Blood in the urine, or hematuria, is the presence of red blood cells. Gross hematuria is visible to the naked eye (pink, red, or brownish urine), while microscopic hematuria is only detectable under a microscope. While seeing blood in urine can be alarming, it warrants prompt medical attention to determine its underlying cause.
Understanding Fluid Intake and Hematuria
Generally, consuming excessive amounts of water does not directly cause blood in urine. High fluid intake can dilute urine, which might make any existing blood less noticeable, but it does not introduce blood into the urinary system. Dehydration also does not directly cause hematuria, though it can lead to concentrated urine that might irritate the bladder.
In contrast, “drinking too much” often refers to excessive alcohol consumption, which can indirectly contribute to blood in urine. While alcohol is not a direct cause of hematuria, chronic heavy alcohol use can damage the kidneys and liver. Kidney damage can lead to blood in urine because the kidneys’ ability to filter waste is impaired. Alcohol also acts as a diuretic, increasing urine production. This can increase the risk of kidney stones or urinary tract infections, both of which can cause hematuria.
Primary Causes of Blood in Urine
Many conditions can cause blood to appear in the urine, ranging from common benign issues to more serious medical concerns. Urinary tract infections (UTIs) are a frequent cause, particularly in women, as bacteria entering the urinary tract can lead to inflammation and bleeding. Kidney infections, a more severe type of UTI, can also cause blood in urine, often accompanied by fever and pain.
Kidney stones, formed from mineral crystals in the kidneys or bladder, can irritate or block urinary passages, resulting in visible or microscopic bleeding. In men, an enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common cause of hematuria. The enlarged gland can press on the urethra, leading to bleeding from strained blood vessels or increased risk of infection.
Certain kidney diseases, such as glomerulonephritis, involve inflammation of the kidney’s filtering units, which can cause blood to appear in the urine. Strenuous exercise, particularly activities like long-distance running, can also lead to temporary hematuria, sometimes referred to as “jogger’s hematuria.” This may involve trauma to the bladder during physical activity.
Various medications can induce hematuria. Blood thinners like warfarin, heparin, and aspirin can increase the likelihood of bleeding throughout the body, including the urinary tract. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can also cause kidney inflammation or damage that results in blood in the urine. Additionally, some anti-cancer drugs, like cyclophosphamide, are known to cause this side effect.
Injury to the kidneys or urinary tract, such as from an accident or contact sports, can directly cause blood to appear in the urine. While less common, more serious conditions like bladder, kidney, or prostate cancer can also manifest with blood in the urine, often as an early symptom. This underscores the importance of medical evaluation, as these cancers might not present other symptoms until more advanced stages.
When to Consult a Doctor
Any instance of visible blood in urine, or the detection of microscopic blood during a test, warrants medical attention. Even if the blood is intermittent, painless, or seems to resolve on its own, it should be evaluated by a healthcare provider. Ignoring hematuria can lead to the worsening of serious underlying conditions. The presence of blood clots in the urine also indicates a need for immediate evaluation, as they can cause significant pain or block urine flow.
It is particularly urgent to seek medical care if blood in urine is accompanied by other symptoms. These include:
- Pain or burning during urination.
- Frequent or urgent need to urinate.
- Abdominal or lower back pain.
- Fever.
- Chills.
- Nausea.
- Vomiting.
- Difficulty urinating.
Medical Evaluation and Treatment
When a person experiences hematuria, a medical evaluation is essential to identify the underlying cause. This typically begins with a thorough review of the individual’s medical history and a physical examination. Urine tests, including urinalysis and urine culture, are standard initial steps to confirm the presence of blood and check for infection.
Further diagnostic tests may include blood tests to assess kidney function or other systemic conditions. Imaging studies like ultrasound, CT scans, or MRI can provide detailed views of the kidneys, bladder, and other urinary tract structures to detect abnormalities like stones, tumors, or structural issues. In some cases, a cystoscopy may be performed, involving the insertion of a thin tube with a camera into the urethra and bladder to visually inspect the lining for problems.
Treatment for hematuria depends entirely on the specific cause identified. If an infection is present, antibiotics are typically prescribed. Kidney stones may be managed with medications to help them pass, or procedures such as extracorporeal shock wave lithotripsy (ESWL) may be used to break them into smaller pieces. For an enlarged prostate, medications to shrink the gland or improve urine flow might be prescribed, and in some instances, surgery may be considered. If a more serious condition like cancer is diagnosed, treatment will involve specialized approaches such as surgery, chemotherapy, or radiation therapy.