Disease In Focus: Blood In Urine (Hematuria)
Seeing blood in your urine can cause anxiety. While in many instances there are benign causes, blood in urine (hematuria) can also indicate a serious disorder.
Blood that you can see is called gross hematuria. Urinary blood
that's visible only under a microscope is known as microscopic hematuria and is found when your doctor tests your urine. Either way, it's important to determine the reason for the bleeding. Treatment depends on the underlying cause.SYMPTOMS
The
visible sign of hematuria is pink, red or cola-colored urine — the result of
the presence of red blood cells. It takes very little blood to produce red
urine, and the bleeding usually isn't painful. If you're also passing blood
clots in your urine, that can be painful. Bloody urine often occurs without
other signs or symptoms.
It's
possible to have blood in your urine that's visible only under a microscope
(microscopic hematuria).
When to
see a doctor
Make an
appointment to see your doctor anytime you notice blood in your urine.
Some
medications, such as the laxative Ex-lax, and certain foods, including beets,
rhubarb and berries, can cause your urine to turn red. However, blood in the
urine looks distinctly different.
A change
in urine color caused by drugs, food or exercise may go away within a few days.
But you can't automatically attribute red or bloody urine to medications or
exercise; that's why it's best to see your doctor anytime you see blood in your
urine.
CAUSES
In
hematuria, your kidneys — or other parts of your urinary tract — allow blood
cells to leak into urine. A number of problems can cause this leakage,
including:
Urinary tract infections. Urinary tract infections often
occur when bacteria enter your body through the urethra and begin to multiply
in your bladder. Symptoms can include a persistent urge to urinate, pain and
burning with urination, and extremely strong-smelling urine.
Kidney infections. Kidney infections (pyelonephritis)
can occur when bacteria enter your kidneys from your bloodstream or move up
from your ureters to your kidney(s). Signs and symptoms are often similar to
bladder infections, though kidney infections are more likely to cause fever and
flank pain.
A bladder or kidney stone. The minerals in concentrated urine
sometimes precipitate out, forming crystals on the walls of your kidneys or
bladder. Over time, the crystals can become small, hard stones. The stones are
generally painless, and you probably won't know you have them unless they cause
a blockage or are being passed. Then there's usually no mistaking the symptoms
— kidney stones, especially, can cause excruciating pain. Bladder or kidney
stones can also cause both gross and microscopic bleeding.
Enlarged prostate. The prostate gland — located just
below the bladder and surrounding the top part of the urethra — often begins
growing as men approach middle age. When the gland enlarges, it compresses the
urethra, partially blocking urine flow.
Signs and symptoms of an enlarged
prostate (benign
prostatic hyperplasia, or BPH) include difficulty urinating, an urgent or
persistent need to urinate, and either visible or microscopic blood in the
urine. Infection of the prostate (prostatitis) can cause the same signs and
symptoms.
Kidney disease. Microscopic urinary bleeding is a
common symptom of glomerulonephritis, which causes inflammation of the kidneys'
filtering system.
Glomerulonephritis
may be part of a systemic disease, such as diabetes, or it can occur on its
own. It can be triggered by viral or strep infections, blood vessel diseases
(vasculitis), and immune problems such as IgA nephropathy, which affects the
small capillaries that filter blood in the kidneys (glomeruli).
Cancer. Visible urinary bleeding may be a
sign of advanced kidney, bladder or prostate cancer. Unfortunately, you may not
have signs or symptoms in the early stages, when these cancers are more
treatable.
Inherited disorders. Sickle cell anemia — a hereditary
defect of hemoglobin in red blood cells — can be the cause of blood in urine,
both visible and microscopic hematuria. So can Alport syndrome, which affects
the filtering membranes in the glomeruli of the kidneys.
Kidney injury. A blow or other injury to your
kidneys from an accident or contact sports can cause blood in your urine that
you can see.
Medications. The anti-cancer drug cyclophosphamide
(Cytoxan) and penicillin can cause urinary bleeding. Visible urinary blood
sometimes occurs if you take an anticoagulant, such as aspirin and the blood
thinner heparin, and you also have a condition that causes your bladder to
bleed.
Strenuous exercise. Although it happens rarely, it's
not quite clear why strenuous exercise may lead to gross hematuria. It may be
linked to trauma to the bladder, dehydration or the breakdown of red blood
cells that occurs with sustained aerobic exercise. Runners are most often
affected, although almost any athlete can develop visible urinary bleeding
after an intense workout.
Whatever
the cause, contact your doctor right away if you see blood in your urine.
RISK FACTORS
Almost
anyone — including children and teens — can have red blood cells in the urine.
Factors that make this more likely include:
Age. Many men older than 50 have
occasional hematuria due to an enlarged prostate gland.
Your gender. More than half of all women will
have a urinary tract infection at least once in their lives, possibly with some
urinary bleeding. Younger men are more likely to have kidney stones or Alport
syndrome, a form of hereditary nephritis that can cause blood in the urine.
A recent infection. Kidney inflammation after a viral
or bacterial infection (post-infectious glomerulonephritis) is one of the
leading causes of visible urinary blood in children.
Family history. You may be more prone to urinary
bleeding if you have a family history of kidney disease or kidney stones.
Certain medications. Aspirin, nonsteroidal
anti-inflammatory pain relievers and antibiotics such as penicillin are known
to increase the risk of urinary bleeding.
Strenuous exercise. Long-distance runners are
especially prone to exercise-induced urinary bleeding. In fact, the condition
is sometimes called jogger's hematuria. But anyone who works out strenuously
can develop symptoms.
LIFESTYLE AND HOME REMEDIES
It's
generally not possible to prevent hematuria, though there are steps you can
take to reduce your risk of some of the diseases that cause it. Prevention
strategies include:
Urinary
tract infections. To reduce your risk of urinary tract infections, try drinking
plenty of fluids, urinating when you feel the urge and after intercourse, and
wiping from front to back after urination (for women). Avoid feminine hygiene
products that may irritate your genitals.
Kidney stones. To help lower the likelihood of
kidney stones, drink plenty of fluids and limit salt, protein and
oxalate-containing foods, such as spinach and rhubarb.
Bladder cancer. Stopping smoking, avoiding
exposure to chemicals and drinking plenty of fluids can cut your risk of
bladder cancer.
Kidney cancer. To help prevent kidney cancer,
stop smoking, maintain a healthy weight, eat a healthy diet, stay active and
avoid exposure to toxic chemicals.
READ MORE ON UTI: Avoiding Chicken to Avoid Urinary Tract Infections