Blood in Urine (Hematuria): Causes and Treatment

What does blood in urine mean?

Hematuria refers to the presence of red blood cells in the urine and can vary in how it presents. In some cases, it is clearly visible, while in others, it may only be detected through medical testing. Understanding these forms can help in recognising the condition early and seeking timely care. Hematuria can manifest in two primary forms: 

• Gross Hematuria- This occurs when blood in the urine is visible to the naked eye, causing the urine to appear pink, red, or even a cola-brown colour. The colour change may vary depending on the amount of blood present and can appear suddenly or intermittently, often prompting immediate medical attention. 

• Microscopic Hematuria- Microscopic Hematuria: In this case, the blood in the urine is not visible to the naked eye and does not cause any noticeable change in urine colour. It is typically detected only through laboratory analysis of a urine sample, often during routine health check-ups or investigations for other conditions.

What are the common causes of hematuria? 

Individuals with hematuria often wonder why blood comes in urine. Many medical conditions and lifestyle factors can cause blood in urine, ranging from minor to more serious. These may include:

• Urinary Tract Infections (UTIs)- Bacteria entering the urethra can cause frequent, painful urination, and often present with blood in urine symptoms. Over 85% of UTI-related hematuria cases are effectively treated with antibiotics.

• Kidney stones- Hard deposits of minerals can irritate or injure the urinary lining, leading to pain and blood in urine.

• Enlarged prostate (BPH)- In men, an enlarged prostate can compress the urethra, partially block urine flow and cause blood in urine.

• Kidney disease- Inflammation of the kidney's filtering system (glomerulonephritis) can cause microscopic hematuria.

• Certain medications- Some drugs, like blood thinners or certain pain relievers, can cause blood in urine as a side effect.

• Strenuous exercise- Less commonly, intense physical activity can cause temporary, usually harmless, blood in urine.

• Serious conditions- While most cases are benign, blood in urine can occasionally signal more serious conditions like kidney or bladder cancer. Early diagnosis is vital.

How is hematuria diagnosed? 

Diagnosing hematuria involves a combination of clinical evaluation and specialised tests to identify the underlying cause accurately. Based on your symptoms and medical history, your doctor may recommend one or more of the following investigations: 

• Urine tests- Urinalysis confirms blood presence; urine culture identifies infection. 

• Blood tests- Check kidney function, blood disorders, or other systemic issues. 

• Imaging tests- Ultrasound, CT Scan, or MRI provide detailed images of the urinary tract. 

• Cystoscopy- A urologist uses a thin, lighted tube to examine the inside of your urethra and bladder. 

• Kidney biopsy- In rare cases, a small tissue sample from the kidney may be needed.

What are the symptoms associated with hematuria?

Hematuria or blood in urine causes several distinct symptoms. It is crucial to identify them and discuss with your doctor without further delay. With the presence of blood in urine, symptoms you may notice are:

• Pink, red, or cola-coloured urine (visible blood)  

• Pain or burning sensation while urinating  

• Frequent urge to urinate (increased frequency)  

• Urgency to urinate with little output  

• Lower abdominal or pelvic pain

• Flank pain (pain in the sides or lower back)

• Passage of blood clots in urine  

• Fever and chills (especially if infection is present)  

• Nausea or vomiting  

• Unexplained fatigue or weakness

How is hematuria treated?

The treatment approach is tailored to address the underlying cause identified during diagnosis, ensuring effective and targeted care for each patient. Common treatment options include: 

• UTIs- A course of antibiotics is typically prescribed to eliminate the infection, along with adequate hydration and supportive care to relieve symptoms and prevent recurrence. 

• Kidney stones- Increased fluid intake, medications, or procedures like extracorporeal shock wave lithotripsy (ESWL) for larger stones. 

• Enlarged prostate (BPH)- Treatment options range from medications to relax or shrink the prostate, to minimally invasive procedures or surgery in more severe cases to improve urinary flow and relieve symptoms. 

• Kidney disease- Treatment focuses on managing the specific kidney condition with medications and lifestyle changes. 

• Cancer- Early intervention with surgery, radiation therapy, chemotherapy, or immunotherapy, delivered by our multidisciplinary oncology team. 

• No identifiable cause- For microscopic hematuria without a specific cause, regular monitoring may be recommended.

Conclusion

The presence of blood in urine, whether visible or microscopic, may indicate an underlying issue in the urinary system and should never be ignored. It is important to avoid self-diagnosis and seek prompt medical evaluation. At Manipal Hospitals, our expert team of doctors specialising in renal sciences uses advanced diagnostic tools and a comprehensive approach to accurately identify the cause and provide effective, compassionate treatment, ensuring timely care and a smooth recovery. If you or a loved one is experiencing these symptoms, do not delay- book an appointment with our renal science experts at Manipal Hospitals Kolkata today and take your first step towards a disease-free lifestyle.