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Urine - bloody

Hematuria; Blood in the urine

 

Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the blood is visible. It often turns the toilet water red or pink. Or, you may see spots of blood in the water after urinating.

Causes

 

There are many possible causes of blood in the urine.

Bloody urine is may be due to a problem in your kidneys or other parts of the urinary tract, such as:

  • 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

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. 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)

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

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

 

When to Contact a Medical Professional

 

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.

Never ignore blood you see in the urine. Get checked by your doctor, 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. This may be due to a problem related to your reproductive system.
  • You have urine dribbling, nighttime urination, or difficulty starting your urine flow. This may be from a prostate problem.

 

What to Expect at Your Office Visit

 

Your doctor will perform a physical exam and ask you questions such as:

  • When did you first notice blood in your urine? Has the amount of your urine increased or decreased?
  • What is the color of your urine? Does your urine have an odor?
  • Do you have any pain with urination or other symptoms of infection?
  • Are you urinating more often, or is the need to urinate more urgent?
  • What medicines are you taking?
  • Have you had urinary or kidney problems in the past, or recently had surgery or an injury?
  • Have you recently eaten foods that may cause a change in color, like beets, berries, or rhubarb?

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.

 

 

References

Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011: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.

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    Female urinary tract

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            Review Date: 12/27/2013

            Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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