Overview

Bleeding may happen once or it may be recurrent. It can indicate different problems in men and women. Causes of this condition range from non–life threatening (e.g., urinary tract infection) to serious (e.g., cancer, kidney disease). Therefore, a physician should be consulted as soon as possible.

Types
There are two types of Hematuria, microscopic and gross (or macroscopic). In microscopic hematuria, the amount of blood in the urine is so small that it can be seen only under a microscope. A small number of people experience microscopic hematuria that has no discernible cause (idiopathic hematuria). These people normally excrete a higher number of red blood cells.

In gross hematuria the urine is pink, red, or dark brown and may contain small blood clots. The amount of blood in the urine does not necessarily indicate the seriousness of the underlying problem. As little as 1 milliliter (0.03 ounces) of blood will turn the urine red.

"Joggers hematuria" results from repeated jarring of the bladder during jogging or long-distance running.

Reddish urine that is not caused by blood in the urine is called pseudohematuria. Excessive consumption of beets, berries, or rhubarb; food coloring; and certain laxatives and pain medications can produce pink or reddish urine.

Incidence
Hematuria occurs in up to 10% of the general population.

What causes Hematuria?
There are many different causes of hematuria. In about 25% of all patients, the source of hematuria is a disease that may be serious. Some of the most common causes and symptoms are listed below.

• Kidney or Ureteral stones: often associated with intense pain in the mid and lower back that may travel around the side, to the front, and into the groin 

• Cystitis: a bladder infection with pain or burning during urination and a strong urge to urinate immediately. Cystitis occurs more often in women, it may follow sexual intercourse.

• Cancer: cancer in any part of the urinary tract often causes hematuria. In the kidneys, it is often painless and microscopic. In the bladder, it may also cause pain and discomfort similar to that of cystitis. Bladder cancer is more common in men than in women and usually begins after 50 years of age. Tobacco smoking is thought to predispose bladder cancer.

• Enlarged prostate: in some older men, the enlarged prostate becomes inflamed and causes hematuria.

• Injury: falling and hitting your back or side can bruise a kidney and produce bleeding. High-impact sports or long-distance running can also jar the kidneys and produce hematuria.

• Underlying medical problem: sickle cell disease or trait (sickle cells are abnormal red blood cells) and glomerulonephritis (a serious inflammation of the kidneys).

• Medications: blood thinners, such as aspirin-containing medications and drugs used for arthritis or the relief of pain, may also cause hematuria.

• Foods: certain foods, such as beets or berries, can turn your urine red. If this is the case, further testing is not necessary.

Additional Causes
Many conditions are associated with hematuria. The most common causes include the following:

• Benign prostatic hyperplasia (BPH) in men over 40
• Kidney and bladder stones
• Kidney disease
• Medications (e.g., quinine, rifampin, phenytoin)
• Trauma (e.g., a blow to the kidneys)
• Tumors and/or cancer in the urinary system
• Urinary tract blockages
• Viral infections of the urinary tract and sexually transmitted diseases, particularly in women

There are rare diseases and genetic disorders that also cause hematuria. Some of these are:

• Sickle cell anemia (inherited blood disorder)
• Systemic lupus erythmatosus (chronic inflammatory disorder of connective tissue)
• von Hippel-Landau disease (hereditary disease in which benign tumors form on the spinal cord, kidneys, testicles, and other organs)

Signs and Symptoms
In many cases, blood in the urine (gross or microscopic) is the only sign of a disorder. In others, a variety of symptoms, such as the following, may be present.

• Abdominal pain
• Decreased urinary force, hesitance, incomplete voiding
• Fever
• Frequent urination (polyuria)
• Pain during urination (dysuria)
• Pain in the flank or side
• Urinary urgency

Diagnosing Hematuria
If your doctor finds hematuria, he or she will ask you questions about your health history, give you a complete physical examination, and order certain tests. Your doctor may be able to tell what is causing your hematuria by finding out when and how it occurs.

Some of the most common tests that your doctor may order include:

•  Urinalysis: usually done when you have a complete physical examination. A fresh urine sample is sent to the laboratory where it is put through a series of studies and examined through a microscope. This is the most definite way to know if you have a hematuria.

•  Urine culture and sensitivity: this test is done to see if there are bacteria in the urine. Bacteria are grown and identified in the laboratory so your physician will know which medication will provide the most effective treatment. A urine culture is usually ordered when your doctor thinks you may have a urinary tract infection.

•  Urine cytology: when your doctor thinks that you may have bladder or kidney cancer, he or she orders this cell study. Your urine is examined under a microscope for any abnormal types of cells.

• Intravenous pyelogram (IVP) or computed tomography (CT) urogram: in these tests, a fluid is injected and x-rays taken of your kidneys, ureters, and bladder. Tumors, stones, blockages, and other disorders are often seen on the IVP or CT urogram.

• Ultrasound: in this test, your kidneys, bladder, and prostate are viewed using sound waves to produce images if these organs.

• Cystoscopy: examines the inside of your bladder and urethra with a cytoscope, a tube-like viewing device.

• Dipstick: a chemically treated paper is dipped into a sample of your urine. The test will tell if there is blood in your urine and is often done along with urinalysis.

Treatment of Hematuria
The treatment of hematuria depends on the cause of the bleeding and where the bleeding is located. Since hematuria is not a disease in itself, bleeding can only be stopped when the underlying condition is found and treated.

A few of the diseases that commonly cause hematuria and their usual treatments include:

• Cystitis: generally caused by bacteria that come from a woman's own intestinal tract. Cystitis is treated with antibiotics.

• Urinary stones: made of hard mineral deposits, stones can be found in any part of the urinary system. They may contain bacteria that trigger hard-to-cure infections. Depending on their size and position, stones can be passed out of the body with the urine, removed surgically, or broken into smaller pieces by shock waves. 

• Bladder tumors: these growths are usually cancerous and need to be removed surgically. In addition, further treatment with chemicals or radiation may be needed.

• Idiopathic: refers to bleeding without an obvious cause that is not serious. Although idiopathic hematuria does not require treatment, the urologist will check on it periodically to be sure that it is not a sign of a more serious problem.