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Causes of blood in urine

When should you be worried. Find out now.

I ve noticed blood in my urine. Do I need to worry? Yes, and no. Blood in the urine, medically termed haematuria, is usually not a very serious condition and resolves quickly. Sometimes, blood in the urine can be a sign of some serious conditions such as advanced stage of bladder, kidney, or prostate cancer. Knowing what causes your haematuria can help you understand why you shouldn't ignore this sign, serious or not, and see a doctor.

Haematuria is of two types. If you can see the blood in the urine, it is called gross haematuria. Your urine may be pink, red or cola-coloured because of the presence of red blood cells in the urine. You may or may not have other symptoms. But if you have blood clots (these look like coffee granules) in the urine, you will experience severe pain depending upon the extent of clots present in the urine.

Microscopic haematuria, on the other hand, is a type of haematuria where you won t see any blood in the urine. It is detected only when your urine is tested for some other health condition. In most cases, you won t experience any symptoms.

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Common causes of haematuria

Urinary tract infection (UTI)

One of the most common causes of haematuria is a bacterial infection in your urinary tract. The bacteria multiplies in the bladder, in the process, damaging the lining of the urethra, and causes bleeding. Symptoms include pain and burning sensation while urinating, persistent urge to urinate, strong smelling urine or cloudy urine.

Haematuria during UTI may be a benign treatable symptom, but it should not be taken lightly. According to urologists from Freeman Hospital, Newcastle upon Tyne, UK, the presence of UTI does not decrease the likelihood of having a urologic malignancy diagnosed. Hence, there is no indication to delay prompt evaluation in patients with haematuria.[1]

Children too can suffer from urinary tract infections, and these are hard to spot. Take your child to the doctor if your child seems to be ill for no obvious reason. Other symptoms can include vomiting, diarrhoea and fever.

Kidney infections

It is a condition in which the bacteria or virus enters the kidneys from the bloodstream or from the urinary tract, and causes inflammation. In most cases, E. coli is the culprit. Common symptoms include:

  • Blood or pus in the urine
  • Fishy smelling urine
  • Cloudy urine
  • Pain and burning while urinating
  • Abdominal, back and flank pain
  • Nausea and vomiting
  • Shakes /chills

Kidney infection, technically called pyelonephritis, is more common in women, elderly, and in people with diabetes or AIDS or cancer.

Kidney and bladder stone

When you produce less urine, especially if you are dehydrated, crystals of calcium (and sometimes magnesium) are formed on the walls of the kidneys, which form stones over time. Uric acid and an amino acid cysteine can also form stones. If these stones cause blockage, you may experience symptoms such as excruciating pain in the lower back, flanks, abdomen and groin.

Haematuria in the form of pink, red or brown urine is also a symptom of kidney stone. When the stones pass into the bladder and get stuck there causing a blockage you may experience difficulty while urinating, or painful and burning sensation and cloudy and foul smelling urine.

Familial benign haematuria

This is a type of inherited kidney disease that is characterized by the presence of persistent or recurrent hematuria, usually detected in childhood. Haematuria remains isolated and usually never progresses toward end-stage renal disease.Other inherited disorders, such as sickle cell anaemia and Alport syndrome, a condition which affects the filtering membranes in the glomeruli of the kidney, can be the cause of microscopic and gross haematuria.

Benign prostatic hyperplasia (BPH)

This is a condition in which the prostate gland enlarges compressing the urethra and partially blocking the urine flow. Haematuria (either microscopic or gross) is one of the symptoms of BPH.

Diverticulosis

Sometimes pouches called diverticulum are formed in any hollow organ including the bladder. When diverticulum is formed in the bladder it is called bladder diverticulum. You may notice blood in the urine if you have large diverticulum in your bladder. But that is of course for your doctor to find out. [4]

Cancers and radiation therapies

About 85 percent of bladder cancers and 40 percent of kidney cancers exhibit gross haematuria. Although not always a symptom, haematuria is also associated with prostate cancer. Radiation-induced haematuria is common after prostate cancer treatment due to the close proximity of the bladder and urethra to the prostate. Haematuria commonly occurs within the first three years following treatment but may occur many years later.

Trauma

Penetrating or blunt injury to kidneys, bladder, ureter and urethra can cause gross haematuria. For example, vehicle accidents or stabbing and gun shots can cause kidney and bladder injuries, which lead to haematuria. Endoscopic procedures such as ureteroscopy can sometimes cause blood to show up in urine.

Sexual intercourse

Another reason you can notice blood in your urine is sexual intercourse. For example, in a study published in the British Journal of Urology, researchers found that 25 percent of women subjects developed microscopic haematuria after sexual intercourse. None of the men tested positive for haematuria after sexual intercourse. [2]

Menses

Some women may notice blood in the urine during their periods. It may be because of endometriosis, a condition in which endometrial tissue (lining in the inside of the uterus wall) starts growing outside the uterus. During periods this abnormal tissue also bleeds and blood can show up in the urine.

Medication

Anti-tuberculosis drugs (rifampicin), Parkinson s drugs (levodopa, methyldopa), NSAIDs and aspirin, penicillin, omeprazole, chlorothiazide and ciprofloxacin are some of the drugs that may cause haematuria. [3]

Physical exercise

Sometimes strenuous exercise too can cause haematuria. These include contact sports such as football and boxing, or non-contact sports such as marathon, swimming, and rowing. Cases of bike riding (spinning) have also been reported to cause haematuria. Exercise induced haematuria is usually benign and self-limiting resolving within 72 hours of onset, but if it persists beyond three days or you have some urinary tract problems, see a doctor. [3]

Foods

Certain foods such beetroot, rhubarb, and blackberries, and artificial food colorants can turn your urine red. This is by no means haematuria, but just mimics the symptoms.

When is haematuria worrisome?

Since red urine is not always caused by blood, don t panic. Try to remember if you ate blackberries or some food with added colouring. Or, was it some medicine that you had taken for the first time? Too much swimming maybe? Are you sure it was not the bleeding from the hard stool that dripped into the toilet bowl and got mixed in with the urine?

You can start worrying if the bleeding doesn t resolve in a day or two.

See a doctor immediately if you are passing too much blood or if you are not able to urinate or if you have severe pain while urinating.

Risk of serious diseases increases with age. Don t ignore your haematuria, if you have diabetes or kidney disease. Sign of blood in the urine is actually a symptom that your condition has reached an alarming level.

Also, if you are over 50 and it isn t any of the above reasons, get yourself tested for cancer. Younger people with risk factors for cancer too need to get tested. According to a study published in the journal Radiation Oncology, approximately 20 percent of patients with gross haematuria are found to have a tumor of the urinary tract. [5]

If haematuria is left alone and is not treated timely, the results could be disastrous. It is important to find the cause of why blood is showing up in your urine and take necessary steps to treat it.

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Reference:

  1. Vasdev N, Thorpe A. Should the presence of a culture positive urinary tract infection exclude patients from rapid evaluation hematuria protocols?. Urologic Oncology: Seminars and Original Investigations. 2013;31(6):909-913. doi:10.1016/j.urolonc.2011.07.016.
  1. Harris, N.M., Yardley, I., Basketter, V. and Holmes, S.A.V. Is sexual intercourse a significant cause of haematuria? BJU International. 2002:89: 344 346. doi: 10.1046/j.1464-4096.2001.01720.x
  1. Aafp.org. Evaluation of Asymptomatic Microscopic Hematuria in Adults - American Family Physician. Available at: http://www.aafp.org/afp/1999/0915/p1143.html#sec-3.
  1. Silberman M, Jeanmonod R. Bladder Diverticulitis: A Case Report. Case Reports in Emergency Medicine. 2011;2011:1-3. doi:10.1155/2011/303498.
  2. Gurka MK, Chen LN, Bhagat A, et al. Hematuria following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer. Radiation Oncology (London, England). 2015;10:44. doi:10.1186/s13014-015-0351-6.

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