Blood in the urine in a professional language is called hematuria. If there is blood in the urine, its color changes due to the presence of red blood cells in the blood. Depending on the amount of blood, hematuria differs in gross hematuria and micro hematuria. In the first case, there is so much blood that it can be seen with the naked eye. In the second case, the amount of blood is scanty and it is detected only during laboratory testing or with the help of special one-time tests – strips. In symptomatology, hematuria can be painful or painless. And by the origin of glomerular or postglomerular. In any case, the presence of blood in the urine sample is not normal.
Amount says nothing
Any amount of blood in the urine may indicate a very serious illness. Therefore, even if microscopic blood impurities are detected, a complete examination of the body is necessary. And the older the person, the more likely the presence of serious diseases.
Causes of blood in the urine
Blood can enter the urine from organs that are in the path of urine, that is, from the kidneys, ureters, bladder or urethra. There are more than a hundred and fifty different reasons for this phenomenon.
The most common causes of hematuria:
- Infectious diseases,
Less common causes of blood in the urine: 1. Congenital anomalies: cysts or polycystic kidney disease. 2. Diseases for which blood coagulation worsens: leukemia, hemophilia, sickle cell anemia, as well as taking medications that worsen blood coagulation. 3. Vascular diseases: renal vein thrombosis, the presence of a blood clot in the renal vessels. 4. Other kidney diseases:
- Pyelonephritis. With this disease, the patient may not experience pain, but this is rare. Usually the first signs of pyelonephritis are chills, pain in the lower back,
- Glomerulonephritis. Glomerulonephritis produces a microscopic amount of blood that can only be detected under laboratory conditions. The disease can pass completely without any signs, symptoms of renal failure can be observed,
- Papillary necrosis. This disease is typical for patients with diabetes mellitus, with impaired oxygenation. The disease is treatable.
This is primarily tuberculosis of the kidneys or bladder, as well as purulent processes triggered by pyogenic microorganisms, cystitis, urethritis.
Blood in the urine after injury may be observed at a rupture of the kidney. Trauma can be both dull and penetrating. Can be injured and the bladder. For example, during a long run with an empty bladder, its walls may rub each other. After a similar run in the urine may well be a slight presence of blood. Such a patient should be examined immediately. Already during his examination and interview, the doctor may suspect a source of blood excretion. In the event that the bruise of the abdomen or pelvic region was very strong, and also, if there was no urination after the injury, the doctor may suspect rupture of the urinary organs. If the perineum was damaged in a “horse riding” position, there is a risk of injury to the urethral bulb. If it hurts over the pubis, and the pain spreads all over the abdomen, if the patient becomes sick, you may suspect a rupture of the bladder. If the upper abdomen hurts, there is a possibility of a severe injury to the kidneys.
With kidney stones or bladder
To ensure the presence or absence of stones in the urinary tract, you can use excretory urography.
If there are no other symptoms besides blood clots, there have been no injuries and the patient has already turned forty years old, it is likely that a bladder cancer is present. Three types of cancer can develop in the bladder: the most common is transitional cell, which develops from mucosal transitional epithelium cells. Squamous cell carcinoma or adenocarcinoma is slightly less common. The most common cause of the disease is the chronic presence in the body of the schistosome, a parasitic worm. Very rarely does adenocarcinoma develop in the urinary organs. Bladder cancer is treated promptly and in most cases does not affect the deep layers. If the tumor spreads to all layers or gives metastases, bladder removal or radiation is prescribed. Sometimes with bladder cancer with metastases, chemotherapy is also effective.
In cancer of the urethra, blood is observed not only in the analysis of urine, but it can be detected in the interval between urination in the outer end of the urethra.
If the blood clots are in the form of worms, it is very likely indicates kidney cancer.
Not only malignant neoplasms lead to the appearance of blood in the urine test. Benign tumors can also be the cause. However, they are very rare in the urinary organs. Most often these are kidney cysts.
Angiomyolipoma is a benign neoplasm, most commonly found in women during pregnancy. Its volumes can be very large, and in this case it can manifest itself by the presence of blood in the urine. The entire tissue of the angiomyolipoma is riddled with blood vessels and fat cells. Vessels often spontaneously burst, and blood enters the urine. This type of tumor is treated only with surgery. It is removed without damaging healthy tissue.
The most common cause of the appearance of blood in the urine of women are inflammatory processes in the urinary system. When such processes change blood circulation, the infection leads to the fact that red blood cells penetrate into the tissues of the body.
Very often, the presence of hematuria is due to cystitis. During urination, a woman experiences acute pain, cramps or burning. The anatomical composition of the pelvic organs in women is such that favorable conditions are created for infection of the urinary organs. Due to the short urethra infection, it is easy to enter the bladder. If hematuria occurs during menstruation, this indicates the presence of endometriosis of the bladder.
In pregnant women, blood can often be detected in the urine. But so far, no doctor can really explain the reason for this phenomenon. One explanation says that during fetal development, the uterus grows in size, pinches the nearby urinary organs and causes microscopic injuries. They are absolutely harmless to the health of both mother and fetus. However, if blood is found in the urine during pregnancy, it is imperative that you visit a doctor as soon as possible.
The causes of the appearance in the urine of blood in women can be both diseases peculiar to both sexes, for example, urolithiasis, cyst, pyelonephritis, small cell anemia, kidney cancer, and quite physiological reasons. For example, during the collection of urine analysis, menstrual blood flowed into it. Sometimes when taking hormonal birth control pills, some blood is detected in the urine. This is due to the fact that the hormones that are in tablets, violate the state of the walls of blood vessels in the urinary organs. Trophic tissue deteriorates, inflammations develop, which sometimes cannot be detected visually.
In prostate adenoma or benign hyperplasia, there is a low probability of blood appearing in the urine. But more often it happens with a combination of adenoma and cystitis in the acute form.
Diagnose the disease by determining the level of outflow of urine and the amount of residual urine in the bladder. Treatment is carried out promptly. Very often in men, blood in a urine sample is found after heavy physical exertion. Blood pressure increases, blood movement in the kidneys is activated and under the action of certain substances remaining in the body under heavy loads, a small amount of blood enters the urine. Good rest – and there will be no more disturbing phenomena.
Prostate cancer About 20% of patients who came to the clinic with clear signs of blood in the urine, are sick with this particular disease. If the amount of blood is so small that it is detected only by chance during the analysis, the probability of prostate cancer is 5%. This disease is detected by a biopsy performed under ultrasound control. The method of therapy is selected depending on the degree of the disease. Sometimes, prostate removal and subsequent irradiation are indicated. If the disease is at the terminal stage of development, hormone treatment is also attached. Inflammation of the prostate – prostatitis. The presence of blood in the urine is not the most common symptom of this disease. However, in some cases they are related.
In half of the children undergoing screening for hematuria, glomerulonephritis is detected.
- Hereditary predisposition to kidney disease,
- Illiterate care of organs of reproduction after birth,
- Trauma to the urethra caused by the child during the game.
Baby’s blood vessels are thinner and more fragile than those of an adult. Therefore, some diseases can contribute to the penetration of blood into the urine. This may be a hemorrhagic diathesis or other disease. Sometimes blood can enter the urine when treated with some strong drugs.
The most common cause of blood in the urine of a child is inflammation in the kidneys or bladder. More susceptible to such diseases are girls, since their urethra is shorter and the way for infection is less. In case of inflammation, the child will necessarily complain of pain, often urinate, cry during urination. Sometimes parents panic at the sight of the changed urine color of the child. But sometimes red does not mean the presence of blood. It may appear when using some products. If the child did not eat anything brightly red, you should definitely and immediately visit the doctor.
Blood can be detected during pregnancy at any time of gestation. In this case, a similar symptom is always very unnerving and the woman herself, and her doctors. Although in the overwhelming number of cases this phenomenon is unreasonable (idiopathic) and does not cause any trouble, a woman must be carefully examined.
Doctors believe that the presence of blood in the urine during pregnancy can be associated with changes in hormonal levels, as well as squeezing of the urinary organs. Usually, immediately after the birth of the child, all disturbing symptoms disappear, and only sometimes hematuria does not go away. But in this case, it is a symptom of a bladder, urethra or kidney disease.
If an elderly person has hematuria combined with pain in the region of the iliac bones, this may indicate an embolism of the renal arteries. It is important to identify diseases of the blood vessels and the heart from such a patient, and also to find out whether he is taking medication for such diseases.
Hematuria after sex is a sign of cystitis
If blood in the urine is combined with pain and appears after intercourse, the patient is likely to have postcoital cystitis. It develops on the background of inflammation caused by pathogenic microflora, penetrating into the urinary organs during intercourse. Next, the microorganisms rise up to the bladder.
The structure of the urinary organs in women contributes to the development of post-coital cystitis. When the urethra is in such a way that, during copulation, seminal fluid and vaginal mucus penetrate into it, infection of the urinary system and inflammation in the urethra and bladder are likely to occur. The posture in which mating is performed is very important. Since the vagina, the urethra and the anus are in close proximity to each other, the likelihood of infection increases. Signs of post-coital cystitis may find themselves both from the first sexual experiences and at a later age.
Diagnosis is carried out by a urologist on the basis of examination and laboratory tests. Medical treatment of the disease, in some cases, if it is ineffective, is prescribed an operation. To prevent the development of post-coital cystitis, hygiene requirements should be observed, barrier contraceptives should be used, and sperm and vaginal secretions should be prevented from entering the urethra.
It is not always really blood.
Often food affects the color of urine. So, eating red beets gives urine an intense reddish tint. Some dyes added to food also cause urine to stain. A number of drugs can change the color of urine. For example, when treating tuberculosis with rifampicin, urine may turn orange-colored, some patients believe it is from the presence of blood.
How to identify hematuria?
There are three methods for detecting blood in the urine:
- Organoleptic (by eye),
- Using the express test,
- Using a microscope.
The first two methods are fairly approximate. So, when examining urine, any red dye can be mistaken for blood. A test can give a false positive result in the presence of hemoglobin in the urine. The mechanism of action of test strips on blood in the urine is based on the reaction with the hemoglobin of red blood cells. Tests have a very high sensitivity. However, their results should be re-checked using laboratory tests. Such tests often give false positive results than false negative ones.
How to detect the cause of hematuria?
For this there are a lot of diagnostic methods:
- Patient survey
- Inspecting it
- General urine analysis,
- Bacterial urine analysis
- Urine cytology,
- Intravenous urography,
- CT scan,
In a large number of cases, it is enough only to examine and interview the patient. So, by the fact, at what stage of urination blood appears, it is already possible to suspect the cause of the violation. If blood is found in the first portion of urine, then the urethra is affected. If blood appears in the last portions of urine and is combined with pain, this indicates stones in the bladder, cystitis. In urolithiasis, blood is released if the walls of the bladder contract around the stone during urine excretion. Sometimes all urine contains blood. And in this case it is more difficult to establish the source of blood.
If the presence of blood in the urine is combined with pain in the lower back or abdomen, there is a possibility of infectious inflammation, neoplasm or kidney stones. Cystitis often occurs with fairly heavy bleeding. In this disease during urine, the patient suffers from burning or cutting. The presence of blood in the form of clots in middle-aged patients with a high degree of probability indicates the presence of a malignant tumor of the bladder. Representatives of the stronger sex have difficulty urinating, for example, a sluggish jet, inhibition of urination, and long urination suggests impaired prostate function.
During the examination, women must consult a gynecologist, and men need a rectal examination. Sometimes this makes it possible to immediately detect a tumor. In order to clarify the presence of blood in the urine and its causes, it is necessary to pass an analysis, including on the bacterial flora. If the patient has already suffered a cancer, he will be prescribed cytology, showing the composition of the cells present in the urine.
Visual inspection of the urinary system
This inspection is mandatory in the presence of blood in the urine, even with its very small amount. Usually, ultrasound or urography is used to examine the upper part of the urinary system. For urography, an iodine-based contrast agent is infused intravenously. The device captures the movement of the contrast agent in the urinary system. As a result, the doctor receives several X-ray images of different parts of the urinary system. This is the most widely used method for diagnosing the condition of the excretory organs, which helps to detect stones and neoplasms in the upper parts of the urinary system.
Instead of urography, ultrasound is sometimes used along with a radiograph. The great convenience of ultrasound is that this type of examination is completely harmless. If the cause of blood in the urine are small tumors of the kidney parenchyma, then ultrasound will detect them rather than urography. But if the tumor appeared in the drainage system of the kidneys, urography is more effective. The benefits of any of these measures directly depends on the qualifications of the doctor. But in any case, urography and ultrasound are complementary methods. Sometimes both examinations are prescribed. If these examinations indicate the presence of a neoplasm, computed tomography is chosen as an additional method. As the first method, CT examinations for such symptoms are never used. But neither ultrasound nor urography will not detect a tumor in the bladder. For this, cystoscopy is used. With hematuria, this examination is necessarily assigned.
What to do?
Most people who find blood in their urine will experience great anxiety. And rightly so. In no case should not try to diagnose and treat yourself. It is necessary as soon as possible to sign up for a consultation with a urologist. Usually prescribed in such cases, ultrasound examination of the urinary organs, complete blood count and urine, blood sugar levels, the level of creatinine in the blood. Since for diagnosis it is important to understand from which part of the urinary system blood penetrates, the physician will interview the patient in detail and examine him.
After determining the cause, the appropriate treatment will be prescribed:
- For injuries, it is drug therapy and, often, surgery,
- When a tumor is formed in the kidney, an operation is prescribed
- For an autoimmune disease or infection, drug therapy is used,
- When urolithiasis is used ultrasonic fragmentation or surgery,
- For bladder ailments, such as a neoplasm or a polyp, surgical treatment is used,
- When infection of the bladder is prescribed antibiotic therapy,
- When infection of the urethra is prescribed antibiotic therapy,
- In diseases of the prostate gland, therapy with antibiotics is also prescribed, and later on they usually resort to surgical treatment.