Urine - bloody

Definition

Blood in your urine, or hematuria, is blood that is found in your urine. It can be microscopic or gross.

• Microscopic hematuria is when there is very little blood in the urine and it can only be detected with urine tests or under a microscope.
• Gross hematuria is when there is enough blood in the urine that you can see it with the naked eye. Usually it turns toilet water pale pink or bright red. Or, you may see spots of blood in the water after urinating.

Alternative Names

Hematuria; Blood in the urine

Considerations

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

In any case, you should see a health care provider.

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

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. The health care provider will follow up to see if it persists and find the cause.

When you can see blood in your urine, you will need an evaluation as soon as possible. Children may need to stay in the hospital for tests.

Causes

There are many possible causes of blood in the urine. Often, bloody urine is due to a problem in your kidneys or other parts of the urinary tract. 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.

Kidney and urinary tract causes include:

• 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

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)

When to Contact a Medical Professional

Never ignore blood in the urine. Tell your doctor about this symptom and get it checked, 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 -- the problem may be related to your reproductive organs
• You have urine dribbling, nighttime urination, or difficulty starting your urine flow -- the problem may be due to your prostate

What to Expect at Your Office Visit

Your doctor will take a medical history and perform a physical examination. Medical history questions may include:

• When did you first notice blood in your urine?
• What is the color of your urine?
• Do you have any pain with urination?
• Has the amount of your urine increased or decreased?
• Does your urine have an odor?
• Are you urinating more often?
• Do you have an urgent need to urinate?
• What medications are you taking, including over-the-counter drugs?
• Have you recently eaten foods that may cause a change in color, like beets, berries, or rhubarb?
• Do you have any other symptoms?
  • Pain in your back, abdomen, or side?
  • Fever, weight loss, nausea, vomiting, or diarrhea?
  • Nighttime urination?
  • Dribbling?
  • Discharge from your penis or vagina?
  • Pain with intercourse?
• Have you had past urinary or kidney problems?
• Do you have any allergies?
• Do you have a history of tobacco use?
• Have you had a recent injury?
• Have you had any recent procedures involving the urinary tract?

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. If a urinary tract infection is confirmed, you may take antibiotics. Your health care provider may also prescribe pain medications, if you need them.

References

Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: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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