Hematuria, Blood in the Urine

A hand holding a urine sample

Blood in the urine should never be ignored. This could be the first sign of a serious condition. In order to help your doctor with the correct diagnosis, you may try to provide details such as:

  • Was it associated with pain?
  • Did you see blood clots?
  • What shape did the clots have?
  • The color of the blood (brown, cherry, bright red, pink or orange)
  • At what time during urination did you see blood in the urine (beginning or end of stream or during entire stream)?

Blood in the urine can present in one of two ways:

  • gross hematuria (blood that you can see in the urine)
  • microscopic hematuria (blood that is only seen when the urine is examined under a microscope).

Both types can have serious causes.

Interpreting these Symptoms

When passing blood in urine is associated with pain, especially abdominal pain, it could be associated with kidney or ureteral stones. The pain could be localized to the back, to the side, to the groin, or the penis in men and the labia in women.

If you are passing different-shaped clots in your stream, they could represent bleeding from the urethra or prostate (in men). Clots can be wormlike, and if associated with pain it could represent clots coming from your ureters(tubes from your kidneys to your bladder).

The color of the urine can be also affected by certain foods or medications. However, you should always consult your doctor if this develops.

When the blood in the urine is at the beginning of urination, it most likely comes from the urethra, (the tube from the bladder to the outside). Blood throughout urination is most likely from the bladder or kidneys or ureters (the tubes connecting the kidneys and the bladder). Blood at the end of your stream may be from the bladder or prostate (in men).

Causes

Causes of blood in the urine vary, from inflammatory conditions to cancers. Urinary tract infections and kidney, bladder, or ureter stones are also frequent causes. In men, blood can also come from an enlarged prostate. Cancer of the urethra, bladder or kidneys also may also show up as blood in the urine.

Blood in the urine in anyone over the age of 35, especially in people who smoke, should warrant full urologic evaluation because the most common cause of blood in the urine in this group of people is bladder cancer. Before that age, infection may be the cause. However, if gross hematuria is present, even once, it certainly needs to be further investigated. In this case full evaluation should be done by a urologist to rule out cancer or other abnormalities.

Treatment and Response

Full evaluation includes an x-ray study of your kidneys and bladder, and cystoscopy. Cystoscopy involves the doctor looking directly inside your bladder by using a very small camera.

If you have blood in the urine, you should contact your physician immediately. Your doctor then would possibly determine the cause and refer you to a urologist if needed.

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