Urine - bloody

Answer 1

Definition

Blood in your urine, or hematuria, can be classified as microscopic or gross.

• Microscopic hematuria is when there is very little blood in the urine and it can only be seen with a microscope.
• Gross hematuria is when there is enough blood in the urine that you can see it with the naked eye. Usually it turns toilet water pale pink or bright red, or you may just see spots of blood in the water after urinating.

Alternative Names

Hematuria; Blood in the urine

Considerations

In women, blood may appear to be in the urine when it is actually coming from the vagina. In men, what may be mistaken for urinary bleeding is sometimes a bloody ejaculation, usually due to a prostate problem. In some cases, blood in the urine can sometimes be confused with blood from a bowel movement. In any case, you should see a health care provider.

Discoloration from certain drugs, beets, or other foods can mimic blood in the urine.

You may not see blood in your urine. In some cases, it is found microscopically when your doctor checks your urine during a routine exam. Your doctor will follow up on this problem to see if it persists and identify the cause.

When blood is visible to the naked eye, prompt and thorough evaluation is always needed. In children, hospitalization is often necessary to complete the work up.

Common Causes

There are many potential causes of blood in the urine. Often, bloody urine is from a problem in your kidneys or other parts of the urinary tract. If your kidneys, urinary tract, prostate, and genitals turn out to be fine, your doctor may check to see if you have a bleeding disorder.

Kidney and urinary tract causes include:

• Cancer of the bladder or kidney
• Kidney or bladder stones
• Kidney disease following strep throat ( post-streptococcal glomerulonephritis) -- a classic cause of blood in the urine in children
• Kidney failure
• Infection of the bladder, kidney, or urethra
• Inflammation of the bladder, urethra, prostate, or kidney ( glomerulonephritis)
• Injury to the bladder or kidney
• Polycystic kidney disease
• Recent urinary tract procedure such as catheterization, circumcision, surgery, or kidney biopsy

Causes from blood disorders include:

• Bleeding disorders (such as hemophilia)
• Blood clot in the kidneys
• Low numbers of platelets
• Medications including blood thinners (such as warfarin)
• Sickle cell disease

Call your health care provider if

Blood in the urine should never be ignored. Tell your doctor about this symptom and get an appropriate evaluation, especially if you have unexplained weight loss, discomfort with urination, frequent urination, or urgent urination.

Call your doctor right away if:

• You have fever, nausea, vomiting, shaking chills, or pain in your abdomen, side, or back
• You are unable to urinate
• You are passing blood clots in your urine

Also call your doctor if:

• You have pain with sexual intercourse or heavy menstrual bleeding -- the problem may be related to your reproductive organs
• You have urine dribbling, nighttime urination, or difficulty starting your urinary flow -- the problem may be related to your prostate

What to expect at your health care provider's office

Your doctor will take a medical history and perform a physical examination. Medical history questions may include:

• When did you first notice blood in your urine?
• What is the underlying color of your urine?
• Do you have any pain with urination?
• Has the quantity of your urine increased or decreased?
• Does your urine have an odor?
• Are you urinating more frequently?
• Do you have an urgent need to urinate?
• What medications are you taking, including over the counter drugs?
• Have you recently eaten foods that may cause discoloration, like beets, berries, or rhubarb?
• Do you have any other symptoms like pain in your back, abdomen, or side? Fever, weight loss, nausea, vomiting, or diarrhea? Nighttime urination? Dribbling? Discharge from penis or vagina? Pain with intercourse?
• Have you had previous urinary problems or kidney problems?
• Do you have any allergies?
• Do you have a history of tobacco use?
• Have you had a recent injury?
• Have you had any recent diagnostic or surgical procedures involving the urinary tract?

Tests that may be done include:

• Abdominal ultrasound
• Antinuclear antibody test for lupus
• Blood creatinine level
• Blood differential
• Complete blood count (CBC)
• CT scan of the abdomen
• Cystoscopy
• Intravenous pyelogram (PVP)
• Kidney biopsy
• Kidney x-rays
• Strep test
• Tests for sickle cell, bleeding problems, and other blood disorders
• Urinalysis
• Urine culture
• 24-hour urine collection for creatinine, protein, calcium

The treatment will depend on the cause of the blood in the urine. If a urinary tract infection is confirmed, antibiotics may be prescribed. If appropriate, pain medications will be given.

References

Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 3.

Answer 2

Definition

Blood in your urine, or hematuria, is blood that is found in your urine. It can be microscopic or gross.

• Microscopic hematuria is when there is very little blood in the urine and it can only be detected with urine tests or under a microscope.
• Gross hematuria is when there is enough blood in the urine that you can see it with the naked eye. Usually it turns toilet water pale pink or bright red. Or, you may see spots of blood in the water after urinating.

Alternative Names

Hematuria; Blood in the urine

Considerations

Blood that looks like it is in the urine may actually be coming from other sources, such as:

• The vagina (in women)
• Ejaculation, often due to a prostate problem (in men)
• A bowel movement

In any case, you should see a health care provider.

The urine can also turn a red color from certain drugs, beets, or other foods.

You may not see blood in your urine because it is too small. Your health care provider may find it while checking your urine during a routine exam. The health care provider will follow up to see if it persists and find the cause.

When you can see blood in your urine, you will need an evaluation as soon as possible. Children may need to stay in the hospital for tests.

Common Causes

There are many possible causes of blood in the urine. Often, bloody urine is due to a problem in your kidneys or other parts of the urinary tract. If there is no problem with your kidneys, urinary tract, prostate, or genitals, your doctor may check to see if you have a bleeding disorder.

Kidney and urinary tract causes include:

• Cancer of the bladder or kidney
• Infection of the bladder, kidney, prostate, or urethra
• Inflammation of the bladder, urethra, prostate, or kidney ( glomerulonephritis)
• Injury to the bladder or kidney
• Kidney or bladder stones
• Kidney disease after strep throat ( post-streptococcal glomerulonephritis) -- a common cause of blood in the urine in children
• Kidney failure
• Polycystic kidney disease
• Recent urinary tract procedure such as catheterization, circumcision, surgery, or kidney biopsy

Causes from blood disorders include:

• Bleeding disorders (such as hemophilia)
• Blood clot in the kidneys
• Blood thinning medications (such as aspirin or warfarin)
• Sickle cell disease
• Thrombocytopenia (low numbers of platelets)

Call your health care provider if

Never ignore blood in the urine. Tell your doctor about this symptom and get it checked, especially if you also have:

• Discomfort with urination
• Frequent urination
• Unexplained weight loss
• Urgent urination

Call your doctor right away if:

• You have fever, nausea, vomiting, shaking chills, or pain in your abdomen, side, or back
• You are unable to urinate
• You are passing blood clots in your urine

Also call your doctor if:

• You have pain with sexual intercourse or heavy menstrual bleeding -- the problem may be related to your reproductive organs
• You have urine dribbling, nighttime urination, or difficulty starting your urine flow -- the problem may be due to your prostate

What to expect at your health care provider's office

Your doctor will take a medical history and perform a physical examination. Medical history questions may include:

• When did you first notice blood in your urine?
• What is the color of your urine?
• Do you have any pain with urination?
• Has the amount of your urine increased or decreased?
• Does your urine have an odor?
• Are you urinating more often?
• Do you have an urgent need to urinate?
• What medications are you taking, including over-the-counter drugs?
• Have you recently eaten foods that may cause a change in color, like beets, berries, or rhubarb?
• Do you have any other symptoms?
  • Pain in your back, abdomen, or side?
  • Fever, weight loss, nausea, vomiting, or diarrhea?
  • Nighttime urination?
  • Dribbling?
  • Discharge from your penis or vagina?
  • Pain with intercourse?
• Have you had past urinary or kidney problems?
• Do you have any allergies?
• Do you have a history of tobacco use?
• Have you had a recent injury?
• Have you had any recent procedures involving the urinary tract?

Tests that may be done include:

• Abdominal ultrasound
• Antinuclear antibody test for lupus
• Blood creatinine level
• Complete blood count (CBC)
• CT scan of the abdomen
• Cystoscopy
• Intravenous pyelogram (IVP)
• Kidney biopsy
• Strep test
• Tests for sickle cell, bleeding problems, and other blood disorders
• Urinalysis
• Urinary cytology
• Urine culture
• 24-hour urine collection for creatinine, protein, calcium

The treatment will depend on the cause of blood in the urine. If a urinary tract infection is confirmed, you may take antibiotics. Your health care provider may also prescribe pain medications, if you need them.

References

Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 3.

Landry Dw, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116.

Reviewed By

Review Date: 09/16/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc