Blood in Urine

I am Peeing Blood!!!

If you “see” blood in your urine, the information below is for you. Many people Do Not see blood in urine but come to know of it through a urine dipstick test. If that’s true for you too, Click Here. Some people learn that they have blood in urine through a urine microscopy test that shows RBCs. If your urine microscopy shows RBCs, Click Here.

 

Top Causes of Blood in Urine

Seeing blood in urine can be quite alarming. Though it may mean something serious, many times it doesn’t, and most of the time it’s something treatable. Just to let you have a quick glance, here are the commonest causes found in patients passing visible blood in urine, a condition that doctors call gross hematuria.

 

Do note that these figures are from a mixed group of people of all ages with varying symptoms and risk profiles. It does not really reflect the likelihood of a particular disease in your case. For e.g. if you are a 25 year old male, you are much more likely to have a stone than a cancer.

Why Am I Peeing Blood?

  • Are you a sports or fitness enthusiast? Before we get to more serious reasons, it’s worthwhile to let you know that long distance running or other heavy-duty physical activity can sometimes cause blood to leak into your urine. It goes away with a few days rest. However, it’s recommended that you get a doctor’s opinion even if it goes away on its own, as blood in urine because of a more serious reason could very well appear after exercise, plainly by chance. At the least, some simple urine tests are wise to make sure that it isn’t anything serious.
  • It could be a urinary tract infection (UTI). Infections in the urinary tract are responsible for more than 1 in 4 cases of blood in urine. If you have noticed symptoms such as pain while passing urine or a frequent urge to pee, an infection in the urinary tract is highly likely. Most of the time it’s an acute infection of the bladder (acute cystitis). Less often, it may be an infection in the kidneys (pyelonephritis) or the prostate gland in men (prostatitis).
  • It could be a kidney stone. Stones are a fairly common cause of blood in urine. Though they are notorious for causing pain, in some cases blood in urine may be the only sign.
  • Are you a middle aged/ elderly male?  If you are a male well into your middle age, an enlarged prostate because of Benign Prostatic Hyperplasia (BPH) may be putting pressure on your urethra and causing blood in urine.
  • No Other Symptoms and Age >40 years? Statistically speaking, cancers of bladder, kidney or prostate are the second most common cause of frank blood in urine, and among them bladder cancer is the commonest. But the risk in a given individual depends on age and several other factors such as smoking. Age is by far the most important criteria, with people >40 years of age considered to be at high risk. They are nearly always referred to a urologist for a thorough work-up.
  • Problems in kidney’s blood vessels: A small percentage of cases of blood in urine are caused by a congenital defect or blockage in veins and arteries supplying the kidney.
  • When during urination do you see the blood?  The point when blood appears gives some idea about where it’s coming from. Blood seen only at the beginning of urination is likely to be from a disease in the urethra. Blood seen throughout the urine stream is more likely to be from the kidneys or upper part of bladder. Blood seen only towards the end is mostly from a disease involving the prostate. However, these are probabilities and do not hold true in all cases.
  • Are you “really” peeing blood? Finally, there’s a chance that it isn’t really blood that you see. Sometimes there is no mistaking it, but we can’t always be so sure. Your urine could appear reddish, brown, or pink because you are passing a colored substance other than blood (pseudohematuria).
  • Food and Drugs: Rich colored fruits and veggies such as beetroot rhubarbs, blackberries, blueberries, paprika, fava beans, and artificial food colors can give your urine a blood-like tint. Medicines causing such color change include some antibiotics, laxatives, antimalarials and several others.
  • Diseases outside the urinary system: The red blood cells pigment hemoglobin, muscle pigment myoglobin and bile pigment bilirubin can cause brownish / red urine in people with diseases outside the urinary tract. Your doctor can make out from your medical and drug history if pseudohematuria is a possibility. A urine microscopy can confirm if it’s blood or something else.
  • Other causes: Trauma to the urinary tract and urethral strictures may cause visible blood in urine in a small percentage of cases. If you are receiving blood thinners (drugs such as warfarin, aspirin etc) they might cause the appearance of blood in urine, but mostly only if an underlying disease is also present. It’s not an expected side effect of these drugs and must be investigated thoroughly. Kidney diseases are an uncommon cause of frank blood in urine.
  • No Detectable Cause:  In about 1 in 10 cases no cause is found even after thorough investigations. Your urologist may advise you to come for regular follow-up depending on your risk of developing a serious urinary disease in future.

Exams and Tests

  • Urinalysis: Urinalysis is extremely helpful in the initial evaluation.  It will rule out red discoloration caused by other reasons and confirm blood on urine microscopy. It will also show additional abnormalities accompanying some common causes of blood in urine, such as pus cells or protein in urine.
  • You will also need one or more of the following tests
  • Renal function tests
  • Blood tests for bleeding disorders
  • Renal ultrasound
  • Intravenous pyelography
  • X-ray of the kidney-ureter-bladder (KUB) area
  • CT urogram
  • Urine cytology
  • Test for tumor markers such as PSA
  • Cystoscopy and biopsy
  • Antinuclear Antibody
  • ASO Titer
  • Serum complement (C3, C4, C50)
  • Collect 24 hour Urine Calcium
  • Collect 24 hour Urine Uric Acid

Treatment

Treatment will be guided by the diagnosis. A UTI will go away with a course of antibiotics. Stones may be medically or surgically managed depending on their size and severity of symptoms. Similarly, an enlarged prostate may be treated with medicines or surgery. Urinary tract cancers mostly require surgery as the primary treatment. Advanced techniques produce good results in most cases that are detected early.

 

When to Seek Medical Attention?

You should seek medical attention if you notice even a single instance of blood in urine. A family doctor or internist can do the initial evaluation. You may be referred to a urologist who will do the further –work up and treat any disease found.

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