Scientist testing bloody urine.

So, You Have Some Blood in your Urine? Possible Causes, What Happens Next, and Treatment Options

By Dr. Bryce Wyatt, M.D.

Seeing blood in your urine can be an extremely dramatic and frightening experience that, unfortunately, many people will experience in their lifetime. Blood in the urine, or “hematuria”, is one of the most common reasons someone will seek the care of a urologist.  While it can be scary and seem like you’re losing a lot of blood, it’s important to remember that just a little drop of blood can make a lot of urine look red, just like a small drop of food coloring will turn an entire glass of water any color you like.

In general, there are two ways to classify hematuria, “microscopic” and “gross”.  Microscopic hematuria means that the blood can’t be seen with your own eyes. Oftentimes, your primary care doctor will mention to you that blood was seen on your urine sample. That is called microscopic hematuria. Gross hematuria is more obvious and is when your urine is red in color or you can see blood clots.  Both types of hematuria should be evaluated by a trained professional and should not be ignored, even if the bleeding goes away.

In this blog, we will talk about a few of the common causes of hematuria, how your doctor will determine why this is happening, and some treatment options for the various causes.

Possible Causes

Blood in the urine can come from anywhere in the urinary system. It can come from all the way up in the kidneys down to the bladder and there are many potential causes.  Furthermore, about one third to half of the time we never find a reason for microscopic hematuria. However, with gross hematuria, it can be easier to nail down a diagnosis.

The following are some of the more common reasons to have blood in your urine:

Urinary Tract Infections (UTI)

UTIs are extremely common and often easily treatable and can cause bloody urine. If you have a history of urinary tract infections, if you are peeing more often, feel pressure in your pelvis, pain in your back, start noticing a strong smell to your urine, it hurts to pee, or your having fevers/chills, you may have a urinary tract infection.

Kidney Stones

Kidney stones or bladder stones can result in severe pain in your back or stomach and can show up as blood in the urine. Kidney stones can sometimes cause damage to your kidneys and should be evaluated right away.

Cancer

The most important reason to be evaluated for blood in the urine is to look for kidney or bladder cancer. Men over the age of 50 with a history of smoking are especially at risk of being found to have cancer.  Depending on the type and stage of cancer when it is found, it can be treated, which is why it’s so important to see a doctor as soon as possible when you have blood in your urine.

Other Causes

Having a large prostate, vigorous exercise, dehydration, sickle cell disease, recent surgeries, catheters, blood thinners, and other medical issues can lead to blood in the urine.

Next Steps

Your doctor has many tools in their belt to identify potential sources of blood in the urine, but, in general, there are four tests they will likely perform.

Urine Culture

Since a UTI is such a common cause of hematuria, oftentimes your doctor will first make sure you don’t have an infection. All you have to do is leave a urine sample for your doctor to test. Once an infection has been ruled out with a negative urine culture, the rest of the investigation will begin. It can take a couple of days for a culture test to result but your doctor may start you on antibiotics just in case before the test comes back.

Urine Cytology

This is another easy test to do. All you have to do is leave a urine sample just like with a culture. By looking at the urine under a microscope, we can identify any abnormalities that may be concerning for possible cancer.

CT Scan

A CT scan is an important part of finding the source of bloody urine. A CT scan can identify kidney or bladder stones, tumors in the kidneys and ureter, and even bladder cancer. Unfortunately, a CT scan does require radiation, but the small amount required is not considered to be harmful.
You will also need to have an IV placed as the CT scan requires an injection of something call “contrast”.  The contrast causes certain parts of the body to light up on the CT scan making it easier for the radiologist to identify any concerning findings. The contrast can make you feel a little funny including warm sensations, a metallic taste in your mouth or even sick feeling.  Rarely, contrast can cause hives, swelling, or skin redness. It’s important to let your doctor know if you have had a reaction to contrast before as special precautions will need to be taken.

Cystoscopy

Last and certainly the least fun of all the studies is the cystoscopy. Cystoscopy is using a small camera inserted into the bladder to get a direct look at the bladder wall. While it can be uncomfortable, it is a very quick and necessary study. The CT scan can only see large bladder abnormalities, but oftentimes bladder cancer can be small and flat appearing that only a cystoscopy will reveal. This is done in the office using a small flexible scope inserted through the urethra after applying some numbing cream to the area.

Treatment Options

Depending on the source of the bleeding, there are many treatment options available:

Urinary tract infection (UTI)

Antibiotics are the mainstay of treatment for UTIs and are typically given for three to seven days depending on how bad the infection is. Sometimes the antibiotics must be changed based on the urine culture result if the bacteria found is resistant to the first antibiotic.

Stones

Stones can be treated in several different ways. Pain pills and medications can help with the passage of kidney stones but sometimes your doctor will have to perform surgery if the stone is too large to pass. Shockwaves can be used to break up the stone into pieces that will pass easily, or your doctor can go into your kidneys with a tiny camera and blast the stones with lasers if necessary.

Cancer

Depending on the type and stage of cancer there are many treatment options available. Kidney cancer is often treated with surgery to remove part of or the entire kidney. Bladder cancer can be treated by using a small camera to enter the bladder and remove the cancerous parts.  Afterward, different medicines can be put into the bladder to help prevent cancer from coming back.  Sometimes if the bladder cancer is severe, the bladder may need to be removed.

Other Causes

There are many different procedures that can help with big prostates and bleeding. If you have difficulty with urination and hematuria, your urologist can discuss some of the many options available to help with both problems.
Hematuria is a very common and very important reason to see your urologist because the causes can range from being nothing at all to dangerous. If you or someone you know has blood in their urine, they should make an appointment right away to get checked out. Schedule an appointment with the urology experts at Georgia Urology!