Blood in Urine – Hematuria

Blood in Urine – Hematuria: First time when you notice blood in your urine, it might seem scary. Your urine may look orange, pink, red or brown. The colour actually depends on the amount of blood in urine and also the pH of urine. If you can see a noticeable colour change in the urine due to blood, its called “Gross Hematuria”. However there are times, when there might be blood in urine and appearance wise, it may look normal. This condition is called “Microscopic Hematuria” because it can be diagnosed only under a microscope in a laboratory.

It is also interesting to note that sometimes, urine may appear red but it may not be because of blood. Red-brown discolouration of urine may be caused due to some other reasons such as

1. Hemoglobinuria – When hemoglobin (which is a protein that makes Red blood cells RBC) breaks down due to some conditions like major burns, crush injury etc.
2. Drugs – There are some drugs, which when excreted in urine, can make the colour of the blood appear in the shades of red. It might give a false illusion that there is blood in urine. Such drugs include aspirin ,warfarin , methyldopa, rifampin, duphenylhydantoin, phenazopyridine, phenothiazines, Senna etc.
3. Some food Items – such as beetroot, rhubarb or even strong food colourants can sometimes change the colour of the urine.
4. Myoglobinuria – When myoglobin (the protein that makes up muscles) breaks down in large quantities, it makes the urine appear red-brown.
5. Porphyria – porphyrias are a group of diseases that are caused due to deficiencies in production of heme (the substance that gives blood its red colour).

What to do when you see blood in the urine for the first time?

First and foremost, rule out any drugs or food items that may have caused this (make sure you’re feeling normal otherwise). If there are no drugs or foods that may be doing this, it is always best to book an appointment with your urologist. However, if you’re facing gross hematuria, or you see clots of blood, please visit a good urologist immediately. Also, if hematuria is accompanied by other symptoms such as pain, you need to see the urologist right away.

What are the Causes of Blood In Urine?

Blood in urine can appear due to various causes. Some of the causes are

1. Urinary Tract Infection – UTIs are caused by bacteria that enter your urinary pathway and multiply. They make their way up to the bladder and may cause other symptoms too. You may have burning while urinating, you may get a strong desire to pass urine and that desire can exist for a long time. When these symptoms accompany blood in urine, we need to rule out UTI first thing.
2. Cystitis – when the bacteria from UTI, make the inner lining of the bladder inflamed, there may be some bleeding giving rise to hematuria.
3. Pyelonephritis – When the bacteria in the bladder, reaches upto the the kidney, it causes infection of the kidney. This is called as pyelonephritis.
4. Urinary Stone Disease – When there is a formation of stone anywhere on the urinary pathway, there may be some amount of bleeding. In fact, kidney and bladder stones are some of the most common causes of blood in urine.
5. Physiological Causes – menstruation, sexual activity, contact sports injury, intense exercise etc.

Other Serious, Less Common Causes of Blood in Urine – Hematuria

1. Benign Prostatic Hypertrophy – This is a condition when the prostate in males grows beyond 20-22 g giving rise to urinary symptoms.
2. Cancer – Cancer anywhere on the urinary tract including bladder, kidney, ureter, urethra or prostate can give rise to blood in urine.
3. Inherited Diseases – such as sickle cell anemia can cause hematuria.
4. Structural abnormality of Urinary Tract – such as polycystic kidney disease. Renal stones in ectopic kidneys have a higher chance of presenting with hematuria.
5. Intense Exercises
6. Strictures – are narrowing scars that partially obstruct the flow of urine and may give rise to blood in the urine.
7. Endometriosis – Ectopic endometrium or the inner lining of the uterus grows at places where it is not supposed to be and it starts shedding (bleeding) during menstruation time.

What are the tests for making a diagnosis of Hematuria?

1. Urinanalysis (Urine Routine Test)– This test tells us about the amount of RBCs in the urine. It also tells about the presence of WBCs (White blood cells) and proteins in the urine. This is the first test usually done because it straight away rules out infectious causes of blood in urine. If there is an infection in the urine, you will also be asked to do a Urine Culture & Sensitivity test which detects the microorganism causing the problem and finding out which antibiotic works best.
2. Blood Test – to detect any signs of infection (counts are high in case of pyelonephritis). Also rules out other diseases such as some autoimmune diseases like lupus.
3. Ultrasound KUB (& Whole Abdomen) – An ultrasound is the best non invasive and safest technique to detect multiple problems such as stones anywhere in the urinary tract, cysts, tumours, clots etc. Ultrasound is able to detect these and it tells us about the exact location as well.
4. Cystoscopy – This is a test where a very small scope is used to visualise the urethra, bladder and ureter. This further helps in narrowing down to a diagnosis if the previous tests have been inconclusive. This test is exclusively done only by a urologist with good equipments.
5. Other tests such as CT Scan and MRI Scans, Kidney Biopsy, Complement proteins can be done in some cases when the urologist feels that it is important to do these tests to further establish the diagnosis.

Treatment of Blood in Urine or Hematuria

Practically speaking, the treatment is based on the diagnosis. As aforementioned, there may be many causes of blood in urine, therefore we always focus on treating the cause of the disease. For eg, if the hematuria is caused due to UTI, we do a urine routine test that detects the infection, then we do culture and sensitivity that tells us which antibiotic would be best to fight off the causing microbe and accordingly the antibiotic is given. Just like this, we focus on early and exact diagnosis. Once the diagnosis is made, we provide precise treatment so that the patient can have prolonged and permanent relief as much as possible.

We at Institute of Urology, Jaipur are dedicated to patient care of utmost quality and comfort. We are proud to serve our patients with some of the best equipments and technology from around the world. Please feel free to contact me for any query at (0091) 8601539297, 9829013468. Direct consultation available at our hospital – Institute of Urology, C Scheme, Jaipur.