Hematuria – Symptoms, Diagnosis and Prevention

The blood in urine may be visible or microscopic. The presence of blood in your urine is called Hematuria. Hematuria does not always have to occur because of an underlying disease. It may occur as a result of an exercise or individual variation. Blood in the urine may indicate mild to serious problems in your body. 

What are the types of hematuria?

There are two types of hematuria: 

• Gross hematuria: Blood in gross hematuria is visible to the naked eye. It produces red, pink, cola-coloured, or tea-colored urine.
• Microscopic hematuria: Blood in microscopic hematuria can only be seen under a microscope.

What are the symptoms of hematuria?

The only symptom of hematuria is blood in the urine, sometimes with pain. The blood may be pink, red, or cola-coloured. It may also produce blood clots in your urine which can be very painful. Hematuria is often accompanied by symptoms of an underlying disease. 

When should I consult a doctor?

If you notice blood in urine, consult your doctor immediately. It may only be discolouration due to a food substance or medication, but to be on the safe side, visit a doctor. Hematuria due to an underlying issue may range from mild to serious. Hematuria is usually accompanied by pain, which is another sign that you need to visit a doctor. 

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What does blood in the urine indicate?

Hematuria could occur as a result of an underlying condition,  which allows blood to leak into your urine. Some conditions that may cause this symptom are:

• Urinary tract infection (UTI): This is a condition that occurs when bacteria enters your body through your urethra. The bacteria travel to your bladder and multiply there, causing an infection. Symptoms of this infection are:
  • A constant urge to urinate.
  • A burning sensation and pain while urinating.
  • Urine with a very strong odour.
  • For many adults, the only sign of this condition might be microscopic hematuria.
• Pyelonephritis (kidney infections): When bacteria travel to your kidneys through your ureters or enter your kidney from the bloodstream, it can cause a kidney infection. A kidney infection may sometimes lead to blood in the urine. Symptoms of pyelonephritis are the same as bladder infections. It is often accompanied by flank pain and fever. 
• Kidney stones or bladder stones: Certain minerals like calcium may crystallize on the walls of your kidneys and bladder. Over time, these crystals turn into hard stones. As long as they are inside the bladder or kidney without causing any disturbance, they go unnoticed. However, when they pass out, there is no ignoring it. Hematuria also occurs when there is a blockage due to stones. Some bladder and kidney stone symptoms are:
  • Excruciating pain
  • Gross and microscopic hematuria
• Mineral imbalances in the urine: High levels of calcium in the urine may lead to hematuria. It may be painless or may cause pain in the kidney, and a burning sensation during urination. Those with high levels of calcium in the urine are at a higher risk of developing a kidney stone. 
• An enlarged prostate: As men approach middle age, their prostate gland usually enlarges. A prostate gland is a small gland that surrounds the upper portion of the urethra and is located below the bladder just below the bladder. When the prostate gland expands, it compresses the urethra. This, in turn, partially blocks the flow of urine. An infected prostate gland causes the same problems and has the same symptoms. Common symptoms of an enlarged prostate gland are:
  • Difficulty in urination.
  • Gross or microscopic hematuria.
  • Urgency and persistence in urination.
• Kidney disease: Kidney diseases such as glomerulonephritis can be triggered by strep infections, vasculitis (blood vessel infections), IgA nephropathy, etc. These infections affect the glomeruli (capillaries in the kidney that filter blood) and cause inflammation, thus triggering glomerulonephritis. A common symptom of glomerulonephritis is microscopic hematuria.
• Structural causes: Kidneys that are blocked or contain cysts (fluid-filled sacs) may lead to blood in the urine. An ultrasound of the kidney can determine if an abnormal structure is causing hematuria.
• Cancer: Cancer in your excretory system may cause blood in the urine. Gross hematuria may be a symptom of advanced bladder, kidney, or prostate cancer. However, visible signs such as hematuria do not occur when the cancer is in the early stages when it is easily treatable. 
• Exercise: Strenuous exercise may cause blood in your urine. This usually occurs as a result of trauma to the bladder, dehydration, or the breakdown of RBCs due to constant aerobic exercise. Anyone can develop visible hematuria after a vigorous workout, but it mostly affects long-distance runners. A blow to your kidney during contact sports may also result in gross hematuria. However, do not always assume that blood in your urine is caused by a recent workout. You may have a more serious, underlying issue as well. Consult a doctor if you see blood in your urine often. 
• Inherited disorders: Some inherited disorder such as sickle cell anemia (a genetic defect of hemoglobin in RBCs), Alport syndrome (a condition that affects the glomeruli’s filtering membranes), hemophilia (a condition in which blood doesn’t clot properly), etc. may have hematuria as a primary symptom. 
• Medication: Some drugs such as penicillin cyclophosphamide can cause visible blood in your urine. Hematuria may also occur when anticoagulants such as blood thinners are taken when you have a condition or disease that causes bleeding in your bladder.
• Idiopathic hematuria: Idiopathic hematuria is when no specific cause can be found for blood in the urine. If it is hereditary, it is called familial idiopathic hematuria. Usually, no treatment is needed for this condition.

Sometimes, blood in your urine may be caused by conditions or situations that are not very serious. Some of the less common and less dangerous causes of hematuria are:

• Menstruation
• Injury
• Sexual intercourse

How is hematuria diagnosed?

To diagnose the cause of hematuria, you will have to send a sample of your urine for lab tests in a process called a urinalysis. Your urine sample will be examined under a microscope to look for unusual cells. You may also have to take blood tests to look for waste particles in your bloodstream. Your doctor will ask you about your medical history and lifestyle. 

Other tests that you may have to take are:

• Following the first urinalysis, you will be asked to send another urine sample. This sample will be examined for blood, minerals, and indications of urinary tract infection. 
• Imaging tests such as a CT scan, MRI scan, ultrasound, etc. will be taken to diagnose the underlying cause of hematuria. CT scans can help diagnose kidney stones, tumors, etc. Ultrasound uses sound waves to assemble an image of your kidney. 
• A cystoscopy may be performed to look for a disease in your urinary system. Your doctor will thread a thin tube fitted with a tiny camera through your urethra into your bladder. Sometimes, tissue samples may be extracted for testing.
• A renal biopsy may be performed by taking a sample of your kidney tissues for examination. This is done if you have high blood pressure, high levels of protein in your urine, a family history of kidney disease, and abnormal blood test results. 

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What are the risk factors for hematuria?

Some risk factors of hematuria are:

• Age and sex: Men are more likely to experience hematuria, especially after the age of 50 years, usually due to an enlarged prostate gland.
• Family history: If you have a family history of kidney disease or stones, you might be at higher risk of hematuria.
• A recent infection: Following a bacterial or viral infection in your kidneys, there might be inflammation. This, in turn, may cause hematuria. This risk factor is more common in children.
• Medication: Nonsteroidal anti-inflammatory pain relievers, aspirin, and certain antibiotics increase the risk of having blood in the urine.
• Strenuous exercise: Exercise-induced hematuria is common among sportspersons and people who work out a lot. The condition is commonly called “jogger’s hematuria.’

How do I prevent hematuria?

To prevent hematuria, you have to prevent the underlying causes. These problems can be prevented by following a healthy lifestyle. Here are some tips:

• Drink plenty of water
• Practice good hygiene
• Urinate immediately after sexual intercourse
• Avoid excess salt
• Refrain from smoking
• Limit your exposure to harmful and toxic substances

Conclusion

Hematuria is generally nothing to be alarmed about. However, if you notice blood in your urine along with other symptoms, it is best to get it checked out by a medical professional. As hematuria is just a symptom, the main focus should be on diagnosing and treating the condition that causes it.

Frequently Asked Questions (FAQs) 

Where does the blood in the urine originate from?

The blood in your urine may originate from the kidney, which makes urine. It may also come from:

• Ureters 
• Urethra
• Bladder

How is hematuria treated?

As hematuria is only a symptom, finding the cause is very important. Treating the underlying issue can eliminate blood in your urine. In some cases, no treatment is needed. 

What are the complications of hematuria?

As hematuria usually indicates an underlying condition, ignoring it can allow the disease to progress. This may even lead to life-threatening situations. Discomfort, pain, infections, and kidney failure are common complications of hematuria.