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Hematuria (Blood in Urine)

Hematuria - blood in the urine - can come from urinary infections, kidney stones, an enlarged prostate, or, less often, cancer. Even a single painless episode deserves medical evaluation.

Genito Urinary
Hematuria means blood in the urine. It comes in two forms: gross hematuria, which you can see as pink, red, or cola-colored urine, and microscopic hematuria, which is invisible and found only when a urine test is examined in the lab. Most causes turn out to be benign, but because hematuria can occasionally be the first sign of a serious condition - including bladder or kidney cancer - it should always be evaluated, even if it happens once and goes away. Causes: Blood can enter the urine anywhere along the urinary tract, from the kidneys to the urethra:
  • Urinary tract infections: Bladder and kidney infections inflame the urinary lining, often with burning and urgency.
  • Kidney stones: Stones scrape the urinary tract as they form or pass, classically with severe, cramping flank pain.
  • Enlarged prostate: In older men, benign prostatic hyperplasia is a frequent source of both visible and microscopic blood.
  • Kidney disease: Inflammation of the kidney's filtering units (glomerulonephritis) can leak blood and protein into the urine, sometimes after an infection.
  • Vigorous exercise: Long-distance running can cause temporary, harmless hematuria that clears within days.
  • Recent procedures or injury: A urinary catheter, a recent prostate or bladder procedure, or a direct blow to the flank can all cause short-lived bleeding.
  • Cancers: Tumors of the bladder, kidney, or prostate can bleed - painless visible blood in an older adult, especially a current or former smoker, is the classic warning sign.
A note about blood thinners: anticoagulants taken for conditions such as atrial fibrillation can make bleeding more apparent, but they are not assumed to be the explanation - blood in the urine on a blood thinner still warrants a full evaluation, because the medication may simply be unmasking an underlying source. Symptoms: Hematuria itself may be the only finding, and visible blood is often painless. Accompanying symptoms help point to the cause: burning and frequency suggest infection; severe one-sided flank pain suggests a stone; a weak stream and nighttime urination in a man suggests prostate enlargement; and swelling with foamy urine points toward a kidney (glomerular) cause. It is also worth knowing that beets, blackberries, certain food dyes, and some medications can turn urine red without any blood at all - a urine test settles the question. Diagnosis: Evaluation begins with a urinalysis and microscopic examination to confirm true red blood cells, plus a urine culture to check for infection. Depending on your age, risk factors, and findings, your physician may order blood tests of kidney function, a CT scan of the urinary tract, and referral to a urologist for cystoscopy - a thin, flexible camera examination of the bladder that is the definitive way to inspect its lining. Microscopic hematuria found on a routine test is typically confirmed on a repeat sample before a larger workup begins. Treatment: Treatment targets the cause, not the blood itself: antibiotics for infection, stone management, treatment of prostate enlargement, or specialist care for kidney disease and tumors. When a thorough evaluation finds no cause - a common and reassuring outcome - your physician may simply recheck a urine sample and your blood pressure periodically. When to Seek Immediate Care: Call your physician the same day, or go to an emergency department, if blood in the urine comes with:
  • Clots or trouble urinating: Clots can block the bladder outlet and cause painful urinary retention.
  • Fever, chills, or flank pain with nausea: These point toward a kidney infection needing prompt treatment.
  • Lightheadedness or a racing heartbeat: Heavier or ongoing blood loss should be assessed urgently.
  • Severe, unrelenting one-sided flank pain: Often an obstructing stone, which may need urgent intervention.
Blood in the urine is a symptom that should never be waved off - and evaluating it promptly is straightforward. The internal-medicine team at Zimmer Medical Group can organize the workup from first urine test to specialist referral - schedule an appointment promptly if you have noticed it.

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