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There’s Blood In My Urine—Should I Be Concerned?

December 16, 2014

Despite the fact that finding blood in one’s urine is relatively common, that doesn’t make it any less alarming if it happens to you. If you see blood in your urine, you may experience confusion and panic. However, it’s best to remain calm and turn to your doctor for help.

As urologists, a good percentage of our practice is dedicated to the evaluation of blood in the urine of both men and women. Our role is to educate you, confirm a diagnosis and develop treatment that may alleviate your symptoms. In some cases, treatment may not be necessary unless the underlying cause is a more serious condition.

Finding Blood in Your Urine

Blood in the urine can be found in two ways:
  • You see the blood: Blood in the urine that is visible to the naked eye is called gross hematuria. It can range from just a slight pink tinge to large clots of dark red blood. Dark, concentrated yellow or orange urine is often a sign of dehydration and should not be mistaken for blood in the urine.
  • Your doctor sees it in your lab studies: When your doctor sees red blood cells in your urine under a microscope, this is called asymptomatic microscopic hematuria. Microhematuria cannot be diagnosed based on a urine dipstick test alone—it requires a microscopic evaluation.
In either case, your doctor can help to explain your condition and what you can expect next.

What to Expect Next

You may be referred to a urologist for an evaluation. Not everyone requires a workup, so you should ask your doctor whether this is necessary for you.

When you see blood in your urine, it can come from anywhere along your urinary tract, including your kidney, ureter, bladder and urethra. In men, it can also originate in the prostate. An evaluation of the entire tract will require some form of imaging, such as a cat scan, ultrasound or X-ray. A cystoscopy, where a flexible instrument and camera are placed into your urethra and bladder, may be necessary. Your doctor also may order some new urine or blood tests.

After an Evaluation

A urologic evaluation may unearth abnormalities such as:
  • Cancer: Blood in the urine can be a warning sign for cancers of the urinary tract. The most common of these cancers is bladder cancer, which often presents with blood in the urine. Most kidney tumors are now diagnosed incidentally on cat scans or after evaluation for blood in the urine. Cancers of the ureter, prostate, and urethra also can be present.
  • Infections: You can have kidney infections, or more commonly, bladder infections that cause blood in the urine. Other symptoms may include painful urination, foul-smelling urine, urgency, flank or abdominal pain, fever or chills. We may treat the infection first and then repeat the urine studies. If blood in the urine persists, then a detailed evaluation may be necessary.
  • Stones: These can be present anywhere in the kidney, ureter or bladder. Associated symptoms could include flank or abdominal pain, fever, nausea, infection and blood in the urine. Stones can be asymptomatic. The management of stones will depend on their size and location, as well as your symptoms.
  • Prostate: The prostate is a small organ the size of a walnut. It is located under the bladder and over the rectum. Through the prostate traverses the urethra, where the urine travels from the bladder to the penis. With age, the prostate can grow and cause difficulty with urination. This growth is called benign prostatic hyperplasia (BPH) and can be treated with medications or surgery. It is important to ensure any enlargement or difficulty is not secondary to prostate cancer.
  • Kidney disorders: Acquired or inherited disorders can cause blood in the urine. If this is the case, then your doctor may refer you to a nephrologist, who is a medical doctor that specializes in treating the kidneys.
  • Medications: Medications that can thin your blood, like aspirin or Coumadin, can put you at increased risk for blood in the urine. There also are other medications that can cause bleeding, such as certain antibiotics or chemotherapy drugs.
  • Trauma: Any blunt or penetrating force to the kidney can cause blood in the urine.

How to Prevent Blood in the Urine

Prevention depends on the origin of the blood. If you have kidney stones, for example, we may suggest dietary changes to prevent stones. We also could recommend a change in medications, antibiotics or prostate medications.

If you are a smoker, quitting can help to alleviate this condition. Bladder and kidney cancer are directly linked with smoking. The sooner you stop smoking, the better, as this can lower your risk of forming malignant growths.

As a urologist, I deal with many patients who experience blood in their urine. It is important to seek medical attention if you notice this. With a detailed evaluation, you could prevent problems in the future and lower your risk of developing a more serious condition.

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