Blood in the urine is a common problem. The medical term for red blood cells in the urine is hematuria. Sometimes blood in the urine is a sign of a serious problem in the urinary tract, while other times it is not serious and requires no treatment. Only after a thorough evaluation by a healthcare provider should blood in the urine be attributed to a non-serious cause.
The urinary tract consists of the following structures:
Kidneys: You have two kidneys, located closer to your back than your front at about waist level. The kidneys filter the blood in your body and produce urine.
Ureters: These narrow, hollow tubes carry urine from the kidneys to the bladder.
Bladder: The bladder is a balloon-like organ that holds urine until it is convenient for you to empty your bladder (urinate).
Urethra: This narrow, hollow tube carries urine from the bladder to the outside of your body. The flow of urine is controlled by internal and external sphincter muscles, which tighten or relax around the urethra, holding or releasing urine.
In men, the genitals and prostate are considered part of the urinary system. The prostate surrounds the urethra in men. It is made up of glands that secrete a fluid that is part of semen. The prostate often becomes enlarged in older men.
Blood in the urine is not always visible. If the amount of blood is small, the urine looks normal. This is called microscopic hematuria because the blood cells are visible only under a microscope. Typically, this is discovered when the patient has a urine test for some other reason.
When there is enough blood to be visible, the urine may look pinkish, red, or smoky brown (like tea or cola). This is called gross or frank hematuria. It takes very little blood in urine to be visible —about one-fifth of a teaspoon in a half quart of urine.
A trace amount of blood in your urine is normal. The average person with a healthy urinary tract excretes about 1 million red blood cells (RBC) in the urine each day. This amount of blood is not visible. This is not considered to be hematuria.
An abnormal amount of blood in the urine can be acute (new, occurring suddenly) or chronic (ongoing, long term). Acute hematuria can occur just once, or it can occur many times.
Sometimes the urine can appear with a color indicating hematuria, but the urine actually does not contain red blood cells, but rather is discolored by medications or foods.
Up to 10% of people have hematuria. About 3% of people develop gross hematuria.
Women develop hematuria more than men because women are more likely to have urinary tract infections.
Older adults, especially men, have hematuria more often than younger people because they are more likely to take medications that can irritate the urinary tract, have enlargement of the prostate, or cancer.
Causes of Blood in Urine
Hematuria has many different causes.
Blood in the urine can come from any condition that results in infection, inflammation, or injury to the urinary system.
Typically, microscopic hematuria indicates damage to the upper urinary tract (kidneys), while visible blood indicates damage to the lower tract (ureters, bladder, or urethra). But this is not always the case.
The most common causes in people younger than 40 years of age are kidney stones or urinary tract infections.
These may also cause hematuria in older people, but cancers of the kidney, bladder, and prostate become a more common concern in people older than 40 years of age.
Several conditions causing hematuria may exist at the same time.
Some causes of hematuria are serious, others are not. Your healthcare provider will perform tests to help tell the difference.
The well-known causes of blood in the urine include the following:
Kidney stones
Infections of the urinary tract or genitals
Blockage of the urinary tract, usually the urethra - by a stone, a tumor, a narrowing of the opening (stricture), or a compression from surrounding structures
Cancer of the kidney, bladder, or prostate
Kidney disease
Blood clotting disorders
Injury to the upper or lower urinary tract, as in a car accident or a bad fall
Medications - Antibiotics [for example, rifampin (Rifadin)], analgesics such as aspirin, anticoagulants [blood thinners such as warfarin, (Coumadin)], phenytoin (Dilantin), quinine (Quinerva, Quinite, QM-260)
Benign (noncancerous) enlargement of the prostate - known as benign prostatic hypertrophy (BPH), a common condition in older men
Chronic diseases such as diabetes, hypertension, and sickle cell anemia
Viral infections
Inflammation of the kidney - usually of unknown cause
Strenuous exercise, especially running - results from repeated jarring of the bladder
Sometimes no cause is found for blood in the urine.
If serious conditions such as cancer, kidney disease, and other chronic diseases that cause kidney damage or bleeding are ruled out, the cause is usually not serious.
The hematuria will probably go away by itself or continue as a chronic condition without doing harm. Any changes should immediately trigger a return visit and evaluation by your healthcare provider.
Urine can be colored pink, red, or brown for reasons that have nothing to do with bleeding in the urinary tract:
Foods - beets, berries, rhubarb in large amounts
Food coloring
Medications - Certain laxatives and pain medications
Menstrual blood
Liver diseases - also can be very serious
Blood in Urine Symptoms
Blood in the urine is itself a symptom rather than a disease. The appearance of the urine is usually not a clue as to the cause.
In gross hematuria, the urine appears pinkish, red, or smoky brown (like cola or tea). There may be small blood clots. The amount of blood in the urine does not indicate the seriousness of the condition.
In microscopic hematuria, the urine appears normal.
Many people with hematuria have no other symptoms. Other symptoms are related to the underlying cause of the bleeding.
Pain in the flank (side of the body between the ribs and the hips), back, or lower belly (abdomen) or groin
Burning sensation or pain when urinating (dysuria)
Fever
Nausea or vomiting
Weight loss
Decreased appetite
Kidney stones: Not all people with kidney stones have all of these symptoms.
Pain, often severe, in the flank, back, or lower abdominal pain that may radiate to the groin area
Nausea and vomiting
Usually a normal temperature
Frequent urination
Burning sensation with urination
Restlessness - constant moving around (writhing) to find relief from pain
Urinary tract infection: Symptoms may be similar to those of kidney stones.
Pain in lower back, flank, lower abdomen, or groin - may be severe but not enough to cause writhing
Fever with or without chills
More frequent urination
Sensation of having to urinate but little urine produced (urgency)
Burning sensation or pain with urination
Cloudy urine - due to pus in the urine
When to Seek Medical Care
Any time you have blood in the urine or other symptoms of urinary tract disease call your healthcare provider. If you cannot get in touch with your provider or get an appointment that day, go to a hospital emergency department.
Any time you have the combination of blood in the urine, fever, and flank pain, you should seek emergency medical care, because this may represent a severe infection in your kidney.
Blood in Urine Treatment
Self-Care at Home
If you have visible blood in your urine, do not attempt to treat yourself with home remedies. See a medical professional without delay.
If you have a urinary tract infection, you will take antibiotics for 3-14 days, depending on what part of the urinary tract is infected.
If you have kidney stones, be sure to drink plenty of liquids to help pass the stones and prevent other stones from forming. You may need to take pain relievers.
Medical Treatment
Many conditions can cause blood in the urine. Some of these have no medical significance and do not require treatment. They usually go away by themselves. Others can be serious and require immediate treatment. Treatment depends on the underlying cause of the bleeding. Anytime you notice blood in the urine you need to consult a healthcare provider for an evaluation.
Kidney stones: For most cases of kidney stones, you will be told to drink plenty of water and other fluids and to take pain relievers.
Most stones will pass through urinary system by themselves. In certain instances, more extensive measures may be required.
One form of therapy, called extracorporeal shock wave lithotripsy, uses sound waves to crush the stones. The smaller pieces can then pass through more easily, though some pain will remain.
Another form of therapy uses cystoscopy to find the stone in the ureter and then to grab and remove it with a small scoop.
Urinary tract infection: Treatment seeks to get rid of the bacteria responsible for the infection. If you have no other significant illness, you will take a course of antibiotics for 3-14 days, depending on the source of the infection.
Benign prostate enlargement: Sometimes eliminating certain foods and medications that irritate the prostate can help shrink the prostate. Sometimes medication is necessary.
Medications: If a medication is causing hematuria, the medication should be stopped. Some medications only discolor the urine without actually causing hematuria. Your healthcare provider should determine if these can be continued. Do not stop a medication without talking it over with your healthcare provider.
Urinary tract blockage: A blockage usually requires surgery or other procedure to correct or remove the block.
Injury: These may heal over time, or you may need surgery or another procedure to repair the injury or remove the damaged tissue.
Next Steps
Follow-up
Follow-up is very important if you have blood in your urine.
Typically, you will go back to your health care provider in one to two weeks for a repeat analysis of your urine to make sure the hematuria has cleared up.
If bloody urine continues, you might need further testing or need to see a specialist (urologist).
You should drink plenty of water and take all medications as recommended if the hematuria is to go away.
Men older than 50 years of age for whom no definite cause is found should have yearly screening for prostate cancer.
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