HEMATURIA : Blood in the Urine


You or your doctor has seen blood in your urine, a condition known as hematuria. You're probably concerned and wondering what it means. Most of the time, the cause of hematuria is not serious. However, blood in the urine should never be ignored. Your doctor can evaluate you to identify the cause of the bleeding and treat it, if necessary.


Two Types of Hematuria:


Blood in the urine may be one of two types:

• Gross hematuria means that the blood can be seen by the naked eye. The urine may look pinkish, brownish, or bright red.

• Microscopic hematuria means that the urine is clear, but blood cells can be seen when urine is looked at under a microscope.

Gross hematuria means blood can be seen in the Urine

Microscopic hematuria blood can only be seen with a microscope

Both gross and microscopic hematuria can have the same causes, and neither one is more serious than the other. Along with either type, you may or may not notice other symptoms-such as pain, pressure, or burning when you urinate. No matter how much blood is found, the cause of the bleeding needs to be identified.



Your urinary tract helps to get rid of your body's liquid waste. The kidneys collect unneeded chemicals and water, making urine. Urine travels through the ureters to the bladder. The bladder fills with urine, holding it until you're ready to release it. The urethra is the canal that carries urine from the bladder out of the body. In men, the prostate gland wraps around the urethra near the bladder. A problem in any part of the urinary tract may cause blood in the urine.



A wide range of problems can lead to blood in the. urine. Some of the most common causes-such as kidney or bladder stones, enlargement of the prostate, and infection-are often easily treated. Other causes, such as cancer, are more serious. Some of the most common causes of hernaturia are listed below.

Stones are collections of crystals that form in the urine. Stones may be found anywhere in the urinary tract, particularly in the kidneys or bladder. Stones in the urinary tract almost always cause bleeding and can sometimes cause severe pain.

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland that can happen as men age. In addition to bleeding, BPH may cause problems with uri­nation and, occasionally, pain.

A urinary tract infection (UTI), caused by bacteria, can lead to inflammation in the bladder and urethra as well as bleeding. UTis are often accompanied by burning, fever, pain, and the frequent need to urinate.

Damage to the urinary tract may cause bleeding. Damage may be due to a blow or accident or the use of a catheter. Very strenuous exercise may sometimes irritate the urinary tract and cause bleeding.

Other Causes

Other causes of bleeding in the urinary tract include:


• Prostatitis (infection of the prostate gland)

• Anticoagulant medications

• Blockage of the urinary tract

• Sickle cell anemia


Occasionally, no cause can be identified, a condition known as idiopathic hematuria.

Cancer may occur anywhere in the urinary tract. A tumor in the urinary tract may sometimes cause no symp­toms other than bleeding.



To evaluate your condition, the doctor will first confirm that blood is indeed present. Then other tests are done to pinpoint where the blood is coming from and why. Your doctor will decide which tests will best determine the cause of your hematuria. Some common tests are listed below.

History and Physical Exam

Your doctor will probably ask you questions about your medical history. Tell your doctor about any symptoms you're feeling, any medical problems you have, and any medications you take. During your physical exam, your doctor feels your sides for tenderness and examines your genital area for redness and inflammation. Your pulse and blood pressure may also be checked.


Lab Tests

During a urinalysis, a sample of your urine is tested to confirm that blood is present, and the urine is examined for signs of infection. A urine culture also checks for infection by growing bacteria on a culture plate. During urine cytology, urine is examined through a micro­scope to check for abnormal cells,

which may mean that cancer is present. Blood tests may also be done to check for prostate or kidney problems.


Cystoscopy is the close visual examination of the urinary tract. Using a special telescope-like instrument called a cystoscope, the doctor can look for problems in your urethra and bladder (and prostate if you're a man). The procedure may be done in your doctor's office or at a hospital. First your doctor will numb your urethra, and you may be given medication to help you relax. Then the cystoscope is inserted. Sterile fluid expands the bladder and makes it easier to examine. When the procedure is finished, the cystoscope is removed.


Other Tests

Depending upon your evaluation and diagnosis, other imaging tests may be necessary. They include:


• Computed tomography (CT or CAT) scan, which is a series of x-ray images that show a cross section of the urinary tract

• Ultrasound, which is an image of the urinary

tract, created by sound waves

• Cystourethrogram, which is an x-ray of the

bladder and urethra

Intravenous Pyelogram

Intravenous pyelogram (IVP) is . a way to take x-rays of your urinary tract. The procedure, which is usually done in the hospital or a radiology clinic, can help detect stones, block­ages, growths, and other problems in the urinary tract. During the test, a special contrast solution is injected into your arm. This solution flows to your urinary tract, making the kidneys, ureters, bladder, and urethra stand out when a series of x-ray images is taken.



Once the cause of your hematuria has been determined, you and your doctor can plan your treatment, if any is needed. Treatment for hematuria varies depending on the cause of the bleeding. Following are some treatment options for common causes of hematuria:

  • A small stone in the bladder or urethra may be removed with a special scope. Larger stones or kidney stones may be broken up using sound waves or a laser. This process is called lithotripsy.
  • An enlarged prostate gland may be treated with medications or surgery.
  • Infections in the urinary tract are usually treated with antibiotics.
  • Damage to the urinary tract often heals on its own, but severe cases may require surgery.
  • Cancer of the urinary tract may be treated using surgery, radiation therapy, or medications.

Remember: If you find blood in your urine, don't ignore it. See your doctor for an evalua­tion to help find its cause.


Associates in Urology of Central Florida

a division of Orlando Physician Specialists, LLC