Blood in the urine is a relatively common problem. The medical term for red blood cells in the urine is hematuria, where sometimes the appearance of blood in the urine can be a sign of a more serious problem in the urinary tract. Other times it may not be serious and require no treatment at all.
What Is the Urinary Tract?
The urinary tract consists primarily of the kidneys. There are two kidneys, located closer to your back than your front at about waist level. The kidneys filter water and waste out of the blood and produce urine from that.
Ureters are the second part of your urinary tract. These narrow, hollow tubes carry urine from the kidneys to your bladder. The bladder is a balloon-like organ that holds urine until it is convenient for you to empty it in a process called urination.
The urethra is a narrow, hollow tube that carries urine from the bladder and outside of the body. The flow of urine is controlled by internal and external sphincter muscles. These muscles tighten or relax around the urethra, holding or releasing urine. In men, the genitals and prostate are considered part of the urinary system, the prostate surrounding the urethra. It is made up of glands which secrete a fluid that is part of semen; the prostate often becomes enlarged in older men.
Blood in Urine
Blood in urine is not always visible, and if the amount of blood is small, the urine appears normal. This is called a microscopic occurrence, because the blood cells are visible only under a microscope. Typically, this is discovered when you have a urine test for another reason (not because you have noticed the blood). When there is enough blood to be visible, the urine may look pinkish, red, or smoky brown, like tea or cola, which is called gross or frank hematuria. It takes very small amount for the blood to become visible in urine. About one-fifth of a teaspoon in a half-quart of urine will make it visible.
A trace amount of blood in urine is normal, and an average person with a healthy urinary tract excretes about one million red blood cells via urine each day. This amount of blood is not visible, and not considered hematuria.
An abnormal amount of blood in the urine can be acute, which means it is new, occurring suddenly. It could also occur as chronically, which means it is an ongoing or long-term bleeding. Acute hematuria can occur once, or it can occur many times in human life. Up to 10% of people have hematuria, and about 3% develop gross hematuria. Women develop hematuria more than men because women are more likely to suffer from urinary tract infections. Older adults, especially men, have hematuria more often than younger people. This is because they are more likely to take medications that can irritate the urinary tract, or to have prostate enlargement or cancer.
Causes of Blood in Urine
Hematuria has many different causes, and blood in the urine can come from any condition that results in infection, inflammation, or injury to the urinary system. Typically, microscopic hematuria indicates damage to the upper urinary tract (kidneys), while visible blood indicates damage to the lower tract (ureters, bladder, or urethra). However, this is not always the case. The most common causes in people younger than 40 years are kidney or ureter stones. A common cause is also urinary tract infection. These infections may cause hematuria in older people, but cancers of the kidney, bladder, and prostate become a more common concern with people over 40 years of age.
Several conditions causing hematuria may exist at the same time. Some of these causes are serious, while others are not. The health care provider is there to do tests which help tell the difference.
Well-known causes of blood in the urine also include urinary tract blockage, usually the urethra by a stone, a tumor, a narrowing of the opening, or a compression from surrounding structures.
Blood clotting disorders and some medications could provoke blood in the urine. Antibiotics (such as Rifampin), analgesics (Aspirin), and anticoagulants (Warfarin, Phenytoin, and Quinine) commonly cause blood in urine.
Benign or non-cancerous enlargement of the prostate, known as benign prostatic hypertrophy is a common condition in older men that lead to blood in urine.
Chronic diseases such as diabetes, hypertension, and sickle cell anemia and viral infections could also be the cause for blood in the urine. In some cases, strenuous exercise, especially running, could cause repeated jarring of the bladder and thus lead to blood in the urine.
On the other hand, sometimes no cause is found for blood in the urine. If serious conditions such as cancer, kidney disease, and other chronic diseases that cause kidney damage or bleeding are ruled out, the cause for blood in urine is almost certainly not serious. The hematuria will probably go away by itself or continue as a chronic condition without doing any harm. Urine can be colored pink, red, or brown for reasons that have nothing to do with bleeding in the urinary tract, for example because of large amounts of certain foods (beets, berries, rhubarb). Food coloring, medications, menstrual blood and liver diseases could also lead to blood in urine.
Symptoms of Blood in Urine
Blood in the urine is itself a symptom rather than a disease, so the appearance of the urine is usually not a clue as to the cause. In gross hematuria, the urine appears pinkish, red, or smoky brown, and there may be small blood clots. It is interesting that the amount of blood in the urine does not indicate the seriousness of the condition. In microscopic hematuria, the urine appears normal and is not visible without a microscope. Many people with hematuria have no other symptoms related to the underlying cause of the bleeding. Pain in the flank, back, lower belly or groin is commonly associated with blood in urine and especially kidney stones. Moreover, patients will commonly experience a burning sensation or pain when urinating, fever, nausea or vomiting, weight loss, and decreased appetite. Not all people with kidney stones have all of these symptoms.
Symptoms of urinary tract infection may be similar to those or kidney stones, and these are pain in lower back, flank, lower abdomen, or groin, which may be severe but not enough to cause writhing.
When to Seek Medical Care
Any time you notice blood in the urine or another symptom of a urinary tract disease, you should call your health care provider. If you cannot get in touch with your provider or get an appointment that day, go to a hospital emergency department immediately. Any time you have a combination of blood in the urine, fever, and flank pain, you should seek emergency medical care because this may represent a severe kidney infection.
Exams and Tests for Blood in Urine
Regardless of whether you have microscopic or gross hematuria, your health care provider will ask questions to try to discover the cause of your blood in urine. You will be asked about your medical condition and history, particularly whether you have ever had blood in the urine before, and also which medications you take or have taken in the past, including over-the-counter drugs, illegal drugs, or drugs of abuse, herbs, supplements, and other alternative products. You will also be asked whether you have had any recent illnesses, accidents, surgeries, or medical procedures or tests. After this initial examination, laboratory and imaging studies may be performed.
Treatment for Blood in Urine
If you have visible blood in your urine, do not attempt to treat yourself with home remedies, but see a medical professional without delay.
If you have a urinary tract infection, you will take antibiotics for 3-14 days, depending on which part of the urinary tract is infected. If you have kidney stones, be sure to drink plenty of liquids to help pass the stones and prevent other stones from forming; you may need to take pain relievers. If the cause of blood in urine is a kidney stone, do not worry, just take your therapy and most stones will pass through the urinary system by themselves. In certain instances, more extensive measures may be required for this condition.
One form of therapy, called extracorporeal shock wave lithotripsy, uses sound waves to crush the stones, so smaller pieces can then pass through more easily, though some pain will remain. Another form of therapy uses cystoscopy to find the stone in the ureter and then to grab and remove it with a small scoop.
If the cause is urinary tract infection, treatment seeks to get rid of the bacterium responsible for the infection, which is the second most common cause of hematuria. If you have no other significant illness, you will take a course of antibiotics for 3-14 days, depending on the source of your infection.
In some cases, benign prostate enlargement could cause blood in urine. Sometimes eliminating certain foods and medications that irritate the prostate can help shrink the prostate, while sometimes medication is necessary.
If a medication is causing hematuria, the medication should be stopped immediately. However, you should not stop using that medication without talking it over with your health care provider.
Urinary tract blockage is also common reason for blood in urine. A blockage usually requires surgery or other procedure to correct or remove that block.
Injury as the main cause is not such a problem, because these usually heal over time. If that does not happen, you may need surgery or another procedure to repair the injury or remove the damaged tissue.
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