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Blood in Urine (Hematuria)

There are many reasons that can lead to a person having bloody urine. This condition is called as hematuria and can often indicate an even serious underlying problem or disorder. At times, it can be a stand-alone problem too.

What is hematuria?

Hematuria is simply defined as having red blood cells in your urine. It can be ‘gross’ (visible) or ‘microscopic’ (visible under microscope).

Microscopic hematuria is found in a urine test for other problem or during a routine medical exam. On the other hand, gross hematuria is clearly seen by the patient and prompts a visit to the doctor.

Hematuria can develop over any portion of the urinary tract. This includes the kidneys, bladder, ureters, urethra and the prostate gland. Research indicates that hematuria may affect around 2.5% to 21% of the population. Many cases have no identifiable cause however in some cases it may indicate an infection, urinary tract cancer or stone disease.

Smoking, radiation, excessive use of certain painkillers and certain chemicals are suspected to raise the risk of hematuria in a person.

What are the causes of hematuria?

Blood in the urine can be caused due to a long list of disorders and other factors. Studies show that almost 18% of all normal adults exhibit symptoms of hematuria. Often times, hematuria can be an indicator of another serious condition that may require urgent and expert medical treatment.

These are the commonly known causes of hematuria:

  • Kidney cancer
  • Bladder cancer
  • Urethral cancer
  • Prostate cancer
  • UTI (urinary tract infection)
  • Urinary stone disease
  • Enlarged prostate
  • Kidney infection
  • Kidney diseases
  • Injury to urinary tract
  • Bladder irritation
  • Exercise hematuria
  • Prostate infection

How is hematuria diagnosed?

Gross hematuria is commonly reported earlier while microscopic hematuria is often detected by chance. Both can be severe in nature and require proper medical attention on time. Often, it shown no symptoms and is normally detected in a urine dipstick test. If the test is positive then the urine may be sent for laboratory analysis to determine the presence of red blood cells in it.

An extensive evaluation of the urinary tract is advised in case gross or microscopic hematuria is detected in a person. The doctor will view the patient’s medical history and perform a thorough physical examination. Urinalysis and examining urinary sediments under a microscope help to determine the presence of hematuria in a person.

Identifying the shape of the red blood cells present in the urine can help point out the part from where they are being released into the urine. UTI and kidney protein test are also advised in some cases. Urine cytology and urine culture test are advised as well.

A complete examination may include x-ray tests of the ureters and the kidney to look for kidney masses, presence of urinary stones and tumors in the ureters. An IVP (intravenous Pyelogram) is normally advised for this. It uses a radiographic contrast dye, which is injected in the blood stream, to check for normal functioning of the ureters. It is also often combined with a renal ultrasound test for more precise evaluation.
The doctor may also advise other imaging tests, such as CT scan to test for kidney masses and urinary stones. CT urography may be used for checking ureters and kidneys simultaneously. MRI or a retrograde pyelography may be advised if the doctor feels so.

However, these imaging tests are not sufficient for evaluating the functions of the bladder and this may call for a cystoscopic evaluation. This is a minimally invasive diagnostic test using a thin and flexible surgical tube to view the working of the bladder through the urethra.

What happens when tests don’t show any abnormalities?

In almost 8% to 10% of hematuria cases, no specific cause can be identified. This percentage may even be higher, according to some studies. Studies have also shown that if left untreated, hematuria may result in urological malignancy in 1% to 3% of these patients. Hence, doctors recommend a form of follow-up tests. These may vary in type and frequency, depending on the individual doctor. Repeated urine cytology and urinalysis are normally advised by urologists. In case gross hematuria is discovered, it is highly advised to get a cystoscopy and repeated imaging tests done. In case painful symptoms are also noticed, the same tests are advised. In case the painful and visible symptoms are not discovered within 3 years from its detection, then no treatment or testing may be required.

What is the treatment for hematuria?

The patient’s physical evaluation, symptoms and medical history will help the urologist to decide the best-suited treatment in the particular case.

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