One of the most stressful experiences in life is to suddenly be confronted with a new health problem we hadn’t even considered before. It’s especially true when it’s related to something we do every day for our entire lives. You move along with your life as usual, not even thinking about something as seemingly innocuous as using the bathroom. And then one day you look down in the toilet and see bloody urine.

It’s perfectly natural to feel some panic set in as you stare into the toilet, wondering if that really is blood in the urine or just some trick of the light. Or maybe some other reason that could explain what you see. Most people will immediately run to the internet to frantically search: what causes blood in urine? 

The term for the presence of blood in urine is hematuria, and there are many possible reasons why you might be experiencing this ailment. For that reason, it’s important to understand the causes and potential related symptoms for your own peace of mind and to give you a sense of when it’s time to talk to your doctor. 

Symptoms of Hematuria

Health care providers divide hematuria into two categories: gross and microscopic. Microscopic hematuria—as the name implies—can only be detected when viewed under a microscope during a urine test; in this case, red blood cells will be present along with the other components of urine. Microscopic hematuria may or may not be accompanied by other symptoms and so isn’t likely to alert you to go see a doctor. 

Gross hematuria, on the other hand, is the name for the condition where blood is clearly visible to the naked eye. In this situation, the urine will appear pinkish or brownish, depending on the underlying problem. In addition to the noticeable color change, you may also experience other symptoms that can point to the underlying cause and should be reported to your doctor: 

  • Increase in urination frequency
  • Increased “urge” to urinate 
  • Pain in your abdomen or flank
  • Pain while urinating 
  • Fever
  • Slower urination flow

What are the Causes of Hematuria?

As noted above, the presence of blood in urine - and the potentially associated additional symptoms - can be caused by a variety of conditions. Here are some of the more common causes to be aware of: 

Kidney Stones: One of the kidneys’ primary functions is to filter excess fluids and wastes from the blood. When there is a higher than normal concentration of wastes (usually in the form of minerals) in your blood, some of the wastes can coalesce into crystalized kidney stones. The presence of these jagged stones - and the process of passing them - can cause blood to appear in your urine.  

Urinary Tract Infection (UTI): A UTI is a bacterial infection of any part of the urinary tract, which includes the kidneys, ureters, bladder, and urethra. Women are more likely to develop these infections and typically in the bladder and urethra. When an infection has happened, blood can show up in the urine as a normal part of your body attempting to fight the infection.

Bladder Cancer: This comparatively common type of cancer forms in the cells lining the inside of the bladder. The hematuria can present as either gross or microscopic. 

Enlarged Prostate: The prostate is a male gland that contributes to sexual reproduction by adding a component to seminal fluid before it passes out of the urethra. When the prostate is enlarged, it disrupt urine flow and sometimes cause blood in the urine. 

Prostate Cancer: With the build-up of cancerous cells in the prostate, the effect can be similar to having an enlarged prostate. The pressure can eventually cause blood to appear in urine in some cases. 

Exercise-Induced Hematuria (EIH): EIH is a condition whose cause is still debated by doctors, but it refers to either traumatic or nontraumatic bleeding that can occur after exercise. Traumatic EIH is usually because of a direct injury to an organ that can rupture and secrete blood into the urinary tract. Nontraumatic EIH is less understood, but it appears to occur after strenuous low impact exercises like long-distance running. One possible factor that may increase the risk for EIH is dehydration during exercise. 

Glomerulonephritis: This disease refers to an inflammation of the glomeruli - the small filters inside your kidneys that do the work of removing waste from the bloodstream and secrete it through the urine. When inflamed and not working properly, the glomeruli can also secrete blood into the urine stream. If this condition persists, it can even lead to long term kidney disease.

Catheters: A urinary catheter is a thin tube used to drain urine in situations where the patient is unable to urinate normally - often during or after surgery. In some cases, the use of a catheter can lead to a urinary tract infection, which in turn can cause blood to appear in the urine. This can also happen if the catheter is implemented improperly and causes damage to the urethra.  

There are also a variety of medications that may have hematuria as a side effect: 

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Blood thinners: aspirin, warfarin
  • Chemotherapy drugs: ifosfamide, cyclophosphamide 
  • Senna (laxative) 

How is Blood in Urine Diagnosed?

If you see blood after urination, it can be a startling discovery. When you go to a doctor’s office and describe your symptoms, the doctor will typically perform a full physical exam as well as a urine test (urinalysis). He/she will also look at your medical history to see what other medical conditions could be at play. Since hematuria can indicate many possible different conditions, your doctor will need to rule out as many conditions as possible in an effort to narrow down the true cause. 

In the discussion with your doctor, you should be prepared to talk about any related symptoms you might have, or any kidney-related trauma you have recently experienced. For instance, fever, chills or pain while urinating may be indicative of an infection. Pain in the side or your abdomen may indicate kidney stones. If you’re a middle-aged man, a prostate exam may even be necessary. 

The purpose of the urinalysis is first and foremost to confirm the presence of blood in the urine. Whether gross or microscopic hematuria, your doctor will be able to determine the extent of blood present. The other purpose of the urine test is to determine whether there is bacteria in your urine; the presence of bacteria would indicate an infection and help further narrow down the possible causes. 

How is Blood in Urine Treated?

Since the cause of hematuria can be a variety of different ailments, so also are the possible treatments varied. Once the consultation with your doctor has determined the cause, the treatments can range from waiting for it to resolve itself (in the case of EIH for example) or something more intensive - as in the case of cancer. Fortunately, the incidences of cancer are relatively rare, so the majority of treatments the doctor may prescribe would likely involve observation or medication. 

Hematuria Solutions

While it can be a somewhat distressing experience to find blood in your urine, the best course of action is to not panic. Your first step should be to take an inventory of any other symptoms you may have as well as any physical trauma you might have recently experienced (for instance, having a collision while playing a sport).  Once you’ve discovered the blood in your urine and considered other symptoms, the next step is to make an appointment with your health care provider. Book an appointment online with the Mississippi Urology Clinic to make an appointment today.