Urine - bloody

Definition

Blood in your urine, or hematuria, can be classified as microscopic or gross.

• Microscopic hematuria is when there is very little blood in the urine and it can only be seen with a microscope.
• Gross hematuria is when there is enough blood in the urine that you can see it with the naked eye. Uusually it turns toilet water pale pink or bright red, or you may just see spots of blood in the water after urinating.

Alternative Names

Considerations

In women, blood may appear to be in the urine when it is actually coming from the vagina. In men, what may be mistaken for urinary bleeding is sometimes a bloody ejaculation, usually due to a prostate problem.

Discoloration from certain drugs, beets, or other foods can mimic blood in the urine.

You may not see blood in your urine. In some cases, it is found microscopically when your doctor checks your urine during a routine exam. Your doctor will follow up on this problem to see if it persists and identify the cause.

When blood is visible to the naked eye, prompt and thorough evaluation is always needed. In children, hospitalization is often necessary to complete the work up.

Causes

There are many potential causes of blood in the urine. Often, bloody urine is from a problem in your kidneys or other parts of the urinary tract. If your kidneys, urinary tract, prostate, and genitals turn out to be fine, your doctor may check to see if you have a bleeding disorder.

Kidney and urinary tract causes include:

• Cancer of the bladder or kidney
• Fractured pelvis
• Kidney or bladder stones
• Kidney disease following strep throat ( post-stretococcal glomerulonephritis) -- a classic cause of blood in the urine in children
• Kidney failure
• Infection of the bladder, kidney, or urethra
• Inflammation of the bladder, urethra, or kidney ( glomerulonephritis)
• Injury to the kidney
• Polycystic kidney disease
• Recent urinary tract procedure such as catheterization, circumcision, surgery, or kidney biopsy

Causes from blood disorders include:

• Bleeding disorders (such as hemophilia)
• Blood clot in the kidneys
• Low numbers of platelets
• Medications including blood thinners (such as warfarin)
• Sickle cell disease

References

Choyke PL, Bluth EI, Bush WH Jr, et al. Expert Panel on Urologic Imaging. Hematuria. [online publication]. Reston, Va: American College of Radiology (ACR); 2005.

Campbell MF, Walsh PC, Retik AB, eds. Campbell’s Urology. 8th ed. WB Saunders; Philadelphia, Pa; 2002.

Yun EJ. Evaluation of the patient with hematuria. Med Clin North Am. 2004; 88(2): 329-343.