Blood in urine

Blood in the urine can be alarming. While it could be a sign of a serious problem in the urinary tract in some individuals; in others it is not serious and does not require any treatment. It is only after thorough evaluation by a health care provider that blood in the urine should be attributed to a non serious cause.

Basics of the urinary tract

The urinary tract is made up of the two kidneys, two ureters, urinary bladder, and the urethra. The kidneys remove waste and excess fluid from the blood, and convert it to urine. Urine then flows through the ureters and is stored in the urinary bladder before it is passed out of the body through the urethra.

Blood in the urine can originate at any point along the urinary tract. The medical term for red blood cells in the urine is haematuria. In this condition, the kidneys or other parts of the urinary tract allows blood cells to leak into the urine. It is commonly divided into gross and microscopic haematuria. Gross or visible haematuria is often alarming and will prompt the patient to seek medical attention. However, microscopic haematuria is an incidental finding as part of a periodic check up at the physicians clinic.

Microscopic haematuria

The term microscopic means that something is so small that it can be only seen with the help of a special tool called as the microscope. Microscopic haematuria is the medical terminology that describes a condition characterized by the presence of red blood cells in the urine that can be seen only through a microscope. Although there is blood in the urine, the person cannot see the blood when he/she urinates. Anyone including adults, teens or children can have microscopic haematuria.

It is very rare that a person with microscopic haematuria will have any symptoms. If present due to any underlying disease there may be constitutional symptoms such as fever, arthritis, upper respiratory tract symptoms, gastrointestinal manifestations, and rash. Some of them may have symptoms of pain in the lower abdomen, urgency, and hesitancy of urine, or pain in the flank that radiates to the groin.

Causes

Some of the common causes of blood in the urine are

  • Urinary tract infections

  • Infections of the kidney

  • Swelling in the filtering system of the kidney

  • stone in the urinary bladder or kidney

  • Viral or bacterial infection of the kidney

  • Enlarged prostate (in men over the age of 50)

  • Familial kidney disorder called as cystic kidney disease,

  • Some medicines (aspirin/non steroidal anti-inflammatory pain relievers, and antibiotics such as penicillin),

  • Blood diseases such as sickle cell anemia, or tumor or growth in the urinary tract.

  • Strenuous exercise may also cause blood in the urine.

Strenuous exercise cause trauma to the bladder, dehydration or breakdown of red blood cells that happens with sustained aerobic exercise. It is seen in long distance runners and is also termed as jogger’s haematuria.

However in such cases haematuria is seen to subside within 24 hours.

Points to remember

There may be blood in the urine of a person without his/her ever visualizing it. This condition is called as microscopic haematuria in which blood in the urine is visible only with a microscope.

Whatever may be the quantity of blood in the urine, the disease conditions that cause the problem are the same. While it may be an incidental finding in some individuals it could also be indicative of a serious underlying disease condition.

Evaluation of the cause for blood in the urine needs thorough assessment of the entire urinary tract. Management of the condition depends on the underlying cause for the blood in the urine.

  • First and foremost, the doctor will take a detailed history and do a thorough physical examination.

  • The doctor will order for urine testing to look for presence of infection, or presence of minerals in urine that can cause kidney stones. Certain blood tests may be done to look for underlying disease conditions that can cause blood in the urine.

  • Further tests such as intravenous pyelogram/ x-ray of the urinary tract after injection of a dye or an ultrasonography (use of high-frequency sound waves and computer processing to view your kidneys and bladder) may be done.

  • Imaging tests such as computerized tomography (CT scan) which uses radiation and a powerful computer to create cross sectional images of the inside of the body and magnetic resonance imaging (MRI), which uses a magnetic field and radio waves instead of X-rays to produce images may be done to provide detailed images of the urinary tract.

  • Procedures such as endoscopy or cystoscopy (insertion of a narrow tube fitted with a miniature camera) may be done to visualize the inside the bladder.

  • At times the workup may be negative and the cause of blood in urine is unknown. In such individuals, observation with repeated urine analysis, blood tests, blood pressure monitoring, and assessment of prostate specific antigen (in men over the age of 50) may be done.

Urine sample collection

While collecting a sample of urine for testing, an individual should take care of the following points.

  • The person needs to wash his or her hands with soap and warm water first.

  • Before urinating women need to clean their vagina with an antiseptic wipe from front to back 3 times by folding the wipe each time so that to ensure wiping with a clean part.

  • Men need to clean the head of their penis with an antiseptic wipe. In men who are not circumscribed the foreskin has to be pulled back behind the head of the penis before using the wipe.

  • After this the person has to start urinating in the toilet. Halfway through the urination he/she has to catch the urine in a sterile urine collection cup.

  • Then he/she needs to wash his/her hands with soap and water.

  • The urine sample can then be handed over to the nurse.

Treatment for blood in the urine will depend on the cause. Treatment of urinary tract infections is primarily by antibiotics. Drinking plenty of fluids may help in cases with kidney stones. If this does not help invasive measures such as a procedure to break the stones by use of shock waves or surgery may be necessary.

In the management of an enlarged prostate certain medications will be prescribed initially to reduce the symptoms. If they don’t help minimally invasive treatments by the use of heat, lasers or sound waves may be tried in order to destroy the excess prostate tissue.

Surgery is necessary in cases of kidney and bladder cancer followed by chemotherapy in some cases

Inherited disorders such as benign familial haematuria that can cause blood in the urine do not require any treatment. Individuals with Alport syndrome (an inherited kidney disorder) may need dialysis (removal of waste products from the blood by artificial means). Individuals with sickle cell anemia are treated with medications, blood transfusions or a bone marrow transplant.

While there is no way that anyone can prevent blood in the urine; certain steps can help reduce the risk of some diseases that can cause it. Steps to prevent urinary tract infection include

  • Drinking plenty of water

  • Urinating regularly and as soon as possible after intercourse

  • Wiping from front to back after urination

  • Avoiding excessive use of feminine hygiene products.

An individual can lower his/her risk of getting kidney stones by drinking lots of water, limiting salt intake, and reducing intake of foods such as spinach and rhubarb that contain protein and oxalate. Stopping smoking, drinking plenty of fluids, and avoiding exposure to chemicals can reduce the risk of bladder cancer and kidney cancer.