- Blood in urine
- What are the causes of blood in urine?
- What are the symptoms of blood in urine?
- What is the treatment for blood in the urine?
- Blood in the Urine (Hematuria)
- Patient feedback can assist providers to identify possible hematuria causes.
- Blood in the stool or urine can range from benign to serious
- Interpreting these symptoms
- Treatment and response
Blood in urine
Having blood in your urine (pee) can be a sign that something is wrong with your kidneys or another part of your urinary tract. The medical name for blood in your urine is hematuria. There are two types of hematuria:
- If you can see the blood in your urine, it is called gross hematuria.
- If you cannot see the blood in your urine without looking at it under a microscope, it is called microscopic hematuria.
Anyone can have hematuria, but you might be more likely to have it if you:
- Have a family history of kidney disease
- Have an enlarged prostate (in men)
- Have a history of getting kidney stones
- Are taking certain medicines, such as pain relievers, blood thinners and antibiotics
- Participate in strenuous (difficult) exercise
- Have or recently had an infection
- What are the causes of blood in urine?
- What are the symptoms of blood in urine?
- What is the treatment for blood in the urine?
What are the causes of blood in urine?
There are many reasons that you might have blood in your urine. Having blood in your urine does not necessarily mean you have kidney disease. Some common causes are:
- Strenuous (difficult) exercise
- Sexual activity
- Having a virus
- Having an infection, such as a urinary tract infection (UTI)
Other more serious problems can also cause you to have blood in your urine. Some of these problems include:
- Kidney or bladder cancer
- Irritation or swelling in your kidneys, prostate (in men) or another part of your urinary tract
- Polycystic kidney disease
- Blood clots or diseases that cause problems with blood clotting
- Sickle cell disease
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What are the symptoms of blood in urine?
You may not notice any symptoms if you have microscopic hematuria. If you have gross hematuria, you may notice that your urine is pink, red or brown. This happens because the blood in your urine makes it a different color. If you have gross hematuria, you may also get blood clots in your urine, which can be painful.
If you notice that your urine is a different color than normal or if you are having pain when you urinate, tell your health care provider. He or she can do some tests to figure out why you have blood in your urine or what is causing the pain and what treatment would be best for you.
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What is the treatment for blood in the urine?
The treatment for having blood in your urine depends on what is causing the problem. For example, if you have blood in your urine because of an infection, your doctor might tell you to take an antibiotic medicine. If you have blood in your urine for another reason, you might need a different kind of treatment.
To find out why you have blood in your urine, your doctor might ask you for a urine sample. The urine sample can be used to test for signs of an infection, kidney disease or other problems. Your doctor will use the results of the urine test to decide if you need more tests or if you can start a treatment.
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Blood in the Urine (Hematuria)
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What Is Hematuria?
- Microscopic hematuria is when blood in the urine can be seen only with a microscope. Often, this goes away without causing any problems. In fact, people might never know they have it unless they get a urine test.
- Gross hematuria is when you can see the blood in the pee even without a microscope. This is because there is enough blood in the pee to turn it red or tea-colored.
How Does Blood Get Into the Urine?
Blood leaks into the urinary tract. This can happen anywhere in the urinary tract such as:
- in the kidneys, which remove waste and water from the blood to make pee
- in the ureters, which are tubes that carry pee from the kidneys to the bladder
- in the bladder, which stores pee
- in the urethra, where pee leaves the body
What Causes Hematuria?
Kids can get hematuria for many reasons. Common causes include:
- bladder or kidney infections
- kidney stones
- high levels of calcium and other minerals in the urine
- a problem with the urinary tract
- injury to the kidneys or urinary tract
- taking some types of medicines, like some over-the-counter pain medicines
- strenuous exercise (many athletes, especially distance runners, get hematuria from time to time)
In rare cases, hematuria can be a sign of kidney cancer or bladder cancer, a blood disease, or a blood clot. If something like that is going on, hematuria usually will be one of many symptoms.
Sometimes what looks like hematuria might be something else. Things like food dye, some foods (like beets or blackberries), a girl’s monthly period (menstruation), and some prescription medicines can make pee look red.
What Are the Signs & Symptoms of Hematuria?
Microscopic hematuria has no visible signs. Doctors will only know someone has it if a urine test finds it.
Gross hematuria is seen because it changes the color of urine, which can happen with only a little bit of blood. Often, red or tea-colored urine is the only symptom.
In some cases, hematuria can be one of many symptoms of another condition. For example, if a bladder infection is causing the hematuria, other symptoms might include fever, pain while peeing, and lower belly pain.
How Is Hematuria Diagnosed?
The doctor will do an exam and ask about symptoms, recent activities, and the family medical history. Your child will give a urine sample (pee in a cup) for testing.
Sometimes, more tests are done, such as a:
- blood test
- urine culture
- kidney ultrasound
- CT scan
Kids with hematuria that doesn’t go away, who have protein in the urine, and/or high blood pressure should see a nephrologist (a doctor who specializes in kidney care).
How Is Hematuria Treated?
Most of the time, hematuria doesn’t need any treatment. If it only happens once, it’s nothing to worry about.
If another condition is causing the hematuria, doctors will treat that condition. For instance, hematuria from a urinary tract infection (UTI) is treated with antibiotics.
If your child was treated for hematuria, the doctor probably will do follow-up tests to make sure there’s no more blood in the urine.
Reviewed by: Robert S. Mathias, MD Date reviewed: September 2019
Patient feedback can assist providers to identify possible hematuria causes.
When a person can visibly see blood in their urine it can immediately cause alarm. In reality, blood in the urine, or hematuria, is frequently seen by urologists and is most often treatable. Still, it is advisable to seek immediate medical attention for an evaluation and diagnosis in order for the urologist to either identify or rule out a more complex medical condition. When discovering blood in the urine, it will help your provider to have as much information as possible to assist them in narrowing down possible hematuria causes. By answering the following questions, the patient will be able to help guide the urologist in making a more accurate and timely diagnosis.
What color is the blood?
Hematuria can appear as a range of colors. It is common for patients to describe their urine as reddish pink in color, to a darker cola shade, or even a vivid red. It does not take a large quantity of blood to affect the shade of urine. Even a small amount of blood cells can cause a noticeable change. Although the doctor will perform an in-office urinalysis test, it is helpful if the patient is able to accurately describe the color of their urine when blood was first detected.
What symptoms are you experiencing?
Along with the color of their urine, it helps the urologist to know if the patient is experiencing any other unexplained symptoms. In actuality, some cases of hematuria do not appear to have any symptoms, aside from the urine change. However, if accompanying health changes are apparent, however small, it’s important to note them and discuss them with your provider. Health changes such as body pain, painful urination, a burning sensation while urinating, or even frequent urination should be discussed. Fever, along with pain located in the flank or back, can be signs that something may be affecting the kidneys.
Have your activities changed?
Hematuria is possible among athletes due to consistent or strenuous exercise. Health experts theorize that dehydration, bladder trauma, and a breakdown of red blood cells may be the a result of these strenuous activities. At times, exercising can have a traumatizing effect on the body, especially if it is a relatively new habit or is particularly intense. If you notice urinary bleeding near or during times of intense exercise, alert your doctor.
What medications are you currently taking?
Carefully consider the medications you are currently taking, including supplements. Anticoagulants, such as aspirin and blood thinners, have been known to cause urinary bleeding. In addition, some anti-cancer drugs have been connected to this condition. Talk to your doctor about any medications you take and discuss their possible side-effects.
Possible Health Causes
Ultimately, hematuria is the symptom of an internal issue involving the urinary tract. For men, prostate issues is an added concern. When problems such as infections, kidney stones, cysts, tumors, and enlargement of the prostate occur arise, the body responds with symptoms to raise awareness of the problem. Hematuria is not the primary issue that needs treatment, but rather the undiagnosed condition.
When hematuria is present, it will help the physician to narrow down possible hematuria causes if they know the color of the urine, the patient’s symptoms, medications they are currently taking, and if they have had any changes in their activity level. A prompt evaluation by a physician can help reduce the chances of serious health problems.
If you have blood in your urine, contact our office to determine if you should schedule an immediate appointment, or proceed to the nearest emergency room.
Blood in the stool or urine can range from benign to serious
When you cut or scrape yourself and see blood, you likely know the source of that blood. However, if you see blood in the toilet after using the restroom, the cause may not be so clear. Here are some possible reasons you might see blood in your stool or urine.
Blood in the Stool
A bloody stool is generally a sign of a problem in the digestive tract. This area of your body includes all the organs from the mouth to the anus, and bleeding can occur anywhere in the tract.
Hemorrhoids are swollen veins in the lower part of the rectum or anus. Hemorrhoids can be very painful and are often the reason behind a bloody stool. They are especially common during pregnancy and after childbirth. Almost half of adults will have them by about age 50 because the tissues that support the veins in the rectum and anus often stretch and become weaker with age.
Hemorrhoids have a variety of causes, including straining while defecating, sitting for long periods of time on the toilet, chronic diarrhea or constipation, obesity, pregnancy, anal intercourse and a low-fiber diet.
Aside from a bloody stool, other symptoms of hemorrhoids include itching or pain around the anus, pain while defecating and lumps near the anus. The best way to prevent hemorrhoids is to keep stools soft so they can pass easily. Ways to keep stools soft include eating food high in fiber, drinking six to eight glasses of water or other non-alcoholic liquids per day, going to the bathroom as soon as you feel the urge, exercising regularly and avoiding sitting for long periods of time.
Even though some causes of bloody stool are minor, others can be serious and potentially life-threatening. Fortunately, many of these causes can be treated successfully if dealt with soon enough. Such causes of bloody stool may include:
- Bleeding in the upper part of the digestive tract, possibly due to abnormal blood vessels, a tear in the esophagus from violent vomiting, bleeding stomach ulcer, gastritis (inflammation of the stomach lining), trauma or a foreign substance in the digestive tract, among many others
- Anal fissures (split or tear in moist tissue lining of the anus)
- Bowel ischemia (when blood supply is cut off to part of the intestines)
- Polyps or cancer in the colon
- Diverticulosis (small sacs on the inner lining of the intestine that become inflamed or infected)
- Inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis
- Infection in the intestines
If you notice blood or any changes in the color of your stool, you should call a doctor immediately.
Blood in the Urine
Blood in the urine is called hematuria, and is caused by blood leaking into the urinary tract. This part of the body starts with the kidneys and ends with the urethra (place where urine comes out).
Seeing blood in the urine is not always a sign of a serious medical problem, but it should always be investigated by you and your doctor.
Potential causes of hematuria include urinary tract infection (UTI), kidney infection, a bladder or kidney stone, enlarged prostate, kidney disease, cancer, genetic disorders such as sickle cell anemia, kidney injury, use of certain medications and vigorous exercise.
It is very important that you see a doctor as soon as possible if you see blood in your urine or are experiencing discomfort with urination, frequent urination, unexplained weight loss, urgent urination or if you are unable to urinate.
Older age, female sex, recent infection, family history of urinary bleeding, certain medications and intense exercise are all risk factors for hematuria.
Though it is generally not possible to prevent hematuria, there are some protective measures you can can take to reduce the risk of the underlying conditions that cause hematuria. To prevent UTI, such measures include drinking a lot of water and urinating as soon as you feel the urge. Quitting smoking, maintaining a healthy weight, eating a healthy diet and staying active can lower the risk for kidney and bladder cancer. Limiting intake of salt, protein and oxalate-containing foods (such as spinach or rhubarb) can lower the chances of developing kidney stones.
Voiding dysfunction program UCSF Pediatric Urology
UCSF pediatric urology has a dedicated program for addressing bladder and bowel dysfunction. In this clinic we help manage the following issues: daytime urinary incontinence (enuresis), nighttime urinary incontinence (bedwetting), urinary urgency and frequency, urinary holding, recurrent urinary tract infections, constipation, and stool accidents. This program consists of a multidisciplinary team including a pediatric urologist, a nurse practitioner, and a clinical nurse. We use state-of-the-art technology and resources to diagnose and treat these conditions in children. Anne Arnhym, NP is medical director and overseas our continence clinic at the UCSF Mission Bay site in conjunction with Dr. Hillary Copp. Lucille Huang, NP overseas our Oakland Children’s site in conjunction with Dr. Michael DiSandro. Both sites have state of the art facilities including urodynamics.
Constipation occurs when stool remains too long in the colon or stool moves too slowly through the colon. As stool remains in the colon, fluid is reabsorbed by the body. The longer the stool remains, the more fluid is reabsorbed. This can make the stool hard and small. As this stool remains in the colon, more stool will accumulate. These stools can combine and make very large stools. Eventually the entire colon can fill with stool. The accumulation of stool can then cause the colon to stretch, which then causes the stool to move even slower through the colon and makes the problem worse.
In some cases, constipation is obvious, as in situations where the child is passing hard, dry, pellet-like stools with straining or only has a bowel movement every few days. Other signs of constipation include; large bowel movements, stomach ache, clogging the toilet with stool, soiling/smearing (sometimes referred to as “skid marks”) in the underwear. The soiling and smearing of stool is caused by liquid stool finding its way around the retained hard stool and eventually leaking to the underwear.
Constipation in children is almost always caused by withholding of stool. One common reason children will withhold stool is due to fear of stooling, maybe because of a past painful stool. Another reason is that many children do not like to stool outside the home, maybe because of “dirty bathrooms at school”. Young children, unlike adults and adolescents, rarely become constipated because of poor diet.
Constipation and Urology
There is a close relationship between the muscles and nerves that control bladder functions and those that control bowel movements. In addition, the bladder and the colon are close together in the body. Large amounts of stool in the colon can put pressure on the bladder which can cause the bladder to not fill as much as it should, or cause the bladder to contract when the bladder is not supposed to contract. This large amount of stool can also cause the bladder to not empty well. All of these problems can lead to daytime wetting, nighttime wetting, urinary tract infections, and in some cases vesicoureteral reflux (see separate handouts).
It is important to treat your child’s constipation to help treat your child’s bladder symptoms. Constipation treatment has two parts. The first part is to “clean out” the colon of all the retained stool. This usually takes a few days and can be done over a long weekend. In some cases the clean out may need to be repeated. The second part is to keep the colon cleaned out while the bowel and bladder heal. The maintenance phase can take 6-12 months. Both phases require medication. Because poor diet didn’t cause the constipation, usually changes in the diet do not cure the problem. This is different in adults where poor diet is often the cause of constipation.
Other accompanying symptoms or circumstances can also be helpful. For example, when hematuria occurs along with intense pain in the lower back that radiates into the groin, it may be a kidney stone. Pain upon urination, urinary urgency and frequency suggest cystitis, an infection of the bladder and urethra. In women, such infections most often follow sexual intercourse, which has given them the common appellation of honeymoon cystitis.
If a person has sustained a blunt injury to the lower back, a bruised kidney may be the source of the bleeding. If the person had suffered a strep infection in recent weeks (for example, strep throat or impetigo), glomerulonephritis, a serious inflammatory disease of the kidneys, could be the cause.
Or if the person tends to bruise easily or suffer prolonged bleeding after a minor cut, a bleeding disorder may be behind the hematuria.
A person who had exercised vigorously just befor experiencing hematuria most likely bruised tiny blood vessels in the bladder or urethra.
Personal or family medical history or drugs a person is taking can give further diagnostic clues. Hematuria can be a symptom of such underlying disorders as sickle-cell disease, polycystic kidney disease, kidney stones or deafness caused by Alport’s syndrome, which tend to run in families.
Drugs the person takes that increase bleeding tendencies, such as anticoagulants, aspirin-containing medications and nonsteroidal anti-inflammatory drugs (such as ibuprofen) may also explain hematuria. Dr. Eichner said that among patients with unexplained hematuria, 54 percent were found to be taking ibuprofen-type drugs. Making a Diagnosis
Based on the clues listed above, the doctor (usually a urologist, gynecologist, internist or general practitioner) may order one or more tests to help zero in on the cause of hematuria. The tests chosen will depend on the suspected source of bleeding.
The two most common causes, cystitis and injury, are usually easily treated — the former with antibiotics and the latter with time. Dr. Eichner suggests that athletes might prevent hematuria by not exercisng vigorously with an empty bladder. He urges runners to drink plenty of fluids beforehand and to refrain from voiding just before running. Cyclists should lower the nose of the saddle, use a cushioned seat cover and rise from the saddle when riding over bumps.
Blood in the urine should never be ignored. This could be the first sign of a serious condition. In order to help your doctor with the correct diagnosis, you may try to provide details such as:
- Was it associated with pain?
- Did you see blood clots?
- What shape did the clots have?
- The color of the blood (brown, cherry, bright red, pink or orange)
- At what time during urination did you see blood in the urine (beginning or end of stream or during entire stream)?
Blood in the urine can present in one of two ways:
- gross hematuria (blood that you can see in the urine)
- microscopic hematuria (blood that is only seen when the urine is examined under a microscope).
Both types can have serious causes.
Interpreting these symptoms
When passing blood in urine is associated with pain, especially abdominal pain, it could be associated with kidney or ureteral stones. The pain could be localized to the back, to the side, to the groin, or the penis in men and the labia in women.
If you are passing different-shaped clots in your stream, they could represent bleeding from the urethra or prostate (in men). Clots can be wormlike, and if associated with pain it could represent clots coming from your ureters(tubes from your kidneys to your bladder).
The color of the urine can be also affected by certain foods or medications. However, you should always consult your doctor if this develops.
When the blood in the urine is at the beginning of urination, it most likely comes from the urethra, (the tube from the bladder to the outside). Blood throughout urination is most likely from the bladder or kidneys or ureters (the tubes connecting the kidneys and the bladder). Blood at the end of your stream may be from the bladder or prostate (in men).
Causes of blood in the urine vary, from inflammatory conditions to cancers. Urinary tract infections and kidney, bladder, or ureter stones are also frequent causes. In men, blood can also come from an enlarged prostate. Cancer of the urethra, bladder or kidneys also may also show up as blood in the urine.
Blood in the urine in anyone over the age of 35, especially in people who smoke, should warrant full urologic evaluation because the most common cause of blood in the urine in this group of people is bladder cancer. Before that age, infection may be the cause. However, if gross hematuria is present, even once, it certainly needs to be further investigated. In this case full evaluation should be done by a urologist to rule out cancer or other abnormalities.
Treatment and response
Full evaluation includes an x-ray study of your kidneys and bladder, and cystoscopy. Cystoscopy involves the doctor looking directly inside your bladder by using a very small camera.
If you have blood in the urine, you should contact your physician immediately. Your doctor then would possibly determine the cause and refer you to a urologist if needed.
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