If you see blood in your urine (medical term ‘hematuria’), it’s only natural that you would be scared. True, more often than not, the cause for the bleed is not serious, but you should never ignore this condition, since it can also be the indication of a serious problem. While visible or gross hematuria can turn the toilet water red, pink or cola-coloured, sometimes the amount of blood in urine is too small to be detected by the naked eye and can only be confirmed in a urine test.

Probable causes of hematuria

It’s a condition precipitated by blood leaking into urine from somewhere in the urinary tract or perhaps the kidneys. Such a leak can be triggered by a plethora of problems including:

Urinary tract infections or UTIs: UTIs or infections in any part of the urinary system, are a familiar cause for blood in urine. Bleeding from UTIs could render the colour of the urine red, pink or brown. This kind of infections are usually accompanied by pain and burning and frequent urge to urinate.
Pyelonephritis or kidney infection: This is usually caused by infestation of bacteria into the kidneys from the bloodstream or the ureters (the tubes which connect the kidneys with the bladder). Such infections can also lead to blood in urine and symptoms similar to other UTIs, apart from fever, or a non-specific pain in the back or side.
Stone in kidney or bladder: Stones in the bladder or kidney/s are formed over time from mineral deposits on the walls. These can be extremely painful, particularly if they lead to blockage or pass through urine, and also cause blood to leak into urine, often visible to the naked eye.
Enlarged prostate: The prostate gland, located below the bladder, can sometimes get enlarged when a man reaches middle age, often exerting pressure on the urethra. This can cause discomfort while urinating and even blood in urine. Infection of the prostate gland or prostatitis can also lead to similar urine bleed.
Cancers: Gross hematuria could also be a sign of advanced cancer in kidneys, bladder or prostate.
Kidney ailment: Microscopic hematuria or blood in urine that can only be detected in a lab environment, is often a giveaway sign of glomerulonephritis, a kidney disease in which the small filters in the kidneys which remove waste from the blood, become inflamed. Glomerulonephritis can surface on its own or as an offshoot of ailments like diabetes.
Kidney injury: Any injury to the kidneys sustained in an accident or from contact sports can also lead to blood in urine.
Medications: Certain medications like the anti-cancer drug cyclophosphamide or the antibiotic penicillin, as well as anti-clotting medicines and blood thinners could cause blood in urine.
Cystitis: This condition indicates inflammation of the bladder either through infection or other causes, and can lead to blood in urine.

Hematuria

How is hematuria diagnosed?

The patient initially undergoes a physical examination which could involve a pelvic exam or a digital rectal examination. To understand and properly evaluate the symptoms, your doctor might prescribe urine tests for routine analysis, culture and cytology. A scope might be used to examine the insides of the bladder and urethra.

A bunch of imaging tests could be done to examine the kidneys, ureters and bladder. These could include ultrasound, CT and MRI scans.

How is hematuria treated?

Treatment protocols would depend on the cause of hematuria emerging from the diagnostic process. The doctor might use any of the following paths:

Prescribe antibiotics to clear the UTI
Advise prescription medication like alpha-blockers and 5-alpha-reductase inhibitors to shrink an enlarged prostate. Prostate which are resistant to medical management may require surgery in minimally invasive manner using lasers.
Stone treatment in urinary tract may be based on location, size and hardness of the stone. It can be done in minimally invasive way using lasers/lithoclast.
In case of cancer, use surveillance, surgery, radiation, chemotherapy, etc depending on the stage and level of the disease
To treat kidney disease, prescribe medicines to lower blood pressure, cholesterol count besides diuretics and RBC boosters for anaemic patients
To address endometriosis, use hormone medications
In some cases, no treatment is required at all.