Blood in the Urine (Hematuria): Causes, Tests and When to Be Seen

What it involves

MedlinePlus calls blood in your urine hematuria. The amount may be very small and found only on urine tests or under a microscope, or it may be visible, turning the toilet water red or pink or leaving spots of blood after you urinate.

Who this is for

• Patients who see pink, red or brown urine, with or without pain
• Patients told that a routine urine test showed blood they could not see
• Patients with burning, urgency or frequent urination along with blood
• Patients taking blood thinners who notice blood in the urine

What to expect

• Questions about when you first noticed it, the color, pain, urinary habits and any recent injury or procedure
• A physical exam and a review of your medicines, including blood thinners and aspirin
• A urine test, which the practice can arrange, along with blood tests if needed
• Referral for imaging or a urologist if the cause is not simple

Seen or unseen

MedlinePlus separates the two forms. Microscopic hematuria is a small amount of blood that you cannot see, and your provider may find it while checking your urine during a routine exam. Visible blood is easier to spot, but the amount you see does not tell you how serious the cause is. A little blood can come from a serious condition, and a lot of blood can come from a simple infection, which is why both forms get the same careful look.

Where the blood can come from

MedlinePlus lists problems in the kidneys or other parts of the urinary tract: infection of the bladder, kidney, prostate or urethra; kidney or bladder stones; inflammation of the kidneys, bladder, urethra or prostate; injury to the bladder or kidney; polycystic kidney disease; kidney failure; and cancer of the bladder or kidney. A recent urinary procedure such as catheterization or a kidney biopsy can also cause it. The urinary tract infection guide covers the most common of these.

Bleeding disorders and medicines

If no structural problem is found in the kidneys, urinary tract, prostate or genitals, MedlinePlus says a provider may check for a bleeding disorder. It names hemophilia, a blood clot in the kidneys, low platelets and sickle cell disease. Blood thinning medicines such as aspirin or warfarin are on the list too. Bleeding from a blood thinner is not a reason to stop the medicine on your own, because the clotting risk it was prescribed for still exists. Call the office and let a provider decide.

What can look like blood but is not

MedlinePlus notes that blood that looks like it is in the urine may actually come from another source: the vagina in women, ejaculation (often due to a prostate problem) in men, or a bowel movement. Urine can also turn red from certain medicines, beets or other foods, and a provider may ask whether you recently ate beets, berries or rhubarb. A urine test settles the question quickly, since red blood cells show up under testing. The urinalysis guide explains how that sample is examined.

Symptoms that raise the urgency

MedlinePlus says never to ignore blood you can see, especially if you have discomfort with urination, frequent or urgent urination, or unexplained weight loss. Contact a provider right away for fever, nausea, vomiting, shaking chills or pain in the abdomen, side or back; if you cannot urinate; or if you pass blood clots. Urinary dribbling, nighttime urination or difficulty starting the stream may point to a prostate problem. Fever with severe flank pain and vomiting needs same-day attention.

The tests a provider may use

MedlinePlus lists the possibilities: urinalysis and urine culture, a complete blood count with platelets, blood creatinine, abdominal ultrasound or CT scan, a cystoscopy to look inside the bladder, urinary cytology, clotting studies, and in some cases a kidney biopsy. Treatment depends on the cause. A primary care provider starts with the urine and blood tests, which the practice lists among its services, and arranges imaging or a urology visit when the cause needs a specialist. The kidney function tests guide explains the blood side.

Sources

• MedlinePlus — Urine, bloody