Noticing blood during urination, or hematuria, is a concerning observation. This always warrants medical evaluation. Understanding its origins and knowing when to seek medical guidance is important for addressing the underlying cause.
Clarifying the Bleeding Source
It’s important to determine if blood originates from the urinary tract or merely appears to coincide with urination. True hematuria means blood from any part of the urinary system: kidneys, ureters, bladder, or urethra. Bleeding from other sources can be mistaken for blood in urine. For instance, vaginal bleeding, rectal bleeding, or external skin irritation can cause confusion. Observing if blood is mixed throughout the urine stream or appears separately can help differentiate its source, but medical assessment is needed.
Common Reasons for Blood in Urine
Urinary tract infections (UTIs) are a frequent cause of hematuria, particularly in women. Bacteria ascending into the urinary system cause inflammation and irritation, leading to visible or microscopic bleeding. Common accompanying symptoms include:
Burning sensation during urination
Persistent urge to urinate
Cloudy or strong-smelling urine
Low-grade fever
Kidney or bladder stones are a common cause of hematuria. These hard mineral deposits form in the urinary tract. As they move or grow, they can irritate or damage the lining of the ureters or bladder, leading to bleeding. This bleeding is often accompanied by intense pain in the back, side, or lower abdomen as the stone passes.
In men, particularly those over 50, benign prostatic hyperplasia (BPH), or an enlarged prostate, can lead to hematuria. The prostate gland, located below the bladder, can enlarge with age, pressing on the urethra. This compression can sometimes rupture small blood vessels within the prostate, resulting in blood in the urine.
Certain medications can increase the risk of bleeding, including within the urinary tract. Blood thinners (e.g., warfarin, aspirin) prevent clots but can make blood vessels fragile and prone to bleeding. Some nonsteroidal anti-inflammatory drugs (NSAIDs) can also affect kidney function or blood clotting, potentially leading to hematuria.
Strenuous exercise, like long-distance running, can occasionally cause temporary microscopic or visible blood in the urine. Known as exercise-induced hematuria, this is thought to result from bladder or kidney trauma during intense exertion or temporary changes in kidney function. This type of bleeding typically resolves shortly after the activity ceases.
Less Frequent Causes to Consider
While less common, certain kidney diseases can manifest with blood in the urine. Conditions like glomerulonephritis involve inflammation of the glomeruli, the tiny filtering units in the kidneys. This inflammation can impair the kidney’s filtering ability and allow blood cells to leak into the urine.
Although rare, blood in the urine, particularly without accompanying pain, can sometimes indicate kidney or bladder cancer. Tumors in these organs can cause blood vessels to become fragile and bleed into the urinary tract.
Physical trauma or injury to the lower back or abdominal area can also result in hematuria. A direct impact from an accident, a fall, or a sports injury could cause internal bleeding within these organs or their associated vessels. The extent of bleeding can vary depending on the injury’s severity.
Some inherited disorders predispose individuals to hematuria. For example, sickle cell trait, a genetic condition affecting red blood cells, can lead to microscopic or macroscopic blood in the urine due to kidney complications. Alport syndrome, another genetic disorder, directly affects the kidneys’ filtering structures, causing progressive kidney disease and persistent hematuria.
Other rare causes include blood disorders affecting clotting, or specific inflammatory conditions.
When to Seek Professional Medical Advice
Unexplained blood in the urine, visible or microscopic, warrants immediate consultation. Visible blood clots necessitate urgent medical attention. Persistent bleeding that does not resolve quickly requires prompt evaluation to identify the underlying cause.
Accompanying symptoms like severe pain (especially in the back, side, or lower abdomen) can indicate kidney stones or a more serious issue. Fever and chills with hematuria suggest a significant urinary tract or kidney infection. Difficulty urinating or complete inability to pass urine are red flags requiring immediate medical intervention.
Unexplained weight loss or persistent fatigue with blood in the urine could point towards systemic or serious underlying conditions. If bleeding occurs after a recent injury or fall, even if seemingly minor, seek medical advice to assess for internal damage.
Blood in the urine in children should always be evaluated by a doctor without delay, regardless of other symptoms. Even if bleeding is intermittent or resolves on its own, a medical evaluation is necessary to determine the underlying cause and ensure no serious condition is overlooked.
Navigating Diagnosis and Management
Upon visiting a doctor for hematuria, the initial assessment involves a review of your medical history, including illnesses, medications, or injuries, followed by a physical examination. This step helps the healthcare provider narrow down potential causes and guide subsequent diagnostic steps.
Diagnostic tests confirm blood presence and investigate its origin. Urinalysis checks for red blood cells, infection, or other urine abnormalities. If infection is suspected, urine culture identifies specific bacteria. Imaging studies (ultrasound, CT scans of abdomen/pelvis) visualize kidneys, bladder, and ureters, detecting stones, tumors, or structural abnormalities. In some cases, cystoscopy (a procedure using a thin, lighted tube inserted into the urethra) may be necessary to examine the bladder lining.
Hematuria management depends on the underlying cause identified through diagnostic procedures. For instance, bacterial infections are treated with antibiotics. Kidney stones may require treatments ranging from increased fluid intake for small stones to surgical procedures for larger ones. Once a diagnosis is established, your doctor will discuss appropriate management options, ranging from lifestyle adjustments to medical interventions for serious conditions.