Blood in the Urine (Hematuria)

Blood in the urine, or Hematuria, is a common urologic condition. Hematuria means red blood cells are found in the urine during a routine urinalysis as part of a checkup (microscopic hematuria). Gross hematuria is blood you can see in your urine. Either way, blood in the urine usually is a symptom of a problem in the urinary tract.

Often there are no other symptoms. But blood in the urine must be evaluated to rule out underlying conditions, even if the bleeding has stopped, and especially if you are over the age of 35 or have a risk factor for urologic cancers like tobacco use or obesity. Your primary care or treating physician will refer you to Erlanger Urology, or you can make an appointment yourself for a full evaluation.

What Are the Symptoms?

This may include abdominal pain, fever and chills and urinary symptoms suggesting infection, flank pain suggesting kidney stones, or burning on urination suggesting infection.

What Causes Hematuria?

Various conditions can cause blood in the urine, including:

• Urinary tract infection (UTI)
• Bladder infection (cystitis)
• Inflammation of the urethra due to sexually transmitted diseases
• Kidney or bladder stones
• Blood clotting disorders like hemophilia or sickle cell disease
• Obstruction, blockage or injury to the kidneys or ureters
• Kidney disease, and cancer

Other common causes include:

• Enlarged prostate - Benign Hyperplastic Prostate (BPH). BPH is the most common cause of hematuria in men over age 50
• Prostate infection (prostatitis)
• Tumors in the bladder, kidney or prostate
• Vigorous exercise and trauma
• Kidney disease associated with diabetes can cause hematuria. Viral infections, strep infections, blood vessel diseases and immune problems that affect the kidneys can also be a cause
• Inherited disorders and some medications like anticoagulants can cause blood in the urine. In women, menstruation may be the cause

Who Is at Risk for Hematuria?

Factors that increase the risk of hematuria include:

• A history of smoking tobacco
• Occupational exposure to chemicals or dyes
• A history of voiding symptoms
• Men over the age of 50 who are at risk for an enlarged prostate
• Women who have urinary tract infections
• A recent infection
• A family history of kidney disease or kidney stones, and
• The use of aspirin or NSAIDS and antibiotics can increase the risk of urinary bleeding

How Is Hematuria Diagnosed?

Your urologist will conduct a clinical evaluation, take your medical history, perform a physical examination to detect abdominal masses and tenderness, order lab tests, check your blood pressure and test a urine sample (urinalysis), and perform a urine culture to reveal any infection in the urinary tract. Men will also receive a digital rectal exam to detect any abnormalities in the prostate. Women may receive a vaginal examination.

Your urologist can employ various tests to determine the cause, including a CT scan, urine cytology and/or cystoscopy. Examination of the prostate may also provide information on the cause. A prostate PSA blood test may be indicated to screen for prostate cancer. This is especially important for men over age 50. If you have hypertension this may indicate a problem with your kidneys. Your urologist will monitor your blood pressure and may recommend referral to a Nephrologist.

In many cases, the cause is not found. But studies show that some of these cases go on to develop into serious conditions. In that case, your urologist will recommend follow-up with repeat urinalysis, microscopic examination of the urine, and blood tests to check kidney function.

How is Hematuria Treated?

Treatment depends on the underlying cause of the problem. Treatment options are discussed on our web pages for kidney stones, BPH, and prostate cancer.

Erlanger Urology is a regional leader in urology, providing care to the people of Chattanooga, Tennessee, Alabama and Northern Georgia. We offer state-of-the-art diagnostic tools and cutting edge solutions for all urological problems in children and adults. We have multiple fellowship-trained and general urologists who can manage any and all of your urologic issues with care, compassion and excellence.