Blood in the urine (hematuria)
The abnormal presence of blood in the urine is called hematuria. Although it may indicate disease, it is not usually a serious symptom and typically resolves within a short period of time.
Symptoms and Causes
Hematuria is the presence of blood in the urine. Its detection is not always clinically significant, but it should be investigated in order to rule out more serious conditions.
There are two types of hematuria, depending on the amount of blood present in the urine:
- Macroscopic or gross hematuria: blood is visible to the naked eye, as the urine becomes reddish, brownish, or pinkish.
- Microscopic hematuria: traces of blood (red blood cells) are only detected when the urine is examined under a microscope.
Urine may become red in color as a result of consuming certain foods or medications, so it is advisable to wait a few days before consulting a specialist. In addition, it is important to differentiate between urinary bleeding, which is the passage of blood during urination, and the presence of blood in the urine from other sources, for example, as a consequence of vaginal, rectal, or perianal bleeding.
The prognosis of hematuria is usually good because, in most cases, it is a sign of a benign condition lasting between 24 and 48 hours. However, when the underlying cause is more serious, the outcome depends on the underlying disease.
Symptoms
The main symptom of hematuria is the presence of blood in the urine, which turns red due to the effect of red blood cells.
In some cases, it may be accompanied by blood clots, pain, or a burning sensation.
It is recommended to seek medical attention as soon as possible if, in addition to hematuria, there is frequent urination, unexplained weight loss, fever, nausea, abdominal or back pain, or difficulty urinating.
Causes
The causes of blood in the urine can be very diverse. Some of the most common are:
- Urinary tract infections: cystitis (affecting the bladder), pyelonephritis (affecting one or both kidneys), prostatitis (affecting the prostate).
- Stones in the kidneys, ureters, urethra, or bladder.
- Enlarged prostate, which is common in middle-aged men.
- Glomerulonephritis: inflammation of the kidney filters responsible for removing waste products from the blood.
- Trauma to the bladder or kidneys.
- Kidney, bladder, or prostate cancer.
- Sickle cell anemia: an inherited disease that causes a change in the shape of red blood cells (crescent-shaped instead of disc-shaped), resulting in anemia and obstruction of blood flow.
- Alport syndrome: a genetic disorder that damages the blood capillaries of the kidneys.
- Intense physical exercise.
- Use of urinary catheters.
- Medical procedures, such as prostate biopsy, urological surgery, or cystoscopy.
- Side effects of anticoagulant or antiplatelet treatments, as well as certain drugs used in oncology patients or radiotherapy.
Risk factors
The risk of hematuria increases in the following cases:
- Age: people over 50 years of age are more likely to develop many of the diseases that can cause blood in the urine, such as cancer or enlarged prostate.
- Sex: prostate disorders increase the incidence of hematuria in men.
- Family history of kidney stones or kidney disease.
- Smoking: associated with bladder cancer.
- Having the diseases or undergoing the treatments described above.
Complications
Although uncommon, hematuria may cause some complications, such as:
- Urinary retention: if blood clots are passed with the urine, there may be difficulty maintaining adequate urinary flow.
- Anemia: excessive blood loss may cause a reduction in red blood cells, iron, or vitamins.
- Hypotension, in cases of severe bleeding.
- Kidney failure if chronic obstruction caused by clots occurs.
What doctor treats blood in the urine?
Hematuria is usually treated within the specialty of Urology, although depending on the cause, specialists in Emergency department, Medical oncology, Nephrology, or Family and community medicine may also be involved.
Diagnosis
The usual tests for the diagnosis of hematuria are:
- Medical history: evaluation of the patient’s personal and family medical history together with the symptoms reported by the patient is essential to determine the reason for blood in the urine.
- Urinalysis: essential for detecting microscopic hematuria, as well as infections or signs of urinary tract stones.
- Diagnostic imaging tests: used to detect stones, tumors, obstructions, complex infections, or malformations that may be causing blood to appear in the urine. Ultrasound is usually the first option because it is fast, non-invasive, and safe. To obtain more detailed images, magnetic resonance imaging or computed tomography is used.
- Cystoscopy: a flexible tube with a camera at the end is inserted through the urethra to examine the urinary tract and bladder.
Treatment
Treatment for blood in the urine focuses on the underlying cause, so each patient requires a different approach. Some of the most commonly used treatments are:
- Antibiotics to eliminate infections.
- Alpha-blockers to relax the bladder muscles and facilitate urination.
- 5-alpha reductase inhibitors to reduce prostate size.
- Extracorporeal shock wave lithotripsy to break up kidney stones and facilitate their passage.
- Ureteroscopy: insertion of a thin instrument through the urethra to fragment stones when the non-invasive option is not possible.
- Radiotherapy to destroy cancer cells.
- Nephrectomy: total or partial removal of the kidney if it is severely damaged or contains malignant tumors.
Lifestyle changes are recommended to prevent hematuria or accelerate recovery:
- Drink enough water to remain properly hydrated.
- Follow a healthy, low-salt diet.
- Reduce the intake of caffeine, spicy foods, and alcohol, as they may irritate the bladder.
- Quit smoking.
- Avoid excessive and strenuous exercise.
- Empty the bladder completely when urinating.
- Maintain proper hygiene: wipe from front to back after bowel movements, urinate after sexual intercourse, wash the area daily with pH-neutral soaps, and dry thoroughly to prevent moisture from promoting bacterial growth.
