What you should know about blood in the urine
![Picture of the urinary tract](https://images.medicinenet.com/images/illustrations/urinary_structures.jpg?output-quality=75)
- Blood in the urine can sometimes be visible only with a microscope.
- Evaluating blood in urine requires consideration of the entire urinary tract.
- Tests used for the diagnosis of blood in urine may include a CT scan, cystoscopy, ultrasound, IVP, MRI, urine culture, and urine cytology.
- Management of blood in the urine depends upon the underlying cause.
What is blood in the urine (hematuria)?
Hematuria, or blood in the urine, can be either gross (visible) or microscopic (blood cells only visible through a microscope). Gross hematuria can vary widely in appearance, from light pink to deep red with clots. Although the amount of blood in the urine may be different, the types of conditions that can cause the problem are the same and require the same kind of workup or evaluation.
People with gross hematuria will visit their doctor with this as a primary complaint. People who have microscopic hematuria, on the other hand, will be unaware of the problem and their condition will most commonly be detected as part of a periodic checkup by a primary care physician.
What are the causes of blood in the urine?
The causes of gross and microscopic hematuria are similar and may result from bleeding anywhere along the urinary tract. One cannot readily distinguish between blood originating in the kidneys, ureters (the tubes that transport urine from the kidneys to the bladder), bladder, or urethra. Any degree of blood in the urine should be fully evaluated by a physician, even if it resolves spontaneously.
- Infection (often called a urinary tract infection or UTI) stemming either from the kidneys or bladder, is a common cause of microscopic hematuria. Urine is naturally sterile and should not contain bacteria.
- Kidney and bladder stones can cause irritation and abrasion of the urinary tract, leading to microscopic or gross hematuria.
- Trauma affecting any of the components of the urinary tract or the prostate can lead to bloody urine.
- Hematuria can also be associated with renal (kidney) disease, as well as hematologic disorders involving the body's clotting system.
- Medications that increase the risk of bleeding, such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix), may also lead to bloody urine.
- Lastly, cancer anywhere along the urinary tract can present with hematuria.
![](https://images.medicinenet.com//images/slideshow/urine-pee-health-s1-urine-test-strip.jpg)
SLIDESHOW
Urine: What Your Pee Says About Your Health See SlideshowWhat tests diagnose the causes of blood in the urine?
The evaluation for blood in urine consists of taking a history, performing a physical examination, evaluating the urine with a chemical test strip and under a microscope, and obtaining a culture of the urine to identify any bacteria present. Lower urinary tract symptoms, such as urgency (feeling a strong need to urinate) and frequency (needing to urinate frequently), as well as burning or pain when urinating, fever, or chills, are suggestive of infection.
Recent trauma, even if believed by the patient to have been inconsequential, should be considered a potential cause. Abdominal or flank pain, especially if radiating to the inguinal or the genital area, may suggest ureteral or kidney stones. All recent medications, including vitamins or herbal supplements, should be reviewed with the healthcare professional. 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, especially in males, as findings consistent with prostatitis (for example, tenderness on palpation of the prostate) or an enlarged prostate suggestive of benign prostatic hyperplasia (BPH), may be useful in making a diagnosis. The finding of a nodule or an area of induration (hardening) of the prostate may be indicative of cancer.
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 in 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: imaging, urine cytology, and cystoscopy.
- CT scan: 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.
- Intravenous pyelogram (IVP): Another test that can be performed, the 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.
- Cystoscopy: 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 using a thin, flexible cystoscope (or fiberoptic camera), which is inserted via the urethra into the bladder to directly visualize any lesions or sources of bleeding. This is usually done with local anesthetic jelly injected into the urethra.
- Cytology: Finally, urine cytology involves giving a urine sample to be analyzed by a pathologist for the presence of cancerous or abnormal-appearing cells.
What are the treatments for blood in the urine?
Treatments for hematuria vary widely and depend on the reason for the bleeding. It is important to note that quite often no cause is found for the hematuria. This should not be a source of major concern, however, since an appropriate workup effectively rules out the most serious causes of hematuria (for example, cancer).
In cases where a workup is negative and the cause of the hematuria remains unknown, observation with repeat urinalyses is a reasonable option. A blood test to check kidney function and a blood-pressure check should be done as well. Caucasian men over 50 should discuss with their doctor an annual prostate-specific antigen (PSA) blood test which is used to screen for prostate cancer. Prostate screening in African Americans traditionally begins at age 45 and in all races, a history of prostate cancer in close family members may indicate an earlier start of the screening.
Further discussion of the treatment for hematuria would depend upon the results of the workup and the exact cause of the hematuria. The urologist who performs this examination is responsible for recommending any further treatment or workup that would be necessary.
Previous contributing author: Mark H. Katz, MD
Top Blood In Urine Related Articles
CT Scan (Computerized Tomography)
A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.Female Screening Tests
What is a health screening? Why is it important to know your blood pressure? How long will your health screening take? Learn about wellness screenings for women for breast cancer, HIV, diabetes, osteoporosis, skin cancer, and more.How Long Can a Newborn Go Without Peeing?
A newborn baby usually passes urine for the first time within 12-24 hours after birth. Not peeing in the first 24 hours points to some urinary tract problem. Here are signs to look for and when to call a doctor.Internal Bleeding
Internal bleeding is a serious consequence of trauma and can be life-threatening, requiring immediate medical attention. Learn about signs, causes, and treatment.Kidney Stone Picture
A stone in the kidney (or lower down in the urinary tract). See a picture of Kidney Stone and learn more about the health topic.Kidney Stone Slideshow
What causes kidney stones? Where is kidney stone pain located on your body? Learn the symptoms and signs of kidney stone pain. Explore kidney stone treatment and how to prevent kidney stones.PSA Test (Prostate Specific Antigen)
Prostate specific antigen (PSA) is a protein found in semen. PSA levels are used to detect prostate cancer and monitor the progression of the disease. Learn about test uses, results, and accuracy.Prostatitis (Inflammation of the Prostate Gland)
Prostatitis is an inflammation of the prostate gland. Signs and symptoms of prostatitis include painful or difficulty urinating; fever; chills; body aches; blood in the urine; pain in the rectum, groin, abdomen, or low back; and painful ejaculation or sexual dysfunction. Causes of prostatitis include STDs, bacteria from urinary tract infections, or E. coli. Treatment for prostatitis depends on if it is a bacterial infection or chronic inflammation of the prostate gland.Symptoms of 12 Serious Diseases and Health Problems
Learn how to recognize early warning signs and symptoms of serious diseases and health problems, for example, chronic cough, headache, chest pain, nausea, stool color or consistency changes, heartburn, skin moles, anxiety, nightmares, suicidal thoughts, hallucinations, delusions, lightheadedness, night sweats, eye problems, confusion, depression, severe pelvic or abdominal pain, unusual vaginal discharge, and nipple changes.The symptoms and signs of serious health problems can be caused by strokes, heart attacks, cancers, reproductive problems in females (for example, cancers, fibroids, endometriosis, ovarian cysts, and sexually transmitted diseases or STDs), breast problems (for example, breast cancer and non-cancer related diseases), lung diseases (for example, chronic obstructive pulmonary disease or COPD, lung cancer, emphysema, and asthma), stomach or digestive diseases (for example, cancers, gallbladder, liver, and pancreatic diseases, ulcerative colitis, or Crohn's disease), bladder problems (for example, urinary incontinence, and kidney infections), skin cancer, muscle and joint problems, emotional problems or mental illness (for example, postpartum depression, major depression, post-traumatic stress disorder (PTSD), mania, and schizophrenia), and headache disorders (for example, migraines, or "the worst headache of your life), and eating disorders and weight problems (for example, anorexia or bulimia).
Testicular Pain
Testicular pain has many causes, including testicular torsion, cancer, injury and epididymitis. Treatment of pain in the testicles depends on the cause.Urinalysis (Urine Test)
Urinalysis (urine test, drug test) is a test performed on a patient's urine sample to diagnose conditions and diseases such as urinary tract infection, kidney infection, kidney stones, and inflammation of the kidneys, or screen for progression of conditions such as diabetes and high blood pressure.Urinary Tract Infection (UTI)
A urinary tract infection (UTI) is an infection of the bladder, kidneys, ureters, or urethra. E. coli, a type of bacteria that lives in the bowel and near the anus, causes most UTIs. UTI symptoms include pain, abdominal pain, mild fever, urinary urgency, and frequency. Treatment involves a course of antibiotics.What Should I Drink if I Have Blood in My Urine?
Blood in your urine is called hematuria. Drink water if you have blood in your urine, but see your doctor as well.