DR AVISEK DUTTA, MS [GeneralSurgery]; MRCS [England]; MCh Urology and Renal Transplant (IPGME&R) Consultant Urologist, Peerless Hospital, Kolkata
Hematuria is the medical term for red blood cells in the urine.
Gross hematuria means that you can see blood with the naked eye because the urine is pink, red, purplish-red, brownish-red.
Hematuria can be either grossly visible (macro hematuria) or only detectable under a microscope (microscopic hematuria). Microscopic hematuria is often asymptomatic and has a prevalence of 4–5% in routine clinical practice. It may be due to an underlying disease of the kidneys or the urogenital tract.
All potential causes of hematuria must be considered, and all individual risk factors taken into account, so that an underlying disease requiring treatment can be identified or ruled out.
Hematuria has many causes, and a broad urological and nephrological differential diagnosis must be considered. In the absence of high-quality scientific evidence, the recommendations of current guidelines for the diagnostic evaluation of hematuria are not uniform; this is particularly so for asymptomatic microscopic hematuria.
Common causes for blood in the urine include:
Urinary infection
Enlarged prostate in older men
Kidney or bladder stones
Bladder, Kidney, Prostate cancer
Kidney trauma
Glomerular causes
There can be a number of different causes of blood in your urine, some more serious than others. These conditions can involve infections or stones, including:
Urinary tract infection (UTI): This means that you have an infection in any part of your urinary system.
Pyelonephritis: This describes an infection that has reached as far as your kidney.
Cystitis: This condition refers to an inflamed bladder, which can have infectious and non-infectious causes.
Injury to your urinary tract: You have blunt or penetrating trauma from accidents or assault.
Kidney (renal) disease: With this chronic condition, damage to your kidneys means they don’t work as well.
Your doctor will want to look for causes of the blood in your urine. This often involves an exam and learning your full health record to see if you have risks for cancer.
Bladder tumor
Bladder tumor is one of the causes of hematuria. Bladder cancer is the ninth most common cancer accounting for 3.9% of all cancer cases as per the Indian Cancer Registry data
When Hematuria occurs due to bladder tumor it might not have any other symptom like burning sensation and usually resolves spontaneously without any intervention making many of us feel that the problem is resolved.However the tumor may continue to grow larger. A stage comes when blood in urine becomes more and more frequent and forces us to seek medical help. Unfortunately it becomes too late then.
When is your risk of having a bladder tumor high?
Smoking history
Age more than 35 years and more so if you are above 60ys
Gender - male
Symptoms – visible blood in urine without any pain
Family history of bladder cancer, cancer of the urinary tract lining, or Lynch Syndrome
Workplace exposures to chemicals such as benzene or aromatic amines
Although blood in your urine doesn’t always mean you have a tumour, it can be an important warning sign to a possible health problem.
Don’t ever ignore bloody urine. Contact a healthcare provider as soon as you find blood in your urine, as earlier detection for any problem is helpful.
Management and Treatment of Hematuria
Treating blood in your urine depends strongly on the actual cause of the hematuria.
Your provider will use the information collected from your medical history, physical exam and test results to work with you to find the best treatment.
For hematuria caused by infections, your provider will prescribe antibiotics. These antibiotics work by killing the bacteria causing the infection, which should stop the bleeding.
For hematuria due to stones, it can be removed or medicines may be given to facilitate its expulsion.
Early stage bladder tumours can easily be taken out through the urinary passage via an endoscopic surgery, while once time passes by they reach and advanced stage where a major surgery or chemotherapy is all that can be offered.
