoms and is detected on a urine dipstick test. If the dipstick test is positive for blood the amount of blood is often determined by looking at the urine with a microscope. If three or more red blood cells (RBC) are seen per high power field on two of three specimens, further evaluation to determine a cause is recommended.

What additional tests are needed?

Any patient with gross hematuria or significant microscopic hematuria should have further evaluation of the urinary tract. The first step is a careful history and physical examination. Laboratory analysis consists of a urinalysis and examination of urinary sediment under a microscope. The urine should be evaluated for protein (a sign of kidney disease) and evidence of urinary tract infection. The number of red blood cells per high-powered field should be determined. In addition the shape of the blood cells should be evaluated. This can help determine where the bleeding is coming from. In patients with white blood cells in the urine, a urine culture should be performed as well. A urinary cytology is also obtained to look for abnormal cells in the urine. A blood test should also be done to measure serum creatinine (a measure of kidney function). Those patients with significant protein in their urine, abnormally shaped red blood cells, or an elevated creatinine level should undergo general medical evaluation for the presence of kidney disease.

A complete urologic evaluation for hematuria also includes X-rays of the kidneys and ureters to detect kidney masses, tumors of the ureters and the presence of urinary stones. This traditionally consisted of an intravenous pyelogram (IVP). In this study, a radiographic dye is injected into the blood stream and X-rays are taken as the kidneys excrete the dye. This study has trouble detecting small renal masses and is often combined with a renal ultrasound.

Many physicians may opt for other imaging studies such as a computerized tomography (CT) scan. This is the preferred method of evaluating kidney masses and is the best modality for the evaluation of urinary stones. Recently many urologists have been using CT urography. This allows the urologist to look at the kidneys and ureters with one X-ray test. In patients with an elevated creatinine or an allergy to X-ray dye, magnetic resonance imaging (MRI) or retrograde pyelography is used to evaluate the upper urinary tract. During retrograde pyelography, the patient is taken to the operating room and dye is injected up the ureters from the bladder and then images are taken.

The main limitation of these imaging studies is the inability to evaluate the bladder; therefore a cystoscopic evaluation is required. This is usually performed in the office under local anesthesia with either a rigid, or more commonly, a flexible cystoscope. After applying a topical analgesic to the urethra the urologist inserts an instrument called a cystoscope through the urethra and into the bladder. Looking through the cystoscope the doctor can examine the inner lining of the bladder and urethra for abnormalities.

What happens if no abnormality is found?

In at least eight to 10 percent of cases no cause for hematuria is found. Some studies have demonstrated an even higher percentage of patients have no cause. Unfortunately, studies have shown that urologic malignancy is later discovered in one to three percent of patients with negative work-ups. Therefore, some form of follow-up is recommended. Recommendations regarding follow-up are sparse and no clear consensus has been agreed upon. Consideration should be given to repeating the urinalysis and urine cytology at six, 12, 24 and 36 months. Immediate re-evaluation with possible cystoscopy and repeat imaging should be performed in the face of gross hematuria, abnormal urinary cytology or irritating urinary symptoms such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is needed.

What is hematuria (blood in urine)?

Hematuria refers to a condition of red blood cells in the urine. This changes the color of the urine to red, pink or cola. However, sometimes the color of urine remains the same. Red blood cells in the urine can come from:

• Kidney (where urine is made)
• Urinary tract along with its parts like the ureters (tubes to carry urine from the kidneys to the bladder), the bladder (where urine is stored), the prostate (in men), and the urethra (the tube that lets the urine out of the body)

Hematuria is not a life-threatening disease but it should not be ignored. And it is also important to investigate the factors that cause hematuria (mostly caused by a serious condition).

What are the types of hematuria?

Hematuria is classified into two types:

• Gross hematuria, and
• Microscopic hematuria

What is gross hematuria?

In gross hematuria, the blood in the urine can be seen with the naked eye as the color of the urine changes to pink, red, purplish-red, brownish-red, or cola.

What is microscopic hematuria?

Microscopic hematuria means that the color of the urine does not change but when viewed under a microscope, an increased number of red blood cells can be seen clearly.

What are the symptoms of hematuria?

In most of the cases, blood in the urine (gross or microscopic) is the only symptom of the disorder. In others, the patient may experience a variety of symptoms, such as the following:

• Abdominal pain
• Decreased urinary force, hesitancy, incomplete voiding
• Fever
• Frequent urination (polyuria)
• Pain during urination (dysuria)
• Pain in the flank or side
• Urinary urgency

What are the causes of hematuria?

In hematuria, the kidneys or urinary tract organs allow blood cells to leak into the urine. This may be because of any disorder or problem. Some of these problems are discussed below:

Urinary tract infections

Bacteria enter the body through the urethra and multiply in the bladder causing urinary tract infections in the urinary tract. Symptoms of such urinary tract infections include a persistent urge to urinate, pain with urination, and urine with an extremely strong and foul smell.

Kidney infections (pyelonephritis)

Bacteria may enter kidneys either from ureters or from the bloodstream. Signs and symptoms of bladder infections with fever and flank pain are seen in kidney infections.

A bladder or kidney stone

Stones are formed when the minerals in concentrated urine form crystals and stick to the walls of kidneys or bladder. With time, the crystals become smaller and harder. Initially, there are no symptoms but with time these stones can cause irritation and abrasion of the urinary tract, leading to hematuria.

Enlarged prostate

As men approach middle age, the prostate gland often enlarges. Enlarged prostate then compresses the urethra and block the urine flow partially which eventually leads to blood in urine.

Kidney disease

Glomerulonephritis is a type of kidney disease that causes an inflammation of the kidney and affects its filtering system leading to microscopic blood in urine.

Cancer

Kidney cancer, bladder cancer or prostate cancer may result in visible bleeding in the urine.

Inherited disorders

Sickle cell anemia is a hereditary defect that affects hemoglobin in red blood cells. This disorder can cause blood in urine, both visible and microscopic hematuria. Alport syndrome is another example of inherited disorder which affects the filtering mechanism of the kidneys.

Kidney injury

Blood may be seen in urine after a blow or other injury to kidneys from an accident or sport.

Medications

Some medications may cause urinary bleeding including:

• Anti-cancer drug (cyclophosphamide)
• Penicillin
• Anticoagulant (aspirin and the blood thinner heparin)

Strenuous exercise

An intense workout may sometimes lead to urinary bleeding. Strenuous exercise may cause trauma to the bladder, dehydration or the breakdown of red blood cells.

What are the risk factors for hematuria?

Almost anyone (including children and teens) can have red blood cells in the urine. Factors that increase the chance of getting the disease include:

Age

Men older than 50 years of age may experience an enlarged prostate gland. This can increases their likelihood of getting occasional hematuria.

Sex

Over half of all females suffer from UTI (urinary tract infection) at least once in their lifetime which increases their risk of getting the disease hematuria.

A recent infection

Kidney inflammation increases the chances of visible urinary blood in children.

Family history

If a person has a family history of kidney disease or kidney stones, he or she is more prone to urinary bleeding.

Certain medications

Use of specific medicines like aspirin, anti-inflammatory pain relievers and some antibiotics make the person more susceptible to urinary bleeding.

Strenuous exercise

Long-distance runners are more prone to exercise-induced urinary bleeding (sometimes called jogger’s hematuria. Anyone who works out continuously and strenuously can develop the symptoms of the disease.

How is hematuria diagnosed?

Hematuria is diagnosed in a series of procedures which includes:

Medical History

Medical history helps the doctor to diagnose the cause of hematuria. In this process, the doctor may ask the patient about:

• A review of symptoms
• List of prescription and over-the-counter medications patient has been taking
• Current and past medical conditions

Physical Exam

Following the medical history is a physical exam in which the doctor physically examines the patient. A healthcare professional:

• Taps on the abdomen and back
• Check for pain or tenderness in the bladder and kidney area
• Perform a digital rectal exam on a man to look for any prostate problems
• Perform a pelvic examination of a woman’s pelvis to know about the source of possible red blood cells in the urine

Urine tests

Urine tests are done to know about the cause of hematuria. This may include:

Urine cytology

Normally urine contains epithelial cells which shed from the urinary tract. Urine cytology evaluates this urinary sediment under a microscope.

Blood tests

Blood tests are done to look for any evidence of kidney or other diseases that may be responsible for hematuria.

CT scan

Computed tomography (CT scan) is done to examine the structure of the kidneys, ureters, and bladder. A dye is injected into a vein just before the test to highlights any possible abnormalities. Kidney stones or abnormalities of the kidneys, ureters, and bladder can be easily seen with a CT scan.

Kidney ultrasound

It is used as an alternative to CT scan because some people are allergic to the dye used in CT. Ultrasound uses sound waves and creates a picture of the kidney's structure.

Cystoscopy

A small tube is inserted into the bladder through the urethra. The tube consists of a camera that shows the inner lining of the bladder. The healthcare professional examines the lining of the bladder and looks for any abnormalities. In presence of any abnormalities, a biopsy of the abnormal tissue is done. A sample of tissue is taken and is examined with a microscope to determine whether abnormal (cancerous) cells are present.

Kidney biopsy

A small piece of tissue from the kidney is removed and examined with a microscope for signs of kidney disease. This biopsy finds out any kidney disease if present that may have resulted in hematuria.

Magnetic resonance imaging (MRI)

MRI is used to take pictures of the patient’s internal organs and soft tissues without using x-rays. This test can help diagnose problems of internal organs (such as the bladder or kidney).

What are the treatment options for hematuria?

Treatment of hematuria basically depends on its causes and reason for the bleeding. The treatment is done in following ways:

When no cause is found

In cases where the cause of the hematuria remains unknown, repeated urinalyses is a reasonable option. Other tests like a blood test (to check kidney function) and a blood-pressure check should be done as well.

Men over 50 should go for an annual prostate-specific antigen (PSA) blood test (which is done to diagnose prostate cancer).

When the cause is urinary tract infection

The treatment for urinary tract infection might involve taking antibiotics. Following antibiotics are recommended to treat urinary tract infections:

• Trimethoprim or sulfamethoxazole (Bactrim or Septra)
• Cephalexin (Keflex)
• Ceftriaxone
• Fosfomycin (Monurol)
• Nitrofurantoin (Macrodantin, Macrobid)

Read about treatment of urinary tract infection.

When the cause is enlarged prostate

Medications are prescribed in this case to shrink an enlarged prostate. Some of the medications include:

• Alpha blockers like alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax) and terazosin (Hytrin)
• 5-alpha reductase inhibitors such as dutasteride (Avodart) and finasteride (Proscar)
• A combination of alpha blockers and 5-alpha reductase

When the cause is kidney or bladder stone

The stones in kidney and bladder can be treated in following ways:

• Sound waves are used to break the stones
• Surgery is done to remove the stones

How can Blood in urine (hematuria) be prevented?

Hematuria can be prevented if the underlying causes are prevented first. To prevent infections one should:

• Drink plenty of water daily
• Avoid holding the urge to urinate
• Urinate after every sexual intercourse
• Practice good hygiene

To prevent stones one should:

• Drink plenty of water
• Avoid excess salt
• Regulate protein and oxalate intake

Occasional Microscopic Hematuria

To prevent bladder cancer one should:

• Refrain from smoking
• Limit exposure to chemicals
• Drink plenty of water

To prevent kidney cancer, one should:

• Quit smoking
• Stay hydrated
• Avoid chemicals
• Eat a healthy and balanced diet
• Try to be active and maintain a healthy weight

How to cure hematuria naturally?

Occasional Hematuria

There are plenty of home remedies that can help to naturally treat hematuria. Some of these home remedies are:

• Drinking lots of fluid and staying hydrated
• Drinking cranberry juice
• Drinking the combination of spinach juice and coconut water
• Eating bitter gourd regularly
• Drinking pomegranate juice
• Consuming foods that are high in vitamin C

What are the complications of hematuria?

Complications of hematuria also depend on the underlying causes which include:

Hematuria With Negative Urine Culture

• Ignoring cancer can lead to an advancement of the tumors that are no longer treatable.
• Untreated infections can eventually lead to chronic kidney disease and eventually kidney failure.
• Ignoring the enlarged prostate may lead to a need to urinate frequently, severe pain, and even prostate cancer if left untreated for a longer time.
• Untreated stones can be very painful.