Blood in the urine is a common problem. The medical term for in the urine is. If there are only a small number of red blood cells in the urine, the urine color might not change and the blood cells are only apparent under a microscope. This is usually referred to a microscopic hematuria. Sometimes blood in the urine is a sign of a serious problem in the urinary tract, while other times it is not serious and requires no treatment. Only after a thorough evaluation by a health-care provider should blood in the urine be attributed to a nonserious cause.
Hematuria has many different causes.
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 track 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.
The evaluation for blood in urine consists of taking a history, performing a physical examination, evaluating the urine under a microscope, and obtaining a culture of the urine. Lower urinary tract symptoms, such as urgency (feeling a strong need to urinate) and frequency (needing to urinate frequently), as well as the presence of fever and/or chills are suggestive of infection. Recent trauma, even if believed by the patient to have been inconsequential, should be considered as a potential cause. Abdominal and/or flank pain, especially if radiating to the inguinal or the genital area, may suggest kidney stones. All recent medications, including vitamins or herbal supplements, should be reviewed with the health-care provider. However, it is important to note that even if the patient has been taking a medication that is associated with bleeding, a full workup (as listed below) should still be undertaken.
The physical exam will focus on possible sources of hematuria. Bruising over the back or abdomen may indicate trauma. A digital rectal exam should be performed, as findings consistent with prostatitis (for example, tenderness on palpation of the prostate) or an enlarged prostate (suggestive of BPH or benign enlargement of the prostate gland) may be useful in making a diagnosis. A repeat urinalysis, as well as a urine culture, should be obtained. The presence of white blood cells on urinalysis is more consistent with a urinary tract infection. Protein, glucose, or sediment in the urine may indicate the presence of a disease of the kidneys. Blood tests are also important, as they will aid in assessing renal function and identifying any clotting abnormalities.
In addition to the basic history and physical exam, there are three additional components for any workup of hematuria: CT scan, urine cytology, and cystoscopy.
The CT scan is an imaging evaluation of the urinary tract. Prior to the procedure, the patient drinks an oral contrast agent and a dye is injected intravenously. The patient then goes through the CT scan machine and images are taken of the abdomen and pelvis. Another test that can be performed, the intravenous pyelogram (IVP), is also a type of X-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of X-rays are then taken over a 30-minute period to look for abnormalities. The CT scan is more commonly performed than the IVP to evaluate the urinary tract and should be considered the test of choice. Both of these studies are especially useful for evaluating the kidneys and ureters but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. This is a simple 10-minute procedure wherein a thin, flexible cystoscope (or fiberoptic camera) is inserted via the urethra into the bladder in order to directly visualize any lesions or sources of bleeding. This is usually done with local anesthetic jelly injected into the urethra. Finally, urine cytology involves giving a urine sample to be analyzed by a pathologist for the presence of cancerous or abnormal-appearing cells.
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.
