Hematuria

Hematuria is the medical name for the presence of blood cells in urine (pee). Healthcare providers label blood in urine as gross, microscopic or dipstick.

• Gross hematuria occurs when there’s enough blood present in your urine that it’s visible to the naked eye. It can turn toilet water a pale pink or bright red color.

• Microscopic hematuria happens when your urine has blood in it, but the amount is too small for humans to see. In fact, you need a microscope to see it.

• Dipstick hematuria results when oxidation of a urine test strip causes a color change. It doesn’t always mean that blood cells are present in your urine. Dipstick tests have relatively high false-positive rates.

How common is blood in urine?
Blood in urine is a common finding. It affects an estimated 2% to 30% of the U.S. adult population.

What are the causes of hematuria?
There can be a number of different causes of blood in your urine, some more serious than others. These conditions can involve infections or stones, including:

• Urinary tract infection (UTI): This means that you have an infection in any part of your urinary system.

• Pyelonephritis: This describes an infection that has reached as far as your kidney.

• Cystitis: This condition refers to an inflamed bladder, which can have infectious and non-infectious causes.

• Urinary stone disease: This term describes stones found in your urinary system, including kidney stones, bladder stones and ureteral stones.

Other conditions leading to blood in urine may include:

• Enlarged prostate (benign prostatic hypertrophy): In this non-cancerous condition, your prostate becomes larger. The prostate is a body part that produces semen.

• Injury to your urinary tract: You have blunt or penetrating trauma from accidents or assault.

• Menstruation: You may see blood in your urine when you have your period.

• Endometriosis: In this condition, fragments of the inner lining of the uterus grow in places other than inside the uterus.

• Kidney (renal) disease: With this chronic condition, damage to your kidneys means they don’t work as well.

• Sickle cell disease: This inherited condition affects your red blood cells.

In addition to these other conditions, cells growing uncontrollably in certain body parts — what we know as cancer — can cause blood in your urine. These conditions include:

• Bladder cancer.

• Kidney cancer.

• Ureteral cancer.

• Urethral cancer.

• Prostate cancer.

What are the signs and symptoms of hematuria?

• Many times, there are no symptoms except blood in your urine. When this happens, your providers may say that you’re “asymptomatic.” 

• If you’re having symptoms, this may include frequent or painful urination or urination that is urgent or needs to happen “right away.”

• There can also be associated nausea, vomiting, fevers, chills or pain in your back or lower abdomen. 

• Although blood in your urine doesn’t always mean you have a disease, it can be an important warning sign to a possible health problem. 

• Don’t ever ignore bloody urine. Contact a healthcare provider as soon as you find blood in your urine, as earlier detection for any problem is helpful.
  

How is hematuria diagnosed?
During your appointment, your healthcare provider will take a medical history and perform a physical examination that might include a digital rectal exam. These things will help your provider understand your symptoms better. Your provider may order other tests. These tests may include:

• Urinalysis: A test on a urine sample.

• Urine culture: A urine test that checks for an infection.

• Urine cytology: A urine test that checks for any abnormal-appearing cells.

• Cystoscopy: A test that uses a device called a cystoscope to look at the inside of your bladder and urethra.

• Ultrasound: A test that uses ultrasound waves to examine your kidney, ureters and bladder.

• Computed tomography (CT) scan: A test that uses X-rays and computers to make cross-sectional images of your abdomen and pelvis.

• Magnetic resonance imaging (MRI) scan: A test that uses a large magnet, radio waves and a computer to produce images of your organs and structures.

How is blood in urine treated?
Treating blood in your urine depends strongly on the actual cause of the hematuria. Your provider will use the information collected from your medical history, physical exam and test results to work with you to find the best treatment.

Medications to treat causes of blood in urine

• For hematuria caused by infections, your provider will prescribe antibiotics. These antibiotics work by killing the bacteria causing the infection, which should stop the bleeding.

• For an enlarged prostate, urologists typically use two classes of medications to treat this condition: alpha-blockers and the 5-alpha-reductase inhibitors.

• For cancer, your provider will conduct treatment that best fits the stage and level of the disease and is in line with your goals of care. This may include surveillance, surgery, radiation, immunotherapy, chemotherapy, hormone therapy or combinations of these options.

• For sickle cell disease, your provider may prescribe disease-modifying agents like hydroxyurea, pain medications, antibiotics and drugs that prevent blood cells from dying or forming into sickles.

• For kidney disease, your provider may prescribe several different types of medications. These may include diuretics, drugs to lower blood pressure and cholesterol, and erythropoietin to build red blood cells if you’re anemic.

• For endometriosis, your provider may suggest hormone-related medications.

• For hematuria caused by an enlarged prostate that isn’t relieved by medications, your provider may suggest surgery.

• For kidney disease, you might need dialysis to filter out waste or even a kidney transplant.

• For cancers, your urologist may be part of a multidisciplinary care team.

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