Blood in Urine
Blood
in the urine is a common problem. The medical term for red blood cells in the
urine is hematuria Sometimes blood in the urine is a sign of a serious problem
in the urinary tract, while other times it is not serious and requires no treatment.
Only after a thorough evaluation by a healthcare provider should blood in the
urine be attributed to a non-serious cause.
The
urinary tract consists of the following structures:
Kidneys:
You
have two kidneys, located closer to your back than your front at about waist
level. The kidneys filter the blood in your body and produce urine.
Ureters:
These
narrow, hollow tubes carry urine from the kidneys to the bladder
Bladder:
The
bladder is a balloon-like organ that holds urine until it is convenient for you
to empty your bladder (urinate).
Urethra:
- This
narrow, hollow tube carries urine from the bladder to the outside of your
body. The flow of urine is controlled by internal and external sphincter
muscles, which tighten or relax around the urethra, holding or releasing
urine.
- In
men, the genitals and prostate are considered part of the urinary system.
The prostate surrounds the urethra in men. It is made up of glands that
secrete a fluid that is part of semen. The prostate often becomes enlarged
in older men.
- Blood
in the urine is not always visible. If the amount of blood is small, the
urine looks normal. This is called microscopic hematuria because the blood
cells are visible only under a microscope. Typically, this is discovered
when the patient has a urine test for some other reason.
- When
there is enough blood to be visible, the urine may look pinkish, red, or
smoky brown (like tea or cola). This is called gross or frank hematuria.
It takes very little blood in urine to be visible —about one-fifth of a
teaspoon in a half quart of urine.
- A
trace amount of blood in your urine is normal. The average person with a
healthy urinary tract excretes about 1 million red blood cells (RBC) in
the urine each day. This amount of blood is not visible. This is not
considered to be hematuria.
- An
abnormal amount of blood in the urine can be acute (new, occurring
suddenly) or chronic (ongoing, long term). Acute hematuria can occur just
once, or it can occur many times.
- Sometimes
the urine can appear with a color indicating hematuria, but the urine
actually does not contain red blood cells, but rather is discoloured by
medications or foods.
- Up
to 10% of people have hematuria. About 3% of people develop gross
hematuria.
- Women
develop hematuria more than men because women are more likely to have
urinary tract infections.
- Older
adults, especially men, have hematuria more often than younger people
because they are more likely to take medications that can irritate the
urinary tract, have enlargement of the prostate, or cancer.
Causes of Blood in Urine
- Hematuria
has many different causes.
- Blood
in the urine can come from any condition that results in infection,
- inflammation,
or injury to the urinary system.
- Typically,
microscopic hematuria indicates damage to the upper urinary tract
(kidneys), while visible blood indicates damage to the lower tract
(ureters, bladder, or urethra). But this is not always the case.
- The
most common causes in people younger than 40 years of age are kidney
stones or urinary tract infections.
- These
may also cause hematuria in older people, but cancers of the kidney,
- bladder,
and prostate become a more common concern in people older than 40 years of
age.
- Several
conditions causing hematuria may exist at the same time.
- Some
causes of hematuria are serious, others are not. Your healthcare provider
will perform tests to help tell the difference.
The well-known causes of blood in the
urine include the following:
Ø Kidney stones
Ø Infections of the urinary tract or genitals
Ø Blockage of the urinary tract, usually the urethra - by a stone,
a tumour, a narrowing of the opening (stricture), or a compression from
surrounding structures
Ø Cancer of the kidney, bladder, or prostate
Ø Kidney disease
Ø Blood clotting disorders
Ø Injury to the upper or lower urinary tract, as in a car accident
or a bad fall
Ø Medications -Antibiotics, analgesics, anticoagulants [blood
thinners],
Ø Benign (noncancerous) enlargement of the prostate - known as
benign prostatic hypertrophy (BPH), a common condition in older men
Ø Chronic diseases such as diabetes, hypertension, and sickle cell
anaemia
Ø Viral infections
Ø Inflammation of the kidney - usually of unknown cause
Ø Strenuous exercise, especially running - results from repeated
jarring of the bladder
Ø Sometimes no cause is found for blood in the urine.
Ø If serious conditions such as cancer, kidney disease, and other
chronic diseases that cause kidney damage or bleeding are ruled out, the cause
is usually not serious.
Ø The hematuria will probably go away by itself or continue as a
chronic condition without doing harm. Any changes should immediately trigger a
return visit and evaluation by your healthcare provider.
Ø Urine can be colored pink, red, or brown for reasons that have
nothing to do with bleeding in the urinary tract:
Ø Foods - beets, berries, rhubarb in large amounts
Ø Food colouring
Ø Medications - Certain laxatives and pain medications
Ø Menstrual blood
Ø Liver diseases - also can be very serious
Blood in Urine Symptoms
Blood
in the urine is itself a symptom rather than a disease. The appearance of the
urine is usually not a clue as to the cause.
In
gross hematuria, the urine appears pinkish, red, or smoky brown (like cola or
tea). There may be small blood clots. The amount of blood in the urine does not
indicate the seriousness of the condition.
In
microscopic hematuria, the urine appears normal.
¬ Many people with hematuria have no other symptoms. Other
symptoms are related to the underlying cause of the bleeding.
¬ Pain in the flank (side of the body between the ribs and the
hips), back, or lower belly (abdomen) or groin
¬ Burning sensation or pain when urinating (dysuria)
¬ Fever
¬ Nausea or vomiting
¬ Weight loss
¬ Decreased appetite
¬ Kidney stones: Not all people with kidney stones have all of
these symptoms.
¬ Pain, often severe, in the flank, back, or lower abdominal pain
that may radiate to the groin area
¬ Nausea and vomiting
¬ Usually a normal temperature
¬ Frequent urination
¬ Burning sensation with urination
¬ Restlessness -
¬ constant moving around (writhing) to find relief from pain
Urinary tract infection:
Symptoms
may be similar to those of kidney stones.
ü Pain in lower back, flank, lower abdomen, or groin - may be
severe but not enough to cause writhing
ü Fever with or without chills
ü More frequent urination
ü Sensation of having to urinate but little urine produced
(urgency)
ü Burning sensation or pain with urination
ü Cloudy urine - due to pus in the urine
Investigations
Lab tests:
After
the initial examination, laboratory and imaging studies may be performed.
Urine
"dipstick": This will probably be the first test performed in the
emergency department or medical office. A strip of chemically treated paper is
dipped into a cup containing a sample of your urine. The paper will show
different colours to indicate the presence of blood, protein, glucose, or
infection. Under certain conditions the dipstick can give a false-positive
result for blood.
Urinalysis:
A
formal urinalysis usually follows the dipstick test. Urinalysis is more
accurate and gives a better idea of what is causing the bleeding. This is
usually not done in the doctor's office, but at a laboratory where the doctor
sends the urine. Protein in the urine, for example, signifies that a kidney
problem is causing the hematuria. The urine is examined under a microscope to
look for red blood cells and white blood cells, which signify infection.
Urine culture:
A
small amount of the urine is brushed on a special dish and placed in an
incubator. Unusual bacterial growth indicates a urinary tract infection.
Imaging:
There are several ways to visualize the urinary system, including ultrasound of
the kidneys, intravenous pyelography, and CT scan
Ultrasound,
also known as sonography, uses high-frequency sound waves to "see"
structures inside your body.This likely will be one of the first imaging
studies performed because it is simple and widely available.Ultrasound is used
in pregnancy because the test involves no radiation exposure that can damage
the developing fetus.It is useful in screening for kidney enlargement from an
obstruction such as a stone, cancer, prostate enlargement, or strictures.
Intravenous
pyelogram, or IVP, is an x-ray of the urinary tract.A dye is first injected
into your vein; the dye is filtered by your kidneys and provides contrast so
the kidneys are easier to see.A series of x-rays is taken over a 30-minute period,
looking for blockages or problems.This study is especially useful for
evaluating the kidneys and ureter, but less effective for the bladder,
prostate, or urethra.It can localize obstruction, stones, or a tumour.IVP
should be performed with care in older people and people with diabetes or
pre-existing kidney disease, because the contrast dye may bring on kidney
failure.
CT
scan is like an x-ray but gives much better detail.It is excellent for
detecting stones in your urinary system.The test can be performed without
contrast dye and is especially useful in people with pre-existing kidney
disease.If stones and infection are ruled out, other tests are needed to look
for less common causes of hematuria. Older people are at especially increased
risk for more serious causes of blood in the urine.Anyone aged 40 years or
older should have a workup to determine if cancer is present in the urinary
system. This workup usually can be done on an outpatient basis.
Cystoscopy:
This test is most likely to be performed by a specialist dealing with the
urinary system (urologist).A thin tube with a tiny camera on the end is passed
through the urethra to visualize the bladder, prostate (in men), and ureters.
You are first given medication to relax you and relieve the discomfort of the
procedure.This procedure usually takes only 10 minutes.Cystoscopy can identify
most problems of the lower urinary system, especially cancers of the bladder
and prostate.Cytology review: In this test, a pathologist examines a sample of
urine for cells from the lower urinary tract.
If
you have cancer, cells with features typical of a malignancy usually are
present.
The
pathologist examines these cells under a microscope and compares them with
normal cells in the urinary system.
Blood in Urine Treatment
Medical Treatment
Many
conditions can cause blood in the urine. Some of these have no medical
significance and do not require treatment. They usually go away by themselves.
Others can be serious and require immediate treatment. Treatment depends on the
underlying cause of the bleeding. Anytime you notice blood in the urine you
need to consult a healthcare provider for an evaluation.
Kidney stones: For most cases of kidney stones, you will be told to drink
plenty of water and other fluids and to take pain relievers.
Most
stones will pass through urinary system by themselves. In certain instances,
more extensive measures may be required.
One
form of therapy, called extracorporeal shock wave lithotripsy, uses sound waves
to crush the stones. The smaller pieces can then pass through more easily,
though some pain will remain.
Another
form of therapy uses cystoscopy to find the stone in the ureter and then to
grab and remove it with a small scoop.
Urinary tract infection: Treatment seeks to get rid of the bacteria responsible for the
infection. If you have no other significant illness, you will take a course of
antibiotics for 3-14 days, depending on the source of the infection.
Benign prostate enlargement: Sometimes eliminating certain foods and medications that
irritate the prostate can help shrink the prostate. Sometimes medication is
necessary.
Medications: If a medication is causing hematuria, the medication should be
stopped. Some medications only discolour the urine without actually causing
hematuria. Your healthcare provider should determine if these can be continued.
Do not stop a medication without talking it over with your healthcare provider.
Urinary tract blockage: A blockage usually requires surgery or other procedure to
correct or remove the block.
Injury: These may heal over time, or you may need surgery or another
procedure to repair the injury or remove the damaged tissue.
For More details Please contact
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