BLOODY URINE

Blood in urine - known medically as hematuria - is usually not a reason for major alarm.

Because blood in urine can be a sign of a serious medical condition, however, it shouldn't be ignored. All cases of hematuria should be evaluated by a doctor who can order tests to confirm or rule out an underlying cause.

There is no specific treatment for hematuria since it's a symptom and not a specific condition. Instead, treatment is aimed at the underlying cause if one can be found. In many cases, no treatment is necessary.

Where Blood in Urine Might Come From

Blood in urine can come from the kidneys, where urine is made. It also can come from other structures in the urinary tract, such as:

• Ureters (the tubes from the kidneys to the bladder
• Bladder (where urine is stored).
• Urethra (the tube from the bladder to the outside of the body).

Symptoms That May Accompany Hematuria

If there is blood in urine, the symptom is obvious. Instead of its normal pale yellow color, your urine may be pink, red, brownish-red, or tea-colored. This is what doctors call gross hematuria.

Sometimes, blood in urine is not visible to the naked eye and the presence of red blood cells can only be detected by the lab. This is what doctors call microscopic hematuria. It's usually only discovered when a urine sample is tested with a dipstick and the results are confirmed with a microscopic examination.

Hematuria may occur without any other symptoms. Some underlying causes, however, are associated with additional symptoms that can be moderate to severe. These include:

• Bladder infections (acute cystitis). In adults, bladder infections usually cause burning or pain with urination. Infants with bladder infections may have fever, be irritable, and feed poorly. Older children may have fever, pain and burning while urinating, urgency, and lower belly pain.
• Kidney infections (pyelonephritis). Symptoms may include fever, chills, and flank pain, which refers to pain in the lower back.
• Kidney stones. Symptoms may include severe abdominal or pelvic pain.
• Kidney diseases. Symptoms may include weakness, high blood pressure, and body swelling, including puffiness around the eyes.

Causes of Hematuria

Common causes of blood in urine include:

• Bladder or kidney infections.
• Bladder or kidney stones.
• Certain kidney diseases, such as inflammation in the filtering system of the kidneys (glomerulonephritis).
• Enlarged prostate (benign prostatic hyperplasia) or prostate cancer.
• Inherited diseases such as sickle cell anemia and cystic kidney disease.
• Certain medications such as aspirin, penicillin, heparin, ncyclophospamide, and phenazopyridine.
• A tumor in the bladder, kidney, or prostate.
• Kidney injury from an accident or sports.
• Vigorous exercise.

Sometimes, what appears to be blood in urine is actually red pigment from other sources such as food dyes, medications, or an excessive amount of beets. Doctors refer to this latter cause as "beeturia."

Assessment of Hematuria

Your doctor will start by taking a medical history and asking what may have caused the appearance of blood in your urine. This will be followed by a test called urinalysis. In this test a urine sample is analyzed.

Urine tests may include urine cytology, which uses a microscope to look for abnormal cells in the urine. Blood tests may also be ordered. If blood contains high levels of wastes that kidneys are supposed to remove, it could be a sign of kidney disease.

In addition to urine and blood tests, you may need additional imaging tests. These may include:

• Computed tomography (CT) scan. A CT, which is a special X-ray scan, can help identify bladder or kidney stones, tumors, and other abnormalities of the bladder, kidneys, and ureters.
• Kidney ultrasound. An ultrasound uses sound waves to create a picture of the kidney's structure.
• Intravenous pyelogram (IVP). This is an X-ray of the urinary tract that requires dye.
• Cystoscopy. This test involves the insertion of a small tube with a camera into the bladder through the urethra. Tissue samples (biopsy) may be obtained to check for the presence of abnormal or cancerous cells.
• Kidney (renal) biopsy. A small tissue sample is removed from the kidney and examined under a microscope for signs of kidney disease.

Treatment of Hematuria

Treatment is aimed at the underlying cause. After treatment, your doctor will recheck your urine to see if the blood is gone. If you still have blood in your urine, you may need additional tests, or you may be referred to a urologist.

Usually, no treatment is necessary unless a serious condition is causing the hematuria.

If no underlying cause is found during the initial evaluation, you may be advised to have follow-up urine testing and blood pressure monitoring every three to six months, especially if you have risk factors for bladder cancer, such as being age 50 or older, smoking cigarettes, or exposure to certain industrial chemicals.