What is hematuria or blood in the urine?
Blood in the urine (medically termed hematuria) refers to the abnormal presence of blood in the urine. Hematuria is of two types, gross (visible with the naked eye) and microscopic (visible only under the microscope).
What is gross hematuria?
If your urine color is visibly pink, red, or dark brown, it is a sign of ‘gross’ or ‘visible’ hematuria.
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What is microhematuria?
In some instances, the urine color remains normal, but a microscopic examination shows red blood cells in the sample. This is called microscopic or microhematuria. At times microscopic hematuria appears in the form of red blood cell casts in urine due to some kidney disease.
What are the symptoms of hematuria?
The physical symptoms of gross or visible blood in the urine are a change in the urine color to pink, red, or brown. Microscopic or microhematuria does not cause a visible change in urine color. Blood clots in the urine, however, cause bladder or back pain. There are no other signs or symptoms directly attributed to hematuria. Symptoms generally associated with diseases like urinary tract infections, kidney stones, or enlarged prostate could provide some clue about the cause of urinary blood.
What are the causes of blood in urine?
Some major causes of blood in the urine include:
- High-intensity sports activity that results in exercise-induced hematuria.
- Infection/inflammation of the kidneys or any other part of the urinary tract, including the bladder, kidneys, or urethra.
- Stones in the kidney or bladder when they cause a blockage or when passed out.
- Cancers of the kidney, bladder, prostate, or urinary tract lining.
- Inherited disorders like sickle cell disease or polycystic kidney disorder.
- Prostate enlargement or infection.
- Viral liver infections such as Hepatitis B and C.
- Injury or accidental blow to the kidneys.
- Bladder trauma due to strenuous physical exercise.
- RBC dehydration or breakdown caused by a tough physical activity.
- Interstitial Cystitis, which is a chronic bladder condition.
- Sexually transmitted diseases, such as chlamydia and gonorrhea.
- Ulcers in the urinary tract (Hunner’s ulcers) can also cause blood in the urine.
How is blood in urine related to your health?
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Blood in urine could have benign or concerning health indications depending on the underlying physiology.
Non-alarming indications:
False Hematuria
Reddish urine could be due to pigments from certain drugs and foods (like beetroot or rhubarb), which get excreted into the urine and falsely mimic hematuria.
Acute exercise-induced Hematuria
Severe physical exertion, e.g., due to long and intense workouts or athletic activity, can result in short episodes of blood in the urine. Also referred to as runner’s bladder or marathoner’s hematuria, it is most commonly observed in swimmers and those running marathons 10,000 meters or above. The severity of exercise-induced hematuria is linked to the intensity and duration of physical exertion.
The exercise-induced hematuria could be caused by renal or bladder trauma (repeated rubbing of bladder walls resulting in vascular lesions) or due to non-traumatic factors such as increased filtration pressure on kidneys or due to damage to the nephrons (filtering units of the kidneys). Generally, exercise-induced blood in urine resolves on its own within 72 hours after the intense stress event, and your urine will run clear. These benign conditions generally do not require clinical intervention. However, it is essential to ensure that no other pathological conditions contribute to hematuria.
Recurring episodes of hematuria should be reported to the healthcare provider for further investigation. Exercise-induced hematuria can also be accompanied by the excretion of protein in urine and white blood cells (leukocytes) in urine and can be worsened due to dehydration.
Blood in urine in menstruating women
Menstrual bleeding in women is also sometimes mistaken for blood in the urine. In such instances, the urine regains its normal color after two or three episodes of urination.
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Acute episodes of blood in the urine do not usually indicate a severe problem, but the risk of a major disease exists. You must report it to your doctor to find out the underlying cause.
Alarming Indications:
Urinary tract infections, kidney or bladder stones, blockage in the urinary tract, and cancers of the kidney, bladder, prostate, or urinary tract all require prompt medical interventions. In addition, blood in urine could be associated with serious diseases such as chronic bladder conditions, such as interstitial cystitis, ulcers of the urinary tract, and sexually transmitted infections, all of which require treatment. In some cases, mucus in urine combined with blood in urine could be an indication of bladder cancer.
You must report the presence of blood in urine to your healthcare provider to find out the underlying cause.
Blood in urine during pregnancy
Women can also experience blood in urine in pregnancy. Hematuria in pregnant women could be a sign of a Urinary Tract Infection (UTI) and should be reported to the healthcare provider immediately for further diagnosis.
Blood in urine due to sexually transmitted diseases
Sexually Transmitted Diseases (STDs) or Sexually Transmitted Infections (STIs), specifically chlamydia and gonorrhea, are often reported to cause blood in the urine.
Since blood in urine can be caused by benign or non-benign health conditions, getting a proper diagnosis of the underlying cause is essential to get the appropriate treatment. Blood in the urine is not a normal finding and a sign from our bodies to take preemptive actions to fix the underlying cause.
Who is at a greater risk of hematuria?
Hematuria is neither gender- nor age-specific. However, certain factors increase its risk:
- Prostate enlargement in men over fifty.
- Kidney inflammation in the wake of a kidney infection.
- UTIs, especially during pregnancy.
- Family history of kidney disease or stones.
- Urinary and bladder stones.
- Chronic consumption of certain medications like blood thinners, aspirin, painkillers, and antibiotics.
- Strenuous exercise, workout, or long-distance running.
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