The presence of blood in a man’s urine, medically known as hematuria, warrants immediate attention. Hematuria is a sign that red blood cells are entering the urinary tract between the kidneys and the urethra, not a diagnosis itself. Because the cause can range from a minor, temporary issue to a serious underlying disease, consulting a healthcare professional promptly is necessary for proper evaluation.
Is It Really Blood
When a person first notices a change in urine color, it is helpful to distinguish between true hematuria and other factors that can mimic the appearance of blood. Hematuria is classified into two types based on visibility. Gross hematuria is visible to the naked eye and can cause the urine to appear pink, red, or even a dark, cola-brown color.
In contrast, microscopic hematuria involves red blood cells present in the urine but in amounts too small to change the color, requiring laboratory analysis under a microscope for detection. A true finding of blood is defined by the presence of three or more red blood cells per high-power field (RBCs/HPF) in a urine sample.
Several common foods and certain medications can temporarily change the color of urine, leading to a false suspicion of bleeding. Eating large quantities of beets or rhubarb, for instance, may result in pink or reddish urine due to pigments that are naturally excreted. Certain drugs, such as the laxative senna or the urinary pain reliever phenazopyridine, can also impart an orange or reddish-brown hue. Medical evaluation remains the only way to confirm whether the color change is due to harmless pigments or actual red blood cells.
Common Causes of Hematuria
Many instances of hematuria are linked to conditions that are frequently managed and not necessarily life-threatening. Urinary tract infections (UTIs) are a primary cause of blood in the urine, although less common in men than women. The bleeding occurs because invading bacteria trigger an inflammatory response that irritates the delicate lining of the urinary tract and bladder. This inflammation causes the small blood vessels to become fragile and prone to leaking red blood cells into the urine stream.
Kidney and bladder stones represent another frequent cause, with the bleeding mechanism being mechanical. These hard mineral formations often have jagged or sharp edges that scratch the mucosal lining of the kidney, ureter, or bladder as they move or attempt to pass. The resulting irritation causes trauma to the tissue and surrounding blood vessels, which then shed blood into the urinary stream.
Sometimes, a transient form of hematuria can be induced by physical extremes. Strenuous exercise, particularly long-distance running, can lead to a condition sometimes referred to as “march hematuria.” This can result from repeated impact trauma to the bladder wall. Another element is intravascular hemolysis, where red blood cells are mechanically broken down in the bloodstream due to continuous pounding. The resulting free hemoglobin is filtered by the kidneys and excreted into the urine.
Age Related and Serious Structural Concerns
As men age, specific structural changes and disease risks in the genitourinary system become more relevant causes of hematuria.
Prostate Issues
Benign Prostatic Hyperplasia (BPH), the non-cancerous enlargement of the prostate gland common in men over 50, is a frequent source of bleeding. As the prostate grows, it can compress the urethra and lead to the development of new, fragile blood vessels on the surface of the gland. The increased pressure within these enlarged vessels makes them susceptible to rupture, especially during the straining associated with urination. Prostatitis, the inflammation or infection of the prostate gland, can also cause bleeding by eroding the small blood vessels within the prostate tissue, allowing blood to seep into the urethra.
Kidney Disorders
More serious conditions originating within the kidneys can also manifest as hematuria. Glomerulonephritis, an inflammation of the tiny filtering units of the kidney called glomeruli, causes hematuria by damaging the glomerular filtration barrier. This structural damage allows red blood cells to pass through the filter and enter the urine, often resulting in misshapen red blood cells visible under a microscope. Polycystic Kidney Disease (PKD), an inherited disorder that causes numerous fluid-filled cysts to grow in the kidneys, may also cause bleeding if one of the cysts ruptures.
Cancer Risk
The potential for genitourinary cancer is the most serious concern, particularly in older men. Painless gross hematuria is a significant warning sign for malignancies such as bladder, kidney, or prostate cancer. The bleeding often results from the tumor invading and eroding the lining of the urinary tract. Because this bleeding can be intermittent and may stop on its own, its occurrence warrants an immediate and thorough evaluation due to the high risk of underlying malignancy.
Medical Diagnosis and Treatment
The diagnostic process for hematuria begins with a comprehensive review of the patient’s medical history and a physical examination, including a digital rectal exam to assess the prostate. A urinalysis is then performed to confirm the presence of red blood cells and check for other indicators, such as protein or signs of infection. If infection is suspected, a urine culture is collected to identify the specific bacteria and determine the appropriate antibiotic treatment.
Imaging and Visualization
To visualize the upper and lower urinary tracts, imaging tests and direct visualization procedures are employed. Computed Tomography (CT) Urography is a common choice, providing detailed cross-sectional images of the kidneys, ureters, and bladder to identify tumors or stones. Alternatively, a renal ultrasound may be used, particularly for younger patients, to evaluate the kidneys without radiation exposure.
For direct inspection of the bladder, a procedure called cystoscopy is performed, especially in cases of gross hematuria or in patients with risk factors for cancer. During a cystoscopy, a small, flexible tube with a camera is inserted through the urethra into the bladder to check for tumors, inflammation, or other abnormalities in the lining. Treatment is always directed at the underlying cause, whether it involves antibiotics for an infection, medications to shrink an enlarged prostate, surgical procedures to remove stones, or specific interventions for cancer.