What Is Hematuria?
Hematuria is a condition characterized by excessive blood in the urine. Hematuria is categorized into two types based on whether the blood in the urine is visible to the naked eye.
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Microscopic Hematuria - On occasions, the presence of blood in urine may not be visually detectable. In cases of microscopic hematuria, the red blood cells can only be identified through laboratory testing.
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Gross Hematuria - In this particular type, the presence of blood is apparent. Rather than its typical pale yellow hue, the urine may exhibit colors such as pink, red, brownish-red, or tea-colored.
What Are the Symptoms of Hematuria?
Gross hematuria produces red or pink-colored urine due to the presence of red blood cells (RBC). A little blood is enough to make the urine red, and bleeding is usually not painful, but passing blood clots in the urine can be painful. In some instances, blood in the urine will not produce any symptoms.
What Are the Causes of Hematuria?
Hematuria is when the kidneys or other parts of the urinary tract allow red blood cells to leak into urine. Some other problems that can cause this leakage are,
1. Urinary Tract Infections (UTI) - UTI occurs when bacteria enter the body through the urethra and multiply in the bladder.
Symptoms:
- Persistent urge to urinate.
- Pain during urination.
- Burning sensation with urination.
- Offensive odor in urine.
2. Enlarged Prostate - The prostate gland, which is just below the bladder and surrounding the top part of the urethra, is often enlarged in middle-aged men. It then compresses the urethra and partially blocks the urine flow.
Symptoms:
- Difficulty in urinating.
- Urgent or persistent need to urinate.
- Visible or microscopic blood in the urine.
3. Kidney Infections (Pyelonephritis) - Pyelonephritis occurs when bacteria enter the kidneys from the bloodstream or move from the ureters to the kidneys.
Symptoms:
- Fever.
- Flank pain.
- Frequent urge to urinate.
- Pain during urination.
- Burning sensation while urinating.
- Unpleasant odor of urine.
4. Bladder or Kidney Stone - The minerals present in the concentrated urine sometimes form crystals on the kidney or bladder walls. After some time, these crystals become small and turn into hard stones.
Symptoms:
It is painless and does not produce pain until it causes blockage or is being passed. After, it starts to block the urine and it creates,
- Excruciating pain.
- Visible or microscopic blood in the urine.
- Fever.
- Vomiting.
- Chills.
- Nausea.
5. Inherited Disorders - Sickle cell anemia is a hereditary disorder of hemoglobin in red blood cells (RBC), which causes blood in the urine (both visible and microscopic hematuria).
6. Cancer- Visible blood in the urine may be a sign of advanced bladder, kidney, or prostate cancer.
7. Medications - Urinary bleeding can be caused by anti-cancer drugs such as:
- Cyclophosphamide.
- Penicillin.
- Visible urinary bleeding sometimes occurs on taking an anticoagulant, such as:
- Aspirin.
- Blood thinner Heparin.
8. Kidney Injury - A blow or other injuries in the kidneys from contact sports or an accident can cause visible blood in the urine.
9. Strenuous Exercise - It is rare for strenuous exercises to cause gross hematuria, but the cause is unknown. It is linked to,
- Trauma to the bladder.
- Dehydration.
- Breakdown of red blood cells.
- Runners are most commonly affected; anyone can develop visible urinary bleeding after intense workouts.
- Other reasons for having blood in the urine are:
- Trauma.
- Vigorous exercise.
- The hepatitis virus causes inflammation of the liver and liver diseases.
- Sexual activity.
- Menstruation.
- Endometriosis.
- More serious causes for people to have hematuria are:
- Bladder or kidney cancer.
- Inflammation of the urethra, kidney, bladder, or prostate.
- Blood clotting disorders, such as hemophilia.
- Sickle cell disease (abnormally shaped red blood cells).
- Polycystic kidney disease.
What Are the Risk Factors of Hematuria?
Blood in the urine can affect people of various ages, including children and teenagers. Several factors can increase the likelihood of this condition:
- Age: Middle-aged and older men, especially those over 50, may have a higher risk due to conditions like an enlarged prostate gland or certain cancers.
- Urinary Tract Infections: Common among children, UTIs are a leading cause of blood in the urine.
- Family History: Individuals with a family history of kidney disease may have an increased risk.
- Certain Medications: Blood thinners, pain relievers, and antibiotics can elevate the risk of hematuria.
- Intense Physical Activity: Engaging in vigorous exercise, such as marathon running or contact sports, can also raise the risk of blood in the urine.
How Is Hematuria Diagnosed?
Hematuria and its cause can be diagnosed by the following:
1. Medical History:
Taking a medical history will help a doctor diagnose the cause of hematuria. It will include,
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The patient's current and past medical history.
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Review of symptoms.
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List of prescription medicines.
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Over-the-counter medicines.
2. Physical Examination:
During a physical examination, the doctor taps on the abdomen and back to check for pain or tenderness in the kidney or bladder area.
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A digital rectal examination is done in men to look for any prostate problems.
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A pelvic examination is done in women to look for red blood cells in the urine.
3. Urinalysis:
The doctor will test the urine using a dipstick or send it to a laboratory for analysis. Sometimes, the urine tests using a dipstick could be positive even though the patient does not have blood in the urine, resulting in a false-positive test. The test samples (urine) are diagnosed under a microscope before ordering other tests.
Before obtaining a urine sample, women will be asked for the last menstrual date. Sometimes, blood from the menstrual period can get into the urine sample and result in a false-positive test for hematuria. Once the menstruation stops, the test will be repeated.
The healthcare professional will confirm the presence of any red blood cells by examining the collected urine under a microscope before ordering other tests.
4. Additional Testing:
When the urine samples detect too many red blood cells (RBCs), then the doctor will order additional tests. They are,
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Blood test.
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Computed tomography (CT) scan.
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Cystoscopy.
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Kidney biopsy.
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Magnetic resonance imaging (MRI).
What Are the Potential Complications Associated With Hematuria?
The treatments for hematuria, which encompass medications and procedures, may entail distinct side effects depending on the specific treatment modality. Nevertheless, neglecting hematuria could escalate into more significant issues, particularly if the underlying cause is more serious than physical exertion. A healthcare provider must address any condition precipitating blood in the urine. In cases where the cause involves conditions such as cancer or kidney disease, timely identification facilitates early intervention, which in turn enhances prognosis and outcomes.
Conclusion
Blood in urine, known as hematuria, can arise from various causes, including infections, kidney stones, or more serious conditions like kidney disease or cancer. Prompt medical evaluation is crucial for accurate diagnosis and timely intervention. Whether visible to the naked eye or detected only through laboratory testing, hematuria warrants attention to ensure proper management and potential resolution.
