Hematuria, the medical term for blood in the urine, warrants attention. This occurrence signals bleeding somewhere within the urinary tract, which includes the kidneys, ureters, bladder, and urethra. While seeing red or pink-tinged urine can be alarming, the underlying causes range widely in severity, from temporary irritation to serious underlying conditions. The source of the bleeding cannot be determined without a proper medical assessment. Any man who notices this symptom must seek prompt medical evaluation to establish the exact cause and determine the appropriate course of action.
Understanding Visible and Non-Visible Blood
Hematuria is classified into two types based on detection. The most obvious form is gross hematuria, which is visible to the naked eye and causes the urine to appear pink, red, or sometimes a darker cola color. This discoloration occurs even with a relatively small amount of blood present in the urine.
The second form is microscopic hematuria, where the amount of blood is so minimal that the urine color remains normal. This type of bleeding is only detectable through laboratory testing, specifically a urinalysis. The volume of blood does not directly correlate with the seriousness of the underlying condition.
Common Non-Malignant Causes
The most frequent causes of hematuria are non-cancerous. A common source is a urinary tract infection (UTI). Bacteria cause inflammation and irritation of the urinary tract lining, leading to bleeding and symptoms like a burning sensation during urination or a persistent urge to void.
Another frequent non-malignant cause is the formation of kidney or bladder stones, known as urolithiasis. These hard mineral deposits develop from concentrated waste products in the urine. As they travel down the narrow urinary tract, they can scrape the delicate inner lining. This mechanical irritation results in bleeding, which is often accompanied by intense, cramping pain that radiates from the back or side toward the groin.
Certain physical activities can also induce a temporary condition called exercise-induced hematuria. This temporary bleeding results from trauma to the bladder walls during prolonged, strenuous exertion. Any significant blow or injury to the lower back or abdomen can also cause trauma to the kidneys, leading to a temporary presence of blood in the urine.
Specific medications may also contribute to hematuria by affecting the body’s clotting ability or directly irritating the urinary tract lining. Blood thinners, such as anticoagulants, can increase the risk of bleeding from minor injuries. Additionally, high doses of certain pain relievers, including nonsteroidal anti-inflammatory drugs, have been associated with kidney irritation and subsequent bleeding.
Causes Related to the Prostate and Malignancy
For men, a common cause of hematuria is related to the prostate gland, which surrounds the urethra just below the bladder. Benign Prostatic Hyperplasia (BPH), or non-cancerous prostate enlargement, frequently affects older men. The enlarged gland can stretch and compress the blood vessels lining the urethra and prostate, making them fragile and prone to rupture, which leads to blood in the urine.
Another prostate-related cause is prostatitis, which is the inflammation or infection of the prostate gland. This condition causes swelling, which irritates the surrounding tissues and blood vessels, leading to bleeding and often causing pain in the pelvic area, groin, or lower back. Bleeding originating from the prostate often manifests as blood at the start or the end of the urinary stream.
While less common than benign causes, malignancies of the urinary tract represent the most serious sources of hematuria. Bladder cancer is strongly associated with visible, painless hematuria, and this symptom is often the first sign of the disease. The tumor growth causes fragile new blood vessels to form on the bladder lining, which bleed easily into the urine stream.
Kidney cancer and, less commonly, prostate cancer can also cause hematuria. Kidney tumors may invade blood vessels within the organ, leading to blood passing into the urine. Hematuria from prostate cancer is less typical as an early symptom but can occur if a large tumor grows into the urethra or bladder neck. For men over the age of 50, the presence of hematuria, particularly gross hematuria, increases the concern for an underlying malignancy.
Medical Evaluation and Next Steps
The evaluation of hematuria begins with a thorough patient history and physical examination to identify risk factors, such as a history of smoking or exposure to certain chemicals. The initial laboratory test is a urinalysis and urine culture, which confirms the presence of red blood cells and checks for signs of infection. If an infection is found, the hematuria may be re-evaluated after a course of antibiotics.
If the cause is not easily identified as an infection, a comprehensive workup is necessary to visualize the entire urinary tract. This involves imaging studies of the upper tract, which includes the kidneys and ureters. Computed Tomography (CT) urography is often the preferred method, as it uses contrast dye to highlight the structures and can effectively detect stones or tumors within the kidneys and ureters.
For a direct view of the lower urinary tract, a specialized procedure called cystoscopy is performed. A thin, flexible tube with a camera is inserted through the urethra into the bladder. This allows the physician to visually inspect the lining of the urethra and bladder for growths, inflammation, or other abnormalities. Evaluation is necessary to ensure that any serious condition is diagnosed and treated.