As a urologist, from time to time I get anxious calls from patients who have noticed blood in their urine. I completely understand why they are upset, because seeing blood in your urine can be alarming. While in many cases the cause is harmless, blood in urine (hematuria) can sometimes indicate a serious disorder. To shed some light on what might be causing this condition, we at Westchester Health offer this information so that people can be better educated and know what to do if it happens to them.
What does blood in the urine look like?
According to the Mayo Clinic’s description, hematuria produces pink, red or dark cola-colored urine due to the presence of red blood cells. It only takes a small amount of blood to produce red urine, and the bleeding usually isn’t painful. Passing blood clots in your urine, however, can be painful.
Some medications, such as the laxative ex-lax®, and certain foods, including beets, rhubarb and berries, can cause your urine to turn red, but these changes usually go away within a few days. Bloody urine is different, so anytime you see red-colored urine, you should contact your doctor or a urologist.
Who is at greater risk of hematuria?
Anyone can have hematuria, but according to the American Kidney Fund, you are more likely to develop it if you:
- Have a family history of kidney disease
- Have an enlarged prostate (men)
- Have a history of kidney stones
- Are taking certain medications, such as pain relievers, blood thinners or antibiotics
- Participate in strenuous exercise
- Have or recently had an infection
The 10 most common reasons for blood in urine
Having blood in your urine does not necessarily mean you have kidney disease, but it often indicates that your kidneys (or other parts of your urinary tract) are allowing red blood cells to leak into your urine. There are many reasons this might be happening, but here are the most common causes as described by the Mayo Clinic and the American Kidney Fund:
Urinary tract infections
UTIs occur when bacteria enter your urinary tract through the urethra and multiply in your bladder. Symptoms can include a persistent urge to urinate, pain and burning with urination, and extremely strong-smelling urine.
When bacteria enter your kidneys from your bloodstream or migrate from your ureters to your kidney(s), this can cause a kidney infection. Signs and symptoms are often similar to bladder infections, though kidney infections are more likely to cause a fever and flank pain.
A bladder or kidney stone
The minerals in concentrated urine sometimes form crystals on the walls of your kidneys or bladder. Over time, these can become small, hard stones that are generally painless unless they cause a blockage or are being passed, at which point they become extremely painful.
The male prostate gland often enlarges as men approach middle age, compressing the urethra and partially blocking urine flow. Signs and symptoms of an enlarged prostate include difficulty urinating, an urgent or persistent need to urinate, and either visible or microscopic blood in the urine. Infection of the prostate (prostatitis) can cause the same signs and symptoms.
Microscopic urinary bleeding is a common symptom of glomerulonephritis, an inflammation of the kidneys’ filtering system. Glomerulonephritis may be part of a systemic disease, such as diabetes, or it can occur on its own. Viral or strep infections, blood vessel diseases and certain immune problems can trigger glomerulonephritis.
Kidney, bladder or prostate cancer
Visible urinary bleeding may be a sign of kidney or bladder cancer and less frequently prostate cancer. Typically this may be the only sign with no other symptoms being present at the time of diagnosis.
Sickle cell anemia (a hereditary defect of hemoglobin in red blood cells) causes hematuria, both visible and microscopic. Another genetic disorder which can cause hematuria is Alport syndrome, which affects the filtering membranes in the glomeruli of the kidneys.
A blow or other significant injury to your kidneys can cause visible blood in your urine.
Penicillin, an anticoagulant such as aspirin, the anti-cancer drug cyclophosphamide and the blood thinner heparin can cause blood in the urine, especially if you have a condition that causes your bladder to bleed.
It’s rare for an intense workout to lead to urinary bleeding but it sometimes happens, most often in runners. It may be linked to trauma to the bladder, dehydration or the breakdown of red blood cells that occurs with sustained aerobic exercise. If you see blood in your urine after exercise, don’t assume it’s from exercising. See your doctor right away.
Read our blogs on the subject
We’ve written several informative blogs about the diagnosis and treatment of urologic diseases and other conditions of the urinary tract, which you can read here.
If you notice that your urine is a different color than normal, or if you are having pain when you urinate, come see us.
If you are noticing changes in the color of your urine, or if urinating has become painful, please call (914) 232-1919 to make an appointment to see one of our Westchester Health urologists. We will evaluate your condition, perform some tests, discuss your options, and together with you, determine what kind of treatment would be best to return you to optimal health. Whenever, wherever you need us, we’re here for you.
By Jerry Weinberg, MD, a urologist with Westchester Health, member of Northwell Health Physician Partners